July 04, 2007

Best Nicotine Solution For People who Have Schizophrenia and Smoke

Over a year ago we published the "Schizophrenia and Smoking Report" that addressed the issue of how people who have schizophrenia and smoked tobacco products could best lower their risk of cancer.

One of the lowest cost, lowest risk approaches to nicotine use is the Swedish smokeless tobacco product called SNUS - which is available online from Swedish web sites.

This week a new debate on this product has been initiated. On the one hand, it’s definitely less risky than smoking (approximately 90% less risky, say the experts). On the other hand, it would be better if smokers kicked the tobacco habit altogether. It’s the classic best-as-enemy-of-good (or at least as-enemy-of-less-bad) conundrum.

Compared to regular chewing tobacco, snus has less of a chemical called nitrosamine, which means it probably has a "much lower" risk of oral cancer than regular chewing tobacco. But snus likely carries some cardiovascular and cancer risks, though the risks are certainly much, much lower than the risks associated with smoking cigarettes.

Those arguing in favor of presenting snus as an alternative for smokers note that in Sweden, where public health officials are snus friendly, tobacco-related deaths have fallen sharply even as tobacco use has remained roughly stable, because tobacco users have shifted from cigarettes to snus. Snus is now the drug of choice for more than half of Swedish tobacco users, the article says.

In our minds, there is no question. If you don't want to stop all nicotine consumption (and most people who have schizophrenia don't), then the best thing to do is to stop smoking and use the least harmful nicotine product. The ideal product would be nicotine replacement products (nocotine gum, spray, etc.) but for most people these products are too expensive for long term use. The best inexpensive alternative to smoking seems to be Swedish Snus.

In the new issue of PLoS Medicine, public health researchers debate the question. The article is available here: Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure?


I feel this blog should include a discussion on how smoking interacts with the medications schizophrenia patients take. Smoking causes antipsychotic medications (particularly clozapine) to metabolize faster, resulting in patients needing to take much higher dosages than patients who do not smoke to achieve the same effect. This has lead to medication difficulties in so many patients, yet is often ignored in discussions about smoking among schizophrenia patients. When schizophrenia patients quit smoking, the blood plasma concentrations of their medications can raise to toxic levels. Relapse back to smoking after a period of abstinence can also make previously effective antipsychotic medications ineffective, since the resumption of smoking causes their medication concentrations to decrease.

Patients should tell their doctor that they are planning to quit smoking and form a plan of what to do if they begin to feel sick.

Has SNUS been evaluated for its interactions with antipsychotic medications? If not, I question whether this website should be putting such a strong endorsement out for it yet.

Posted by: Erin at July 5, 2007 06:31 AM

Snus is not legal in the European Union because it is said to cause cancer. Sweden who is also a member has made a request when it entered in the European Union for it's citizens to allow it, which was granted.

Posted by: joyride at July 6, 2007 03:44 PM

Hi Erin and Joyride,

The researchers have said (see smoking report) that SNUS has an approximately 90% LOWER risk of premature death compared to cigarette smoking. Based on this expert opinion - we think that anyone who feels the need to consumer nicotine, would be much, much better off taking SNUS vs. smoking cigarettes - assuming that a healthy life is the goal. I have not seen any information on the medications/SNUS interactions - but that is something that is a good idea. Nevertheless - SNUS has approximately the same amount of "bioavailable" nicotine, so I suspect that the impact would be the same for SNUS or cigatettes from the medication/SNUS interaction.

SNUS may not be legally sold in the EU - but it is available from many web sites (just do a search on SNUS in google) and they claim that they ship around the world without a problem. We can't guarantee the accuracy of these claims as we've never tried ordering ourselves.

Posted by: szadmin at July 6, 2007 04:13 PM

Hello SZAdmin,

Somehow I feel better taking a chewing gum with nicotine than sucking a bag with substance in it for hours. I guess there is no ban for chewing gum with nicotin and it is said that just the nicotine has a possitive effect for sz. The problem is
that gum with nicotime is almost just as expensive as smoking itself.

Posted by: joyride at July 7, 2007 01:40 PM

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