Safety of nicotine: the smoke causes the harm

A study was published in the journal, Nicotine and Tobacco Research by Dr Stephanie Smith of the Robert Wood Johnson Foundation and Princeton University, showing that the public still has major misunderstandings about the harmfulness of nicotine and tobacco products. She asked over 400 students from John Hopkins University to compare the harmfulness of 11 nicotine delivery products (ranging from a “light” cigarette to a nicotine patch) with the harmfulness of a regular cigarette.

20% perceived the nicotine patch to be as harmful as a regular cigarette, as did 24% for nicotine gum and 53% for the nicotine inhaler! Of course in reality all of these products are far less harmful than smoking cigarettes as they each deliver only medicinal nicotine, without the 4000 other chemicals delivered by a cigarette.

On the other side, over 35% believed that “light” cigarettes are less harmful, and of course they are not. Perhaps the biggest misperception was that 89% incorrectly perceived “dip” or chewing tobacco to be as harmful or more harmful than regular cigarettes. In reality smokeless tobacco is much less harmful than smoking (it doesn’t cause lung cancer or respiratory disease and has lower risks of oral cancer than smoking).

Its important for people to understand that most of the harm from tobacco is caused by inhaling smoke into the lungs. This causes thousands of toxic chemicals to be deposited into the lungs – one of the most important and sensitive organs in the body. Almost anything that doesn’t involve inhaling smoke is bound to be less harmful. In the case of nicotine replacement medications, the only drug involved is medicinal nicotine. Now nicotine itself doesn’t cause lung cancer or respiratory diseases, and when taken by an ex-smoker for a relatively short period really doesn’t do any harm at all. For a smoker using NRT as a smoking cessation aid it has the simple advantage that it doesn’t require taking a new drug – just taking the same one the smoker has taken every day for years – without the 4000 other toxic chemicals. Taken in this way, nicotine has a good safety profile, and an excellent record of helping smokers to successfully quit smoking. (Main exception here is effects on the unborn child if used by a pregnant woman).

One of the big problems caused by people mistakenly believing that nicotine is very harmful is that even if they try NRT they tend to take as little as possible for as a brief a time as possible. In fact the evidence shows that the more you take and the longer the duration, the more likely you are to succeed in stopping smoking. So for a typical pack-a-day smoker combining the nicotine patch with 10 pieces of 4mg nicotine gum for over 12 weeks would likely be much better than just taking the patch for a few weeks. This is partly because these NRT medications deliver lower blood nicotine levels than cigarettes.

So the main message here is that if you are a smoker, it’s the smoke that will kill you, not the nicotine.
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.