Monday, March 16, 2015

Is Nicotine an Alternative Vice and Should We Prohibit it's Use?

A colleague of mine shared that she had met a man who had quit spit tobacco by switching to nicotine gum. He uses 3 or 4 pieces at a time. He was happy that he quit spit and had no desire to stop using the gum. She wondered what she could say to him about his addiction to nicotine gum. Other colleagues gave her suggestions as to how to get the NRT user to change his behavior but no one really answered WHY he should change his behavior. Here is my thoughts: 

When compared with continued smoking/chewing, there is no question that long term use of NRT is preferable but when you compare it to using nothing, I don't think we really know what the relative long term risk of using medicinal nicotine (see links below). We talk about nicotine being a poison yet---the poison is in the dose.  How harmful are low doses of nicotine over a long term? 

In the FDA webinar this week, a presenter made the statement that he thought that within 10 years, if we could get e-cigarettes properly regulated and manufactured to deliver sufficient nicotine, that we could put the tobacco companies out of business. Wouldn't that be a good thing? The very next day during a different webinar, someone posed the question --"How do we put the e-cig manufacturers out of business?" Is this in a smokers best interest or is tough regulation better? 

With e-cigarettes there are other components in the vapor that need to be studied. But I think the long term use of both in regards to nicotine is similar----NRT was not designed for enjoyment as e-cigarettes are, but people do use nicotine (NRT) for their enjoyment. Is nicotine really the demon we need to be fighting, even though it is addictive? It seems to me that there are some people in tobacco control who want to prevent the use of nicotine for enjoyment in any form regardless of it's relative risk strictly because it is addictive or is it our puritanical nature to deny people its pleasure? If addiction is the only criteria, is that enough to warrant its prohibition and the desire to put e-cigs out of business?

Humans use a variety of substances for enjoyment from alcohol, caffeine, marijuana, and now nicotine. With the invention of e-cigarettes, I see using nicotine as a new (or alternative) vice for some. Should it be our job to stop them? Or is this a futile attempt at prohibition again? Although I'm not really sure we can compare nicotine to any other substance. We want to stop the addiction to heroin, meth, cocaine because of the detrimental health effects but so far we don't see that with nicotine addiction. Years ago the policy at the Betty Ford Center (not sure if this is still in effect) was to deny patients all access to caffeine--but they could smoke. To me this is giving the message that ingesting caffeine is more dangerous than nicotine. We know that nicotine is more addictive than all these other substances but is that reason enough to want to prohibit its use?

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