Reflecting changing social attitudes, the future of smoking alternatives and oral nicotine remain promising as these innovations continue to find their footing in the world of harm reduction
Here’s a fun fact that’s sure to dazzle guests at your next Christmas reunion: Did you know that buyo or betel is mentioned in the very first chapter of Jose Rizal’s Noli Me Tangere? Buyo is the colloquial term for betel nut-chewing, often in combination with other substances like betel leaf, slaked lime and tobacco.
In the novel, a tray filled with cigars, cigarettes and buyo welcomes high-ranking visitors into an upper-class home as a gesture of hospitality. Failing to offer betel to guests is considered a serious breach in polite society.
Folk literature similarly holds the leaves in great regard. The Kalinga epic Ullalim liberally repeats the line, “Behold here, a nice red ripe betel nut” as a sort of mantra. The betel nut almost becomes a character unto itself, proof of its immense cultural significance. Meanwhile, the Panay epic Humadapnon has a line describing maidens preparing and serving betel nut.
Imbued with such deep meaning, a betel nut holds a unique place in our country’s history. Amid lush green landscapes and the vibrant cultural heritage that the Philippines proudly calls its own, chewing tobacco has been silently etched into the tapestry of the archipelago.
But this isn’t just a story that begins and ends in the Philippines. The narrative of chewing betel nut and tobacco as a habit transcends borders, connecting with an emerging global phenomenon—snus and nicotine pouches.
Nearly half a millennia ago, the indigenous peoples of the Philippines had already embraced the practice of chewing leaves. Long before cured and processed tobacco leaves were a blip on anyone’s radar, chewing a mixture of betel nut and betel leaf for its stimulant effects was a ritual in many parts of the country.
Just as the modern practice of smoking or vaping became a social activity, betel chewing was a hallmark of social gatherings and played an essential role in ceremonies, symbolizing unity and camaraderie.
Today, betel chewing is primarily still practice amongst the inhabitants of the Cordilleras and in some parts of Mindanao, especially amongst the older generations. Tourists who chance upon the natives of the area may gasp in shock seeing locals with their mouths stained a violent red, spitting what looks to be reddish-brown blood, called nganga.
Not to be outdone, an innovation was quietly taking shape on the other side of the world. In the 1560’s, French Ambassador Jean Nicot came across the tobacco plant, nicotiana tabacum, which was grown in the gardens of Lisbon. He was so enthusiastic about it that he advised Queen Catherine de Medici, then suffering from chronic headaches, to crush the leaves and inhale the powder through her nose. So effective was this “miracle cure” that snus rapidly gained popularity in French court circles.
In the 16th century, Swedes began to mix tobacco leaves with salt and water to place behind the upper lip, creating snus, one of the first smokeless tobacco products.
The proponents of snus had no idea they were taking the first steps towards what would later become a global public health phenomenon.
TOBACCO USE EVOLVES
When the Spanish arrived in the Philippines, the tobacco economy flourished. According to the National Tobacco Administration (NTA), soon there were more people converted to smoking than to Christianity—no mean feat considering almost 90% of today’s Filipino population identify as Roman Catholic.
With tobacco promoted for trade purposes, it did not take long for the local population to catch on. Soon, the indigenous “buyo” habit evolved to incorporate the Spanish-style cured tobacco leaves, setting the stage for widespread popularity of chewing and smoking tobacco across the archipelago.
In Europe, snus was a must for men and women of the aristocracy. But usage went down once the French Revolution was underway.
Snus quickly went out of fashion. Those who came into power during this period switched to smoking cigars.
Fast forward to today and the world has witnessed a revolving door of tobacco and nicotine products. During the first few decades of the 20th century, traditional or combustible cigarettes gripped the globe. As the world became more industrial and problems grew more complex, cigarettes became a recreational activity for some and a full-blown stress reliever for others.
Today, the world knows that smoking cigarettes is one of the worst things you can do for your health.
Several scientific studies have since shown that it is the smoke produced by combustible cigarettes, not nicotine, that poses significant health risks. Cancer Research UK has said that nicotine, while addictive, does not cause cancer. In fact, people have used Nicotine Replacement Therapy (NRT) safely for many years. NRT refers to nicotine patches, gums, sprays, oral inhalers and tablets.
French cancer expert Dr. David Khayat said it is the cigarette smoke that contains more than 6,000 toxic chemicals and ultrafine particles, including 80 carcinogenic substances. These toxic substances are produced by the burning of dried tobacco leaf and are then inhaled by the smoker, causing serious and often fatal tobacco-related lung diseases, including chronic obstructive pulmonary disease (COPD) and lung cancer.
SNUS & THE SWEDISH EXPERIENCE
As cigarettes fell out of vogue, snus began to regain its popularity in the late 1960’s. During the 1970’s, the first portion-packed snus was introduced, an important step for snus to reach a broader public.
The modern version of snus is a moist oral tobacco product which is placed behind the upper lip, either loose or in portioned sachets that resemble miniature tea bags. It is primarily used in Sweden and Norway. Swedish snus in particular is stringently monitored as it is subject to the Swedish Food Act, meaning that the additives used are approved for use in food and that a high standard of hygiene is maintained.
Snus helped reduce Sweden’s smoking rate and disease burden below the European average as many adult smokers transitioned to the oral tobacco product. Just several decades ago, almost half (49%) of Swedish adult males smoked regularly. Over the past 15 years, Sweden has slashed its smoking rates from 15% in 2008 to 5.6% today.
Studies show that snus is 95% less harmful than cigarettes. Snus users have at least 90% to 95% less smoking-related mortality, with minimal reduction in life expectancy, if any at all. The health benefits of smokers who completely transition to snus use are similar to those reported for smoking cessation.
The widespread use of snus has resulted to Sweden, based on current trends, soon becoming the first nation to give up cigarettes, according to “The Swedish Experience: A Roadmap to A Smoke Free Society.”
Sweden is currently one of the three countries with the lowest number of deaths attributed to lung cancer. In fact, Sweden has a 40% lower rate of death of all tobacco-related diseases compared to the EU average.
NEXT STEP: NICOTINE POUCHES
The Nicotine Pouch is the latest leap in the realm of oral smokeless products. It’s a relatively new product as it was only developed in the 2010’s. But it is steeped in tradition, being inspired by snus. It offers users a way to experience the stimulant effects of nicotine, minus the stained teeth and spitting.
One of the earliest to enter the market—and one of the most popular in the category today—was Swedish Match’s ZYN. The product consists of a white pouch containing nicotine, with no presence of tobacco leaf, dust or stem. Similar to snus, no combustion, heating nor inhalation were involved.
Nicotine pouches like ZYN have varying nicotine and flavor contents. Like snus, the user inserts the pouch between the upper lip and gum and leaves it there while the nicotine and the flavor are being released typically for up to 30 minutes.
Because the tobacco has been removed, harmful and potentially harmful constituents that are usually found in varying levels in other tobacco products have been eliminated. The few remaining constituents are found at very low trace levels, comparable to levels acceptable in common food products.
For curious adult Filipino smokers looking to switch to smoking alternatives like oral nicotine, Zyn is now available in the Philippines since November 17 in IQOS stores and select 7-11 outlets, tobacconists and vape stores. It could also be found online at Zyn.com, Lazada and Glife.
As society becomes increasingly health-conscious and seeks alternatives to smoking, nicotine pouches are likely to remain a prominent fixture in the world of nicotine consumption. Reflecting changing social attitudes, the future of smoking alternatives and oral nicotine remain promising as these innovations continue to find their footing in the world of harm reduction.