Nicotine Is Not the Problem

Smoking and Nicotine Use Are Two Different Issues

In the United States, it is estimated that approximately 500,000 Americans die of smoking-related diseases each year, a number that hasn’t wavered much over the last decade, even though smoking rates have consistently dropped year over year. During the same period, a wide array of new products that deliver nicotine without combustion (smoke) entered the marketplace. The presence of these products has been the source of much debate in terms of impact on public health, potential unforeseen health risks that might arise from long-term use of these products, and their role in reducing the health burden associated with smoking cigarettes.

One clear aspect of these novel products is that they deliver nicotine in a manner that carries less risk compared to smoking cigarettes. Whether in the form of electronic cigarettes (ENDS, also referred to as vapes or e-cigarettes), heated tobacco products, or oral nicotine (either tobacco or tobacco-free nicotine pouches), the harm associated with new nicotine delivery systems is much lower than combustible cigarettes. Unfortunately, there have been some conversations about the risks associated with these delivery systems, which have clouded the public’s perception of the wide-ranging benefits of using these products instead of smoking.

One major issue is how the potential health benefits of switching from cigarettes to these novel products are obscured, with messaging from major health organizations often equating the risks of nicotine use to those of smoking. This inaccuracy has confused both consumers and medical professionals, since migrating from cigarettes to reduced-risk nicotine products is the single most effective pathway to better health for smokers who choose to continue to use nicotine products or have been unable to quit smoking using traditional approaches.

Effects of Nicotine Use

In a recent testimony in the U.S. House Oversight Committee, Food and Drug Administration Commissioner Robert Califf stated that there were no health benefits associated with using nicotine. Unfortunately, the scientific literature does not agree with this perspective. In fact, nicotine has been found to have potential benefits in preventing Parkinson’s and Alzheimer’s disease. Studies on animals suggest that nicotine can protect against neuronal degeneration, improve motor abilities, and enhance cognitive performance. Additionally, research indicates that nicotine intake may increase the processing speed of complex tasks in individuals with Parkinson’s. Nicotine also has been shown to have a positive impact on memory by acting on regions of the brain involved in visual attention and attention processing. This is probably due to nicotine acting as a neuroprotective agent by stimulating nicotinic cholinergic receptors in the brain.

Furthermore, nicotine has been shown to promote wakefulness by enhancing brain activity and inducing alpha brainwave activity. This leads to improved attention, alertness, and creativity. The drug also affects various areas of the brain related to arousal and motor activation. Moreover, trials on animals and humans have demonstrated that nicotine can promote weight loss by suppressing appetite. It also improves insulin sensitivity and blood sugar levels.

Studies also demonstrate that nicotine patches can have a positive effect on ulcerative colitis by reducing inflammation in the gut lining. Nicotine provides relief from inflammatory bowel disease and has been shown to stimulate the body to enhance the growth of blood vessel capillaries and tissues. It promotes tissue repair and accelerates healing processes when applied topically in low concentrations through a nicotine patch.

Nicotine Addiction and Dependency

Extensive amounts of research and debate focus on nicotine addiction. Some studies challenge the common belief that nicotine is highly addictive. For example, researchers have proposed that reducing nicotine levels in cigarettes could decrease their addictive properties. They suggest that when nicotine levels are very low, cigarettes become significantly less addictive. Others have argued against the notion that nicotine itself is an addictive drug, questioning the conventional understanding of the “threshold model of nicotine addiction.” Conversely, some have highlighted the widespread acceptance of nicotine as an addictive substance, indicating a prevailing perspective.

Other researchers suggest that the role of nicotine in triggering dopamine release and other neurotransmitters sustains addiction. Additionally, research has outlined the neurobiology of nicotine addiction and stresses the importance of understanding how nicotine creates addiction and influences smoking behavior for effective smoking cessation interventions. These findings demonstrate a complex interaction between nicotine and addiction, involving both neurobiological and behavioral factors.

Yet, when nicotine is evaluated for its abuse likelihood, the drug in isolation is considered to have little influence on establishing addictive traits and consequences that follow addictive behaviors. Some studies have suggested that how the nicotine enters the body has more impact than the dose itself. When administered through the skin, nicotine has been shown to have little abuse risk, and if inhaled via a non-combustible nicotine delivery system, the risk for dependence is still less as compared to smoking. These differences are suggested to be due to the increased absorption through the lungs and faster access to the brain, as