This may not be as stupid a question as it first appears. In the summer of last year, I met a professor of addictions at a British university (better not say which) and he told me he liked to use snuff but he had never found it addictive. I personally think snuff is useful to break the addiction in smokers and chewing tobacco users and can then be picked up and put down at will. What do other people feel, how does snuff help you?
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0 • Insightful Agree LikeIs pure the answer?
Could any of you, who have stopped smoking, go for a day without snuffing?
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0 • Insightful Agree LikeAs bad as I was addicted to Cope, usually 1-1 1/2 cans a day, one day I don't know how but I totally lost the urge to dip. Didn't even crave it. It was literally within the day. I woke up & took a dip & by noon I took the can out of my pocket, took the lid off and just looked at it. The crave wasn't there and didn't want any. My friends where all wondering how I quit so fast and didn't even crave it. I couldn't tell them how because I didn't know. That was back in 02. But now I do enjoy an occasional dip or some loose leaf.
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A NEW AGE FOR SNUFF?
M. A. H. RUSSELL
M. J. JARVIS
C. FEYERABEND
Addiction Research Unit, Institute of Psychiatry, London; and Poisons Unit, New Cross Hospital, London.
Summary
Blood-nicotine levels were measured during non-inhaled cigar smoking and after taking snuff. The rate of nicotine absorption from non-inhaled cigar smoking was slow. This may explain why many cigarette smokers continue to inhale when they switch to cigars. In contrast, the rate of absorption from snuff was extremely rapid. Peak levels which matched those of cigarette smoking were reached within 5 min. Snuff could be an acceptable and less harmful substitute for cigarette smoking.
INTRODUCTION
TOBACCO is the only source of nicotine. For four centuries or more it has been used for chewing, snuffing, or smoking, but no population has given up one form of tobacco use without replacing it with another. The only time the British gave up smoking was in the 18th century, when they switched to snuffing for almost a hundred years. The common factor is nicotine. There is no tar or carbon monoxide without combustion. Nicotine is absorbed through the lungs in cigarette smoking, through the buccal mucosa in tobacco chewing, and through the nasal mucosa in snuffing.
The campaign to eliminate cigarette smoking is proving slow and tedious, and even one doctor in five still smokes cigarettes. 1 Therefore the prospects of abolishing the habit in the rest of the population seem remote. Low-tar cigarettes do not seem acceptable to most smokers, probably because they deliver insufficient nicotine. Also, smokers tend to offset the health advantages by inhaling them more deeply. Similarly, when cigarette smokers switch to cigars or a pipe the health advantage is lost since they usually continue to inhale.2, 3 This is probably because without inhalationthe absorption of nicotine is too slow and inefficient to provide an adequate substitute for inhaled cigarette smoking. 3,4
What about snuff? Would it be a satisfactory alternative for dependent cigarette smokers? Snuffing is simply a matter of inserting powdered tobacco into the nose, and thus has two major advantages. Firstly, there are no products of combustion such as tar, carbon monoxide, and oxides of nitrogen. Secondly, it cannot be inhaled into the lungs, which eliminates any risk of lung cancer, which kills almost 30,000 British smokers a year. Would snuff provide enough nicotine to satisfy the dependent cigarette smoker? The historical evidence suggests that it could. Although its use in Britain has gradually declined since the 1939-1945 war from 1.2 million lb in 1944, to 0.5 million lb in 1964, and to 0.3 million lb in 1977,5 there are about 500,000 regular snuff users in Britain today. 6 We are studying the absorption of nicotine by cigar smokers and snuff users. Preliminary findings presented here show that the absorption of nicotine from snuff is very rapid; snuff could be sufficiently satisfying for cigarette smokers to switch to snuffing relatively easily.
