Reduction in nicotine intake and oral mucosal changes among users of Swedish oral moist snuff after switching to a low‐nicotine product

The purpose of this investigation was to assess nicotine regulation among users of portion‐bag Swedish oral moist snuff ( snus ) when switching from an ordinary snus product (Brand A) to a low‐nicotine product having only half the concentration of nicotine (Brand B). Two studies were performed to compare the short‐term effects on consumption and nicotine intake of switching to low‐nicotine snus with those of long‐term effects. In Study 1, consumption data, soft tissue changes and nicotine intake were measured in a group of 24 habitual users of Swedish portion‐bag snus , both during use of their ordinary snus (Brand A) for 2 weeks and during consumption of the low‐nicotine product (Brand B) for 10 weeks. In study 2, the same data were measured during 2 weeks in a reference group of 18 snus users who had been habitual users of the low‐nicotine snus (Brand B) for at least one year. Although there was no increase in number of hours of daily consumption, the amount of snus consumed increased on average by 2 grams a day (+15%) when switching from Brand A to the low‐nicotine Brand B (Study 1). The Brand B reference group (Study 2) consumed about 3 grams less snus a day during the same number of hours as the subjects in Study 1 who had switched to Brand B. These results indicate that snus users compensate to a small extent for the lower nicotine delivery by increasing their consumption on short‐term switching but the same does not apply to long‐term users. There was a significant reduction in nicotine intake when switching to the low‐nicotine brand. The individual average saliva cotinine levels decreased from 336 ng/ml to 153 ng/ml and total amounts of nicotine equivalents excreted during 24 h decreased from 25.2 mg to 14.4 mg (Study 1), reaching about the same levels found in the reference group in Study 2 (159 ng/ml and 14.3 mg, respectively). After switching from Brand A to Brand B in Study 1, there was a decrease in the frequency of Degree 3 clinical lesions and an increase in Degree 2 lesions. Also, Degree 3 lesions were less frequent, and Degree 1 lesions more frequent, in Study 2 than in Study 1. These observations point to the development of less pronounced changes after both long‐term and short‐term switching to a low‐nicotine snus .