Smokeless tobacco (information taken from Oral Cancer Foundation)

"People who consume 8 to 10 dips or chews per day receive the same amount of nicotine as a heavy smoker who smokes 30 to 40 cigarettes a day." "For smokeless tobacco users, the risk of cancer to the cheek and gum is nearly 50 times greater than non-users." (American Cancer Society, 1998). "Many athletes, especially baseball players, use smokeless tobacco. A study conducted from 1988-1990 found that 37.5 percent were smokeless tobacco users. Most preferred moist snuff." "According to the 1997 National Household Survey on Drug Abuse, 92 percent of smokeless tobacco users are male." "Smokeless "spit" tobacco contains over 2,000 chemicals, many of which have been directly related to causing cancer." While some occur in trace amounts, conclusive data on their safety DOES NOT exist.

There are two types of smokeless tobacco - snuff and chewing tobacco.

Chewing tobacco and snuff contain 28 carcinogens (cancer causing agents). The most harmful carcinogens in smokeless tobacco are the tobacco specific nitrosamines (TSNA's). Snuff dippers consume on average more than 10 times the amount of cancer causing substances (nitrosamines) than cigarette smokers. They are formed during the curing, fermenting and aging of tobacco. TSNA's have been detected in smokeless tobacco at levels 100 times higher than the levels of other nitrosamines that are allowed in bacon, beer and other foods. Other cancer causing substances in smokeless tobacco include formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium (a radioactive element from the soil it is grown in, read more on the dangers of this) Some may argue that many of these are in spit tobacco in very small volumes, and that volume of exposure dictates risk. However, we have no significant research on what the effects of even the smallest amounts of some of these are when a person is exposed to them over decades of intimate exposure/use.

Another element found in smokeless tobacco is nicotine. Nicotine is absorbed by smokeless tobacco users at a rate 2 to 3 times higher than that of cigarette smokers, facilitating rapid addiction. Also, the nicotine stays in the bloodstream for a longer time. It has been reported that some chewing tobacco products actually contain microscopic abrasives which speed the absorption of nicotine, and carcinogens into the cell membranes. This is denied by tobacco manufacturers. In OCF's opinion, a group which has proven their willingness to lie under oath (none admitted that they knew nicotine was addictive contrary to their internal memos) cannot be trusted as a source of information. NO peer reviewed published study address this question with any conclusion. More recently tobacco research dollars were spent to convince the public that "light" cigarettes were a safer alternative to conventional cigarettes. This has subsequently been proven to be not the case, and recent scientific revelations to the contrary have forced them to suspend such claims. The history of the big tobacco companies has been one of deception, and misdirection. An August 2006 U.S. District Court ruling declared that cigarette companies knowingly misled consumers with claims that low-tar and "natural" cigarettes were less harmful than other cigarettes. These so-called "harm-reducing" cigarettes marketed between 1998 and 2004 delivered more nicotine than their predecessors, upping the delivery of smoking's addiction factor in each cigarette by an average of 10 percent. Montanans should be very skeptical about the tobacco industry's newest claims about spit tobacco.

Smokeless tobacco is not a completely safe substitute for cigarettes. There are those who argue that IF it replaced smoking tobacco use in the US we would see a reduction in tobacco (smoking) related death rates, and they are correct; if all smokers used spit tobacco it would reduce the number of lung cancers significantly. We agree that this is a likely scenario. But we do not think that given other nicotine replacement strategies, (nicotine containing gums, patches, lozenges, nicotine nasal sprays, nicotine inhalers, and among a variety of herbal nicotine containing chews, even a black tea based chewing tobacco now available on the market (Blue Whale), which appears to contain no known carcinogens, but only the nicotine found in existing spit tobaccos), that their argument is justification for endorsing spit tobacco use. We also find their passion for this perspective suspect because of the significant tobacco dollars that have been behind their direction. Arguments that they have had other funding will only be met with skepticism until revelation of all funding sources in specific terms is made evident.

There are also prescription medications to help people quit the use of tobacco. The most common of these is Zyban (bupropion hydrochloride) which will dramatically reduce withdrawal symptoms when trying to quit. OCF prefers non tobacco nicotine replacement therapies, with the eventual goal of a release from the addiction completely, not the continued long term addiction to an alternate product. Other nicotine replacement strategies, such as inhalers, nasal sprays, etc. would allow an individual to wean themselves from the addiction, without introducing additional risks for other ailments. Spit tobacco, besides its ties to oral cancer, is also tied to other serious cancers such as pancreatic cancer, and there is still much we do not know about all the possible negative biological implications of its use over long terms. The TRUTH which the harm reduction advocates do not speak to, is that there is more that we do not know about the long term negative effects than what we do. The research dollars which exposed the extensive harm from smoking tobacco and brought down any belief that smoking was harmless, were not directed towards research of smokeless spit tobacco products. As a result, they frequently will talk about how little scientific evidence there is to argue against spit tobacco as a harm reduction strategy from an evidence based perspective. But remember if you find that argument attractive, that the research dollars are only now being spent to explore the negative biological implications of spit tobacco use. The lack of numerous published studies at the current time indicates that the are NO STUDIES, it does not indicate that the product is safe. In our opinion beginning the use of smokeless tobaccos is a step in the wrong direction, and their use as a harm reduction strategy is misguided when other options exist.

Having taken a position of endorsing nicotine replacement for those who cannot quit but wish to reduce their risk of harm, OCF also acknowledges that there is conflicting information about the long term use of nicotine and its effects on the body. It is likely not as benign as caffeine as some insinuate, but until more data is available we find this to be the lesser of evils when it comes to the bigger picture of harm reduction. Bottom line, OCF cannot endorse a policy of adding to the cases of not only oral cancers and pancreatic cancers, but other serious ailments, even if there s a greater good (harm reduction in tobacco smokers) to be served if it means additional mortality and morbidity sacrifices via new oral cancer patients. If we are willing to advocate a different tobacco poison only on the basis that it will help one group, but hurt another to a lesser extent, then there is a moral, not a science question here which needs to be addressed.

Studies indicate that the use of snuff and chewing tobacco is associated with an increased risk for oral cancer. Our Patient to Survivor message board has plenty of real life people that can speak to their addictions and their development of oral cancers, for those who doubt. It is particularly alarming that an increasing number if young people are using such products. The marketing strategies of the tobacco companies to sell these products with fruity flavors that are particularly attractant to our youth is particularly deplorable. Smokeless tobacco users increase their risks of cancers of the oral cavity, pharynx (throat), larynx, and esophagus. Oral cancer can include cancer of the lip, tongue, cheeks, gums, and the floor and roof of the mouth, as well as the tonsils and oropharynx (back of the throat) and it kills readily via metastasis out of the oral environment to vital organs of the body. People who use snuff have a much greater risk for cancer of the cheek and gum than people who do not use tobacco.
Some of the other effects of smokeless tobacco include addiction to nicotine, oral leukoplakia (white mouth lesions that can become cancerous), gum disease (periodontal disease), gum recession (when the gum pulls away, or recedes from the teeth), loss of bone in the jaw, tooth decay (a result of sugar additives to enhance the flavor of smokeless tobacco), tooth loss, tooth abrasion (worn spots on the teeth), yellowing of the teeth, chronic bad breath, unhealthy eating habits (smokeless tobacco lessens a person's sense of taste and ability to smell, so users tend to eat saltier and sweeter foods which are both harmful in excess), high blood pressure (spit tobacco contains high concentrations of salt), and increased risk for cardiovascular (heart) disease and heart attacks. 

Remember that this is a a product which is UNREGULATED and no one in the tobacco industry has to release any information about what it contains, what they know about its effects, or harms that it may cause. This is an industry that has a history of lying to the American public about their products that goes back for decades. OCF feels that any data supported by tobacco dollars, even if through university grants, is suspect and should be confirmed by independent sources. In the long run we believe that tobacco products should be regulated as any other addiction producing product in our marketplace.

Also note that the tobacco industry stays away from making claims about the safety of spit tobacco products, relying instead on paying or providing lucrative grants to 3rd party investigators to publish materials supporting their desired strategic claims. In our opinion these individuals are nothing more than shills for the industry. This situation exists because the smokeless-tobacco makers face a difficult balance in marketing the products - If they tout them as being safer, they face scrutiny from the Federal Trade Commission and state attorneys general, and would have to prove their claims based on clinical trials they now are not required to conduct. These trials would last many years and the likely outcome from them would be disastrous to the tobacco industry as independent documentation of harm would be there for all to see.

Spit tobacco causes oral cancer by the following process: as tissue cells in these areas divide in an attempt to form a barrier against the tobacco, they are exposed to carcinogenic agents and can become cancerous. Pinpointing how long a spit tobacco user can chew or dip before getting oral cancer is difficult to do since it is impossible to predict when and if cells will become cancerous. Consequently, spit tobacco users risk beginning the process to develop oral cancer every time they use. Spit tobacco can also cause other types of cancers. Exposure to tobacco juice which is not intentionally swallowed may induce cancers of the esophagus, larynx, stomach, pancreas and prostate. Clearly the investigation of all the possible mechanisms of harm, particularly in areas remote from the site of use, are not fully explored as of now, and making the ASSUMPTION based on today's data that spit tobacco is safe, would be foolish.