Feature Tobacco Control

Gutkha wars: India toughens up on oral tobacco use

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8238 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8238
  1. Meera Kay, journalist, Bangalore
  1. meerakay{at}ymail.com

This ubiquitous form of smokeless tobacco has been outlawed in much of India, but greater efforts are needed to implement these bans to reduce oral cancer, reports Meera Kay

In early November 1.31 lakh (131 000) pouches of the chewing tobacco product gutkha were seized from a godown (warehouse) in Bhopal, and two people were arrested.1 Gutkha is a concoction of tobacco, areca nut, slaked lime, catechu, and flavourings to be used orally. Bhopal is the capital of Madhya Pradesh, and this was the first state to declare war on gutkha, in April 2012.1

Paan masala is a stimulating oral preparation of betel leaf and areca, which can also contain tobacco. To date, 15 states—Madhya Pradesh, Kerala, Bihar, Maharashtra, Himachal Pradesh, Rajasthan, Haryana, Jharkhand, Chhattisgarh, Gujarat, Punjab, Uttarkhand, Mizoram, Delhi, and Sikkim—and one union territory, Chandigarh, have banned the sale, manufacture, and distribution of gutkha and paan masala that contain tobacco, confirmed Bhavna Mukhopadhyay, executive director of the Voluntary Health Association of India, a non-profit umbrella organisation that links more than 4500 health and development institutions.

Now the directors of 12 regional cancer centres, the Indian Dental Association, and Tata Memorial Hospital, Mumbai, have called on the prime minister for a federal ban on the manufacture and sale of all smokeless tobacco products.2

Gutkha is the second most common form of smokeless tobacco product after khaini, a tobacco-lime mixture.3 Smokeless tobacco contains at least 29 carcinogens. “India has the most oral cancer cases of anywhere in the world, the reason being the rampant use of smoking and smokeless tobacco products,” said Gauravi Mishra, consultant at the department of preventive oncology …

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