INTRODUCTION: It is a moist, powdered tobacco snuff (similar to dipping tobacco or naswar) consumed mostly in Afghanistan, Iran, Pakistan,India, Kazakhstan,

Uzbekistan, Tajikistan and Kyrgyzstan[4] Naswar is stuffed in the floor of the mouth, under the lower lip, or inside the cheek for extended periods of time.[1]Naswar was introduced into Western Europe by a Spanish monk named Ramon Pane after Columbus' second voyage to the Americas during 1493-1496 In 1561, Jean Nicot, theFrench ambassador in Lisbon, Portugal, sent naswar to Catherine de' Medici to treat her son's persistent migrainesThere are two forms of naswar; powder, and a paste cake style mixed with lime. A very pungent and powerful smell, yet a subtle flavour as it mixes with the saliva. The nicotine effect can occur within 5 minutes after intake producing a slight burn to the inner lip and tongue.Naswar has a very distinct smell resembling that of a fresh bale of coastal hay. Readily available in most Afghan tobacco shops, the average cost for a small 15 gram package is 90 afs (equivalent to roughly .30 cents USD). Sun and heat-dried tobacco leaves, slaked lime, ash from tree bark, and flavoring and coloring agents are mixed together. Water is added and the mixture is rolled into balls. Nass: tobacco, ash, cotton or sesame oil, water, and sometimes gum. Naswar, niswar: tobacco, slaked lime, indigo, cardamom, oil, menthol, water.. A large study of almost 10,000 Swedish men published in the International Journal of Cancer in 2008 was unable to statistically confirm a risk elevation for the combined category of oral and pharyngeal cancer. Other studies and opinion pieces in renowned journals such as the British Medical Journal and the Lancet suggest a probable increased risk of pancreatic cancer as a result of naswar use .Many cardiologists believe nicotine products (oral) contribute to the potentiation of sympathetic nerve tone, and may aggravate hypertension due to the effects of nicotine on cholinergic and dopaminergic neurotransmission. At higher doses, tachycardia and reflex bradycardia can also occur, triggering serious arrhythmias or even cardiac arrest in sensitive individuals. Further studies are needed in this regard. The European Union banned the sale of naswar in 1992, after a 1985 WHO study concluded "oral use of snuffs of the types used in North America and western Europe is carcinogenic to humans", but a WHO committee on tobacco has also acknowledged the evidence is inconclusive regarding health consequences for naswar consumers. Only Sweden and EFTA-member Norway are exempt from this ban. A popular movement during the run-up to the 1994 referendum for Sweden's EU membership made exemption from the EU sale ban of naswar a condition of the membership treaty. Recent actions by many European governments to limit the use of cigarettes has led to calls to lift the ban on naswar, as it is generally considered to be less harmful than cigarette smoke, both to the user and to others.

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