Long term nicotine use

Why do people smoke? Although they initially try it out of curiosity and often under social pressure, people generally smoke because they enjoy the subtle psychological effects of the drug, nicotine. These include mild stimulant effects, helping the smoker to focus their attention, curbing appetite, and giving a subtle feeling of satisfaction that is only occasionally strong enough to be described as giving a slight “high”. Of course after smoking regularly the smoker’s brain becomes used to nicotine, and unpleasant withdrawal symptoms and cravings are experienced when the smoker goes without for more than a few hours.

Now all of these effects are effects of nicotine and are part of the process of becoming addicted to nicotine. This pattern would not be much more of a big deal than drinking caffeinated coffee or tea, were it not the case that with smoking the smoker is exposed to inhalation of thousands of toxic chemicals in the smoke. It is these other toxins in smoke that cause the vast problems for smokers’ health.

So if smokers smoke for the effects of nicotine, but are killed by the toxins in the smoke, why not just give them all the nicotine they want, free from all the harmful effects of the smoke? Actually this is not as crazy as it sounds, and this approach to harm reduction, sometimes called “nicotine maintenance” has been proposed before.

The main idea with nicotine maintenance is for someone who feels addicted to smoking tobacco to be able to stay off smoking by switching to a healthier nicotine delivery product. Right now the most common version of this with long term users (apart from smokeless tobacco users) is the use of nicotine gum long term. Now it is better to quit using all nicotine products completely than to continue the addiction in the long term. But it is much better to continue using nicotine in a safer smokeless form (e.g. nicotine gum) than to go back to smoking because of cravings for nicotine.

We need to be clear that nicotine is not harmless. It is harmful to the unborn child of a pregnant smoker, and when used over a period of decades it affects the cardiovascular system, and may increase risks of a fatal heart attack. But nicotine on its own is not nearly as harmful as smoking…and likely avoids over 95% of the harms from smoking. So when you try a nicotine replacement product for smoking cessation, think of using for as long as it takes for you to be confident that you will not go back to cigarettes.

Labels: jonathan foulds, nicotine maintenance, nicotine nasal spray smoking cessation, NRT

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