METHODS
We measured blood-nicotine and blood-carboxyhæmoglobin (COHb) in cigar smokers and in snuff users. The snuffers used their own brand of snuff in their usual way. The cigar (Medallion Petit Corona, a Havana tobacco cigar, length 12.3 cm, circumference 5.4 cm, weight 6.2 g) was smoked in an unnatural way designed to avoid any inhalation and to maximise buccal absorption. This consisted of puffing and then holding the smoke in the mouth for about 45-60 sec, while breathing through the nose so as to avoid inhaling it. This was repeated as often as possible for 60 min, by which time the cigar had been smoked to a butt length of about 2.0-2.5 cm. Blood-samples were taken from a forearm vein via an indwelling catheter. COHb levels were measured with an IL.182CO-oximeter7 and plasma-nicotine by gas chromatography. 8
RESULTS
Even with this form of non-inhaled cigar smoking, nicotine absorption was initially very slow, although absorption rate gradually increased as the cigar was smoked. For example, in one cigar experiment, the blood-nicotine increased by 16.5 ng/ml: only 8.5% of the increase was in the first 20 min, compared with 20.6% from 20 to 40 min, 49.1% from 40 to 60 min, and 21.8% in the 5 min after the cigar was discarded (see accompanying figure). [Sorry, figure not included. - Robert] The pH of this subject's saliva increased from 6.0 to 6.5 as the cigar was smoked.
By contrast the absorption from a single pinch of snuff was extremely rapid. The blood-nicotine level increased 21.1 ng/ml in 5 min, compared with the increase of only 0.9 ng/ml after 15 min cigar smoking. The increase within 5 min of taking snuff was 28% greater than that achieved by cigar smoking in 65 min.
[This is where the accompanying figure was included in the original article. - Robert]
DISCUSSION
The results show two important findings. Firstly, buccal absorption of nicotine is slow even when a large Havana-type cigar is smoked in an unnatural way designed to maximise non-inhaled absorption. Although sufficient nicotine is absorbed to have pharmacological effects (which no doubt contribute to the satisfaction obtained by so-called primary cigar smokers who have never smoked cigarettes and who tend not to inhale)3 the absorption rate is very much slower than that in inhaled cigarette smoking.9-11 This may be why so few cigarette smokers can switch to cigars without inhaling them.
Secondly the rate of nicotine absorption from snuff is very rapid. The blood-nicotine level of over 40 ng/ml matches the peak levels found in heavy cigarette smokers, which average about 35 ng/ml.12 Although the snuff user does not get the puff-by-puff high nicotine boli obtained by inhaling cigarette smokers,13 it takes the cigarette smoker about 10 min to reach a peak nicotine level compared with 5 min or less for a snuff user.
Snuff may well be a satisfactory and acceptable substitute for cigarette smoking. In addition to its capacity to deliver nicotine, snuff could provide many other components of the smoking habit, such as a variety of aromas, attractive packaging, and intricate sensorimotor rituals which add to the pleasure and social aspects of the habit. Furthermore, it is likely to be acceptable to all social classes, since its present limited use ranges from velvet-curtained lounges to the depths of coal mines.
Switching from cigarettes to snuff could have enormous health benefits. Although some problems could arise from continued absorption of nicotine and local nasal irritation in heavy users, the absence of tar and gases such as carbon monoxide, oxides of nitrogen, and many other toxic combustion products, would virtually eliminate smoking-related cancer, bronchitis, and possibly heart disease. Also, snuff does not contaminate the atmosphere for non-users.
Our findings suggest that a new age for snuff is a feasible alternative to cigarette smoking. Snuff could save more lives and avoid more ill-health than any other preventive measure likely to be available to developed nations well into the 21st century.
We thank our colleagues, Dr S. Sutton and Mr M. Raw, for their helpful comments, and Jean Crutch for secretarial assistance. Dr P. V. Cole and Mr Y. Saloojee, St. Bartholomew's Hospital, London, measured the COHb levels. Financial support was provided by the Medical Research Council.
Requests for reprints should be addressed to M.A.H.R., Institute of Psychiatry, Addiction Research Unit, 101 Denmark Hill, London SE56AF.
