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? 

http://cancerpreventionresearch.aacrjournals.org/content/4/11/1719.full.pdf+html

http://circ.ahajournals.org/content/94/5/878.full

http://www.webmd.com/smoking-cessation/features/addicted-to-nicorette

https://quitsmokingcommunity.org/nicotine-gum-side-effects-stories/

Myths about Snus and smokeless tobacco

The new tactic of the tobacco companies is to promote smokeless tobacco and snus as a way to quit smoking but those forms of tobacco are dangerous too. Here are some myths taken from: http://oralcancernews.org/wp/

Debunking the myths
Myth: Smokeless tobacco products are a safe alternative to tobacco smoking.
Fact: Here is the bottom line–smokeless is not harmless. The list of serious illnesses connected to any form of smokeless tobacco is almost too long to print, but includes mouth cancer, cancer of the pancreas, tooth loss, and bone loss around the roots of teeth.

Myth: Smokeless tobacco contains less nicotine than cigarettes.
Fact: The amount of nicotine absorbed from a can of spit tobacco is equal to the amount delivered by three to four packs of cigarettes. Nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco than from cigarettes. Also, the nicotine stays in the bloodstream longer.

Myth: Nicotine and all the other poisons disappear when you spit out the tobacco.
Fact: When chewers place snuff or smokeless tobacco in their mouth, cheek, or lip, they give nicotine a free pass to do its nasty thing. A high dose of nicotine enters the bloodstream and is then carried throughout the body. It takes its toll on many parts of the body, including the heart and blood vessels, hormones, metabolism, and brain.

Myth: A little dip or chew won’t hurt–it’s a harmless habit!
Fact: Even a little smokeless tobacco has enough nicotine in it to get a user hooked, if he keeps using it. Smokeless tobacco contains nicotine, the same drug that makes cigarettes addictive. Holding an average size dip or chew in the mouth for 30 minutes delivers as much nicotine as about three cigarettes. Some smokeless tobacco users sleep with it in their mouths so they keep getting nicotine through the night. That’s an addiction, not a habit.

Myth: Smokeless tobacco use will improve your social and romantic life.
Fact: Just the opposite! Chewing and dipping carry a heavy social price, especially when it comes to dating. Bad breath, ugly gum disease, and stained teeth are universally unappealing. The bulging cheeks, gunk stuck in the mouth, and spitting required by most smokeless tobacco is hardly date-bait. Surgery for oral cancer can result in removal of parts of the face, tongue, cheek or lip, a difficult scenario for a great love connection.

Myth: Americans are getting the message that smokeless does not equal harmless.
Fact: If grades were given for this sort of thing, the Nation’s spit tobacco grade would be a barely passing grade of “D.” Rates of spit tobacco use by high school males are high. Nationally, about one in seven high school males currently use spit or smokeless tobacco products, and in some states that number is one out of four.

For the total Department of Defense male population, the rate of smokeless tobacco use is 21.6 percent, significantly exceeding the rate in the general population.

Myth: If you spit for five years or less you won’t get cancer or heart disease.
Fact: Research reported at the Mayo Clinic and other well-respected organizations indicates that any amount of smokeless tobacco use is dangerous, regardless of whether it’s used for a few years or a decade. Smokeless tobacco users have a greater risk for oral cancer than non-users. Oral cancer can form in as little as five years of regular use.

Myth: Smokeless tobacco is easy to give up–you can quit any time you want to.
Fact: Since smokeless tobacco contains nicotine, it’s as addictive as a cigarette, and users will experience the same withdrawal symptoms. These are usually strongest the first week after quitting. The worst is over after two weeks.

Is Harm Reduction the New Way to Quit Smoking?

Some health care professionals are encouraging smokers to switch to smokeless tobacco or snus as a way to quit smoking because smokeless is less harmful than the combustion and inhalation of smoke. I consider harm reduction the same as wearing a seatbelt--how often do you need to wear one?? Most would say everyday but really you only need a seatbelt when you get into an accident. If you don't get into an accident, then you don't need a seatbelt. The problem is that we don't know when that accident is ging to happen so we prepare for the worse by wearing seatbelts everytime we drive. Same with the use of any tobacco products--Wouldn't it be nice if we knew what our genetic weak link is, so that we could avoid those substances and environmental hazards that will increase our personal risk. What it boils down to is what is the risk an individual is willing to take. By switching to smokeless, there may be a reduction in some types of cancers but there is an increased risk for oral cancers. Regardless of the form, tobacco is a dangerous product. As a 20 year cancer thrivor (I did much more than just survive), I choose to eliminate as many known risks as I am able. The use of addictive substances usually is to satisfy an emotional or spiritual need. I advocate addressing the emotional or spiritual need rather than the use of addictive substances. The tobacco companies used this same philosophy when they came out with low tar and nicotine cigarettes but we found out that they didn't reduce the health risks at all but millions of smokers switched instead of quitting altogether and they health suffered for it. So instead of switching to smokeless, the best thing for you health is to embrace a tobacco free life and enjoy your better health.