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 shortterm 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 1 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.