Alam Khan, a 46-year-old resident of Nowshera district, was rushed to a private dental hospital in an emergency due to excruciating tooth pain. Crying with immense pain while laying his hand on his right face, Alam was immediately shifted to the Oral and Maxillofacial Department of the Sardar Begium Dental College, Peshawar, for surgery on one of his right molars. Upon thorough examination, the doctor diagnosed decayed molars, which had also caused a critical gum infection due to the extensive use of naswar by the patient since his adolescence. Dr. Tahir Khan, senior surgeon of the hospital, said that the molar of the patient was extracted as root canal treatment was not feasible due to decay and gum infection. “I started Naswar in a hostel with a group of friends in a bid to avoid the stress of the MA exam back in 2000, and since then I have not been able to leave the practice due to its addiction,” said Alam, adding that due to excessive use of Naswar, his teeth turned pale and also caused the extraction of his two teeth. “I time and again tried my level best to get rid of this habit, but to no use. Throwing saliva in the office and house makes a very bad impression on my personality.” Dr. Tahir Khan said the severity of naswar addiction could result in severe gum infections, jaw complications, and the loss of multiple teeth. Naswar’s harmful effects extend beyond oral health, potentially causing bone loss, stomach disorders, and facial disfigurement. It may also contribute to an increase in heart rate with cardiac vascular complications, and in some cases, it can lead to more severe conditions like mouth and oral cancer. Referring to a report from the Global Cancer Observatory, Dr. Tahir pointed out that Pakistan faces a significant burden of lip and oral cavity cancers, with about 11,000 new cases in males every year, making it the most common cancer among men. “Poor dental hygiene, tobacco use, and viral infections, besides fake quack doctors, contribute to these alarming statistics,” he informed. Approximately 10,000 people die of cancer of the lips and oral cavity annually in the country, the doctor said, adding that the main reasons for such cancers were chewable and non-chewable tobacco, poor dental hygiene practices, oncogenic viral infections, and genetic predispositions. Despite the grave health risks, naswar remains prevalent in Khyber Pakhtunkhwa, where approximately 70 percent of the population uses it without knowing its serious consequences for health. Besides Charsadda, Swabi, and Mohmand, the super-quality naswar of Dera Ismail Khan, Bannu, and Mardan was mostly exported to Punjab and Sindh provinces, while its demand in Karachi was high due to the presence of a large number of migrants from Khyber Pakhtunkhwa. History revealed that naswar was introduced to the world in the 15th century in Europe when a French ambassador used it to treat her son’s migraines. Initially, it was used for medicinal purposes, but gradually it was consumed as an alternative to tobacco and later came to Indo-Pakistan. Fawad Khan, who has been associated with naswar business for the last 10 years in Nowshera district, said that people aging between 18 and 50 prefer to consume Mardani, Charsadda, and Bannu’s naswar. “The price of smoke-free tobacco varies in the open market, as Rs 25 per snuff packet was being charged per 100 grams,” he said. Regarding its preparation, he said the first tobacco was dried in the sun, then ground into powder, and water was added to this green powder along with calcium hydroxide and artificial color, then plant ashes, species, or oils were used to give it a flavor, and finally the mixture was rolled into fine balls to give it a proper shape. Dr. Muhammad Naeem, former Chairman of the Economics Department, University of Peshawar, while referring to the data of the Pakistan Tobacco Board, said the naswar has an estimated market value of about Rs six billion per year, whereas its unchecked sale and manufacturing exposes its users to different health hazards. He said that although federal excise duty was increased on cigarettes, Naswar was yet to be brought under the direct tax net. Under the first slab of cigarettes, locally produced cigarettes, if their on-pack printed retail price exceeds Rs 9000 per 1000 cigarettes, the rate of federal excise duty was fixed at about Rs 16,500 per thousand cigarettes, while under the second slab, locally produced cigarettes, if their on-pack printed retail price does not exceed Rs 9,000 per thousand cigarettes, the rate of federal excise duty would be charged at Rs 5,050 per thousand cigarettes. Dr. Riaz Khan, senior medical specialist and principal officer of Government Hospital Pabbi Nowshera, said that naswar was mostly made of fresh tobacco leaves, calcium oxide, and other ingredients that may cause different types of cancer, including lung, oral, stomach, and mouth cancer, besides causing bronchitis, kidney, heart, and other diseases. He said the smokeless tobacco contains nicotine and other chemicals, which may have caused side effects on the brain and ultimately oral cancer. Imran Shah, Director of the Social Welfare Department, told APP that the PTI government had increased the tobacco tax up to Rs 12 per kg and taxed naswar at Rs 5 per kg in budget 2022-23 to discourage naswar addiction. However, the PTI government later withdrew its decision to increase taxes on naswar and tobacco under KP Finance Bill 2022 following criticism and public pressure and sought to trim the tax on naswar from Rs 5 to Rs 2.5 per kg, besides slashing the duty rate on tobacco by Rs 6. He said 12 detoxification and rehabilitation centers were established in different districts for the treatment and rehabilitation of drug addicts. These centers were established at Peshawar, Mardan, Charsadda, Nowsehra, Swabi, DI Khan, Karak, Kohat, Malakanad, Swat, and Dir Lower. Under drug-free Peshawar programs, he said addicts of Niswar were also rehabilitated. Imran Shah underlined the need for mass awareness campaigns through electronic, print, and social media, besides the active role of religious scholars and civil society to protect people from the hazardous effects of naswar.