Cancer experts back sale of nicotine hit to beat smoking

Smokers will remain hooked on cigarettes until a new range of addictive recreational nicotine is available, leading cancer experts have warned.

Cancer doctors from the European Institute of Oncology in Milan say nicotine addiction is here to stay and call for a new harm- reduction approach to smoking - including making smokers dependent on another form of nicotine.

Despite 20 years of nicotine replacement therapy, a realistic and attractive alternative to cigarettes that offers smokers a nicotine dose that is absorbed as quickly and as well, has not been offered, they say.

In an article in the medical journal The Lancet, Professor Peter Boyle, director of the Division of Epidemiology and Biostatistics at the Milan institute, and colleague Dr Nigel Gray, a senior research fellow, write that the risks of addictive recreational nicotine are insignificant when compared with the harm caused by cigarettes.

"We believe a more radical approach is needed: a clean addictive recreational nicotine delivery. Health risks associated with clean nicotine are minor compared to those of tobacco.

"Addiction to tobacco-derived nicotine will probably not diminish until there is available on the market a competitive nicotine source which is "clean" in the sense that it does not deliver carcinogens or toxins to the consumer in the wake of the nicotine. Undoubtedly such a product would have addictive potential - to be an acceptable alternative, it would have to.

"Recreational, addictive clean nicotine is a necessary product that does not exist despite two decades of development of nicotine replacement therapy."

They say there is as yet no "clean addictive source of nicotine that can compete commercially with cigarettes."

The cancer experts advocate the rest of Europe adopting the Swedish habit of sucking snus, a form of moist ground tobacco that you place between your lip and gum.

Sweden was the only country to meet the World Health Organisation's target of reducing smoking prevalence to 20% of the population by 2000 - a success attributed to snus.

Among Sweden's 3.4 million men, snus is more popular than smoking: about 19% use snus and 17% smoke - the lowest rate of smoking in Europe. Swedish men have the lowest rate of lung cancer in Europe and the lowest rate of death from smoking-related disease - just 11% compared with 25% in Europe as a whole.

Burning tobacco gives off around 4000 compounds, at least 60 of which are known to cause cancer. Cigarette smoke also contains carbon monoxide, which reduces the blood's ability to carry oxygen and strains hearts and lungs.

Snus isn't completely harmless, however. Users increase their risk of cardiovascular disease, although the risk is still lower than among smokers. And, crucially, snus doesn't appear to cause mouth cancer, which is a serious risk with other forms of oral tobacco. A long-term study of 135,000 Swedish men, published in the American Journal of Public Health in 1994, found that snus caused no increase in cancer risk. Snus is said to be cured under conditions that inhibit carcinogen production.

In Sweden, snus is marketed as a safer alternative to smoking but is illegal in all other European countries. The European Union banned it in 1992. Sweden negotiated an opt-out when it joined the EU in 1995.

Gray and Boyle add: "There are lessons to be learned from the real- world experiment in harm reduction with snus. The most important is that nicotine addiction can be diverted from cigarettes to an orally absorbed nicotine-delivery product, which is competitive with cigarettes as a nicotine source. If it is accepted that nicotine addiction is here for the foreseeable future, a new and better range of addictive recreational nicotine is needed. Any risks of such a product are dwarfed by the magnitude of the tobacco problem."

The cancer experts would prefer smokers to be weaned on to a tobacco-free form of pure nicotine but point out that snus is less harmful than cigarettes and, therefore, worth marketing in the UK.

Dr Gray said: "Snus is a tobacco product but has low levels of nitrosamines (highly carcinogenic compounds derived from tobacco) hence it is cleaner than many other smokeless tobaccos. A demand for it could well be developed by advertising it and only doing the experiment will tell whether the UK users are like the Swedes. It is not my view of the future, which is for a product with only pure nicotine in it, developed to maximise absorption and thus mimic both the cigarette and snus, but does not deliver the other carcinogens and toxins which are in tobacco.

"Our approach is pragmatic and recognises that there are millions of continuing smokers who would like to quit but who do not find current nicotine replacement therapies satisfying enough. We accept that there are minor risks but think that the current cigarette is the worst option available for supporting nicotine addiction. And history has demonstrated that nicotine addiction is with us and not going away under our present policies."

The main manufacturer of snus, Swedish Match, has challenged the ban in the European Courts. Earlier this year Labour MP Paul Flynn urged the British government to back moves to remove snus from an EU list of banned products. Other tobacco companies are now diversifying to create safer forms of nicotine. British tobacco company Gallaher whose brands include Silk Cut and Benson & Hedges makes an oral tobacco called Gustavus, sold in Sweden. If the ban was lifted it could be marketed in the rest of the EU.

Dr Colin Guthrie, a Glasgow GP, added: "People addicted to nicotine are having to inhale dozens of carcinogens in order to get their nicotine buzz. There is no other legally permitted nicotine delivery system in the EU. This concoction of chemicals destroys hearts and lungs causing a huge morbidity and mortality.

"The point here is that the health risk of oral cancer from nicotine placed in the mouth is very small compared to the risk of a whole range of chemicals drawn into our lungs when we smoke."

Action on Smoking and Health Scotland (ASH Scotland) is holding a meeting tomorrow to plan its policy on addictive recreational nicotine.

Dr Laurence Gruer, public health consultant for NHS Health Scotland, would like to see stronger forms of nicotine replacements available but is opposed to snus. He said: "I think there is scope for looking at higher doses and looking at other types of nicotine replacement. Snus is not entirely harm-free. It does cause other problems such as recession of the gums."

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