Nicotine and Nicotine Replacement Therapy- Fact or Fiction?

The World Health organization describes smoking as an “EPIDEMIC” that will cause 1/3 of all adult deaths world wide by 2020(WHO 1999) and that tobacco kills 5.4million people a year from cancer, heart disease, and other illnesses (WHO 2008).

Indeed Quit (2009) estimate that 17.4% of people in Australia are daily smokers and tobacco use is the largest cause of death and disease in Australia with >15,000 people dying annually.

We also know that many people who smoke would like to quit and that these people are likely to have one or more quit attempts under their belt. Unfortunately, there are still some misconceptions out there about nicotine and nicotine replacement therapy (NRT) which may be preventing people from attempting to quit or correctly using therapy to increase their chances of a successful quit attempt.

A review article in Pharmacist (Vol 25, No12, Dec 2006,pg 969-973) highlights some of these commonly held misconceptions.

Here are some quick myths dispelled –

1. Nicotine is the most harmful ingredient in cigarettes.

Not so, nicotine helps maintain addiction (helps keep people smoking) and is not responsible for tobacco related diseases. It is all the other toxins and chemicals which cause disease. It is not carcinogenic.

2. Nicotine causes cancer.

Again, nicotine is not carcinogenic. There is no clinical evidence associating NRT with a higher chance of developing cancer.

3. Smoking while using NRT is unsafe and increases the risk of heart attack.

Not true. Those smoking while using NRT are advised (when able) to stop smoking to help minimize potential side – effects of high nicotine levels such as nausea/ vomiting and help them achieve their quit goal, not due to increased cardiovascular risk factors.

4. Using more than one form of NRT is unsafe.

More than one form of NRT can safely be used together. In fact using NRT together with behavioral interventions can significantly increase the likelihood of a successful quit attempt. It’s all about finding what is right for you.

5. NRT is as addictive as cigarettes.

Nicotine in cigarettes is highly addictive and has a fast delivery system via smoke. On the other hand, all forms of NRT are delivered at a much slower rate to the body and have almost no (or very low) addiction potential.

6. NRT is just as harmful as smoking during pregnancy.

NRT use is safer than ongoing smoking throughout pregnancy which can lead to lower birth weights, premature birth and increased risk of miscarriage. Once again it is the smoke from a cigarette that has known toxins that are harmful to a foetus. NRT use should be carefully considered for those who are unable to quit using other non- pharmalogical interventions.

7. NRT is just as harmful as smoking while breastfeeding.

There is well documented evidence of the risks to babies exposed to cigarette smoke with the most common one being sudden infant death syndrome. NRT use decreases the exposure to smoke. Nicotine is excreted in the breast milk but the levels of nicotine produced from NRT are low (estimated to be 50 times less than the mothers exposure) and therefore not likely to be hazardous to the breastfed baby.

The article summarizes all the evidence quite nicely in the following statement –

“Using nicotine replacement therapy to quit is always safer than continuing to smoke”.

As they say it is never too late to QUIT.

Lisa