Randomized crossover trial of the acceptability of snus, nicotine gum, and Zonnic therapy for smoking reduction in heavy smokers

Introduction: Novel approaches to nicotine replacement therapy (NRT) are needed to improve the modest long-term quit rate of 10%. Snus (Swedish tobacco) and Zonnic (oral nicotine sachet) rapidly deliver nicotine via buccal absorption and have potential as NRTs. As a prelude to formal evaluation of either product as a smoking cessation therapy, it is necessary to determine their acceptability and the willingness of smokers to use them in populations with no history of access to oral tobacco products. Methods: An open-label crossover study of ad libitum snus, Zonnic, and nicotine gum among 63 smokers for 2 weeks each, and smoking reduction if the subjects did not feel the desire to smoke. Diary cards recorded use of products and cigarettes; formal and ad hoc scales measured urges to smoke, withdrawal symptoms, and the sensory quality of the products. Results: Subjects preferred snus and Zonnic over gum. Snus and Zonnic were superior to gum in reducing urges to smoke and caused fewer side effects. All three products suppressed withdrawal symptoms. Subjects reduced their smoking by Ms of 33%, 37%, and 42% during the gum, snus, and Zonnic fortnights, respectively. Discussion: Most subjects reported a strong desire to use Zonnic or snus to quit smoking. Subjects preferred snus and Zonnic, which both had significantly fewer gastrointestinal side effects than gum and resulted in greater reductions in smoking. Snus and Zonnic are effective in suppressing desires to smoke and reducing smoking, and further studies are warranted to investigate their effect on long-term quit rates.