REFERENCES
1. Doll R., Peto R. Mortality in relation to smoking:twenty years' observations on British doctors. Br Med J 1976; iv: 1525-36. --return--
2. Cowie JR, Sillett RW, Ball KP. Carbon-monoxide absorption by cigarette smokers who change to smoking cigars. Lancet 1973;i:1033-35. --return--
3. Turner JAM, Sillet RW, McNichol MW. Effect of cigar smoking on caboxyhæmoglobin and plasma nicotine concentrations in primary pipe and cigar smokers and ex-cigarette smokers. Br Med J 1977;ii:1387-89. --return--
4. Armitage A, Dollery C, Houseman T, Kohner R, Lewis PJ, Turner D. Absorption of nicotine from small cigars. Clin Pharmacol Ther 1978;23:143-51. --return--
5. Lee PN, ed. Statistics of smoking in the United Kingdom. Research Paper 1, 7th edn and Suppl. London Tobacco Research Council, 1976. --return--
6. Roberts S. The techniques and the statistics of snuff selling in 1979. Tobacco 1979;1182:9-15 --return--
7. Russell MAH, Cole PV, Brown E. Absorption by non-smokers of carbon monoxide from room-air polluted by tobacco smoke. Lancet 1973; i:576-79. --return--
8. Feyerabend C, Russell MAH. Improved gas-chromatographic method and micro-extraction technique for the measurement of nicotine in biological fluids. J Pharm Pharmacol 1979;31: 73-76. --return--
9. Isaac PF, Rand MJ. Cigarette smoking and plasma levels of nicotine. Nature 1972;236: 308-10. --return--
10. Russell MAH,Feyerabend C. Plasma nicotine levels after cigarette smoking and chewing nicotine gum. Br Med J 1976; i: 1043-46. --return--
11. Armitage AK, Dollery CT, George CF, Houseman TH, Lewis PJ, Turner DM. Absorption and metabolism of nicotine from cigarettes. Br Med J 1975; iv: 313-16. --return--
12. Russell MAH, Raw M, Taylor C, Feyerabend C, Saloojee Y. Blood nicotine and carboxyhæmoglobin levels after rapid-smoking aversion therapy. J Consult Clin Psychol 1978;46: 1423-31. --return--
13. Russell MAH, Feyerabend C. Cigarette smoking: a dependence on high-nicotine boli. Drug Metab.Rev 1978; 8: 29-57.--return--
This article originally appeared in The Lancet, March 1, 1980,pp 474-5, and was copied out for the benefit of members of the Yahoo [nasal] snuff group by Robert.
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0 • Insightful Agree LikeThis happens several times a day.
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0 • Insightful Agree LikeI also recognise that I am addicted to tobacco as well as the nicotine in it. Even as a kid I used to love the smell - maybe some of us are just born users.
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0 • Insightful Agree LikeI'm still addicted to nicotine per se, and snuff always soothes the beast lurking within.
Could I live without snuff? Most diffently! Would I want to? Hell no!
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0 • Insightful Agree LikeI do the same thing. I have Toque's menthol at my bedside to enjoy the cooling effect while I go back to sleep.
What snuff do you usually keep at your bedside?
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0 • Insightful Agree LikeAt the moment it's McC S'nuff.
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0 • Insightful Agree LikeI myself was snuff marooned several times during the Dark Ages (the time between the closure of specialist tobacconists and the coming of the Internet) and, like the catechist, suffered accordingly. Even that great fall-back, No. 1, was unavailable at times.
If you are not addicted to snuff then you simply don't take enough of it. Nothing less than eight grams daily will do. That, for those who wish to turn their nice snuff hobby into a respectable vice, is my advice.
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0 • Insightful Agree LikeNot sure whether the exclamation is surprise at how little this amount is or how large. If the former then perhaps 12 grams will suffice. (If your chief snuff(s) are the heavy moists then even this amount is not unreasonable.)
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