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Nicotine Is the Reason People Smoke

But It Is Not the Reason That Smokers Die

Smokeless tobacco provides the smoker with satisfying doses of nicotine. Two recent clinical studies show that smokeless tobacco is an effective nicotine substitute for cigarettes.

The New Zealand Study

In 2010 New Zealand researchers published a clinical trial demonstrating that snus is a better cigarette substitute than nicotine gum (1).  After observing smoking patterns and consumption for one (lead-in) week, the researchers gave 63 smokers three different cigarette substitutes, each for two weeks.  The substitutes were Swedish snus (4-gram pouches in three flavors), Habitrol nicotine gum (containing 4 milligrams of nicotine) and a new product called Zonnic (a peppermint pouch containing 4 milligrams of nicotine embedded in microcrystalline beads).

The researchers collected information from the participants about the “acceptability and the willingness of smokers to use” the substitutes.  They asked five questions gauging satisfaction, and they reported that “subjects scored Zonnic and snus more highly than gum for four out of the five…”  All three products significantly reduced craving for cigarettes, and all three “…enabled subjects to reduce their smoking significantly compared with the lead-in week.” 

Participants ranked Zonnic and snus higher than nicotine gum for both quitting and reducing smoking.  “At the conclusion of the study, subjects were asked to rank the three products in order of overall preference. For their first choice, an equal number (40%) chose snus or Zonnic, while 20% chose gum”  This indicates that snus is acceptable to smokers who have no prior experience with oral tobacco.

The study was funded by the Asthma & Respiratory Foundation of New Zealand. 

The South Carolina Study

Researchers from the Department of Psychiatry at the Medical University of South Carolina published a small, but persuasive, study documenting that dissolvable tobacco products “led to a significant reduction (40%) in cigarettes per day, no significant increases in total tobacco use, and significant increases in two measures of readiness to quit, either in the next month or within the next 6 months.” 

The investigators randomly assigned 31 smokers who were uninterested in quitting to receive Ariva or Stonewall, dissolvable smokeless products, or to continue smoking cigarettes.  Smokers were given “minimal instructions on how to use” these products and were “told that there is no safe tobacco product and that the best thing they can do for their health is to quit entirely.”    

The investigators wrote that their findings suggest “that Ariva and Stonewall are effective products to curb withdrawal and craving.”  In other words, these products satisfy smokers.
   
Perhaps the researchers’ most important conclusion was that there is “no evidence that smokeless tobacco (Ariva or Stonewall) undermines quitting. To the contrary, readiness to quit (in the next 1 month and within the next 6 months) significantly increased among smokers who used a smokeless tobacco product relative to those who continued to smoke conventional cigarettes.”

This is important because some opponents of tobacco harm reduction believe that vastly safer smokeless substitutes will “undermine quitting.”  The new research shows that tobacco harm reduction is completely consistent with both the health of smokers and broader public health goals.

The study was funded by the U.S. National Institute on Drug Abuse.

In 2007 the British Royal College of Physicians issued a landmark report on tobacco harm reduction (3).  Its findings were unequivocal: “Compiled by leading experts in the field, this report makes the case for harm reduction strategies to protect smokers. It demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.”

References

1. Caldwell B, Burgess C, Crane J, 2010. Randomized crossover trial of the acceptability of snus, nicotine gum, and Zonnic therapy for smoking reduction in heavy smokers. Nicotine & Tobacco Research 12:179-83, 2010. The abstract is available here.

2. Carpenter MJ, Gray KM, 2010. A pilot randomized study of smokeless tobacco use among smokers not interested in quitting: changes in smoking behavior and readiness to quit. Nicotine & Tobacco Research 12:136-43, 2010. The abstract is available here.

3. Royal College of Physicians, 2007.  Harm reduction in nicotine addiction: helping people who can’t quit.  A report by the Tobacco Advisory Group of the Royal College of Physicians.  London, United Kingdom.  Available here.