Dissolvable tobacco is a relatively new product with potential for tobacco harm reduction, allowing users to avoid the formation of harmful chemicals as a result of combustion and thereby reduce their risk of tobacco-related illness. They are a form of smokeless tobacco, but users don’t need to spit as users do with chewing tobacco because the pellets disappear after being held in the mouth for anything from two minutes to half an hour.
There are some concerns about their potential health risks and in particular the likelihood that they will be swallowed by children as a result of being mistaken for a piece of candy. Learning about the types of dissolvable tobacco and the research conducted thus far into their usage and risks helps you determine whether they pose any danger to smokers or children.
History of Dissolvable Tobacco
Dissolvable tobacco is a new product, having really gained some attention through R.J. Reynolds introduction of Camel-branded dissolvable tobacco Strips, Orbs and Sticks, but it’s actually been around since 2001. Star Scientific produced Ariva and Stonewall brand dissolvable tobacco, but it attracted relatively little attention. The aim was to produce a reduced-harm method of consuming tobacco, specifically with the purpose of creating a low-nitrosamine product. These are carcinogens found in tobacco, and are widely considered to be the main risk from smokeless tobacco.
Tobacco companies got involved in 2009, when R. J. Reynolds tested its products in three cities, before refining the designs and testing the new version in two more locations in 2011. Philip Morris (manufacturer of Marlboro) launched Skoal sticks in 2011 too, and interest in the products has increased in recent years.
Types of Dissolvable Tobacco
There are a few different types of dissolvable tobacco products, but they are all relatively similar to one another. They are made from powdered tobacco, sugars, flavors and binding agents, as well as ingredients to balance the pH. They generally contain between 1 to 3 mg of nicotine per piece. Dissolvable tobacco products are technically not dissolvable, because although they appear to dissolve from the user’s perspective, they actually break into smaller and smaller pieces which are swallowed in saliva, as opposed to forming a true solution (like salt does in water, for example).
Orbs/Lozenges – These are a tablet-like formation of the basic dissolvable tobacco idea. Similar lozenges are made using nicotine by pharmaceutical companies, but these don’t contain tobacco, and non-pharmaceutical versions contain higher quantities of nicotine.
Strips – Strips are more similar to the dissolvable mint strips used as a breath-freshener. They’re thin, tobacco-containing films that are placed into the mouth and dissolve within a few minutes.
Sticks – These are the same basic idea but formed into a toothpick-sized stick. The Skoal brand (created by Philip Morris) is actually a wooden stick partially coated in a ground tobacco mixture, but R.J. Reynolds’ brand is wholly dissolvable and disappears after around 20 to 30 minutes of use.
Health Concerns and Risks to Children
There are some health concerns relating to the use of dissolvable tobacco, particularly relating to the presence of tobacco-specific nitrosamines and the potential for oral and pancreatic cancers. An additional issue with dissolvable tobacco products is that their aesthetic similarity to candy, which stokes fears of both purposeful youth use of the products and accidental poisonings.
Cancer – Although dissolvable tobacco is designed to be low in nitrosamines, there are still tobacco-specific nitrosamines present, which creates concern about the risk of (primarily oral) cancer. The World Health Organization has published standards for the quantities of nitrosamines in smokeless tobacco (two parts per million), and independent analyses show that both Star Scientific products are well within this limit (around 10 times lower) and the Camel-branded orbs, strips and sticks also contain much smaller amounts (around 0.6 – 0.8 parts per million). This alone provides evidence of an extremely low cancer risk (if any increased risk at all), but evidence from snus use in Sweden, which contain higher proportions of nitrosamines, is also useful.
Cancer evidence from snus – Snus are used in the same way (by being held in the mouth) as dissolvable tobacco, and have been researched much more extensively. Overall, Swedish-made or modern US snus have very little (or possibly no) effect on oral cancer risk, and for most other cancers there is no increase of risk observed in users. The only exception to this is pancreatic cancer, which may be slightly more likely in snus users, but the risk will be much smaller than that from smoking. This evidence is useful because Swedish snus generally have 2 to 3 parts per million of nitrosamines (dry weight), which is at least twice as much as is found in dissolvable tobacco.
Chemical research – The Tobacco Products Scientific Advisor Committee for the FDA produced a list of 40 potentially harmful ingredients in smokeless tobacco products, and the Star Scientific products tested either contained undetectably small amounts of these chemicals or significantly lower quantities than is found in snus or chewing tobacco. A different chemical analysis only detected flavorings, binders and nicotine.
Youth Usage – According to the National Youth Tobacco Survey, the proportion of high school students who’d used dissolvable tobacco in the last 30 days (prior to the survey) was 0.4 percent in 2011 and 0.8 percent in 2012. For middle school students, the proportion in 2011 was 0.3 percent and in 2012 it was 0.5 percent. While usage is increasing, considering the corresponding 2012 figures for cigarette smoking (3.5 percent for middle school and 14 percent for high school), youth dissolvable tobacco use is very low.
Poisoning risk – Star Scientific commissioned a report from the American Association for Poison Control Centers to determine how many cases of children being poisoned by dissolvable tobacco occurred from January 2009 to March 2010 (over 12 million Star Scientific products were sold during this period). Out of 651 exposures in the “snuff” category, there were only three for disposable tobacco. These cases were all “non-toxic” exposures, and only home care was needed. Out of 471 cases in the entire snuff category followed up, only 9 had “moderate” effects, and there were no fatalities. In comparison, in 2009 there were around 1,300 exposures to pharmaceutical nicotine products.
Dissolvable tobacco is legal, but it is likely to be brought under regulation by the FDA in the near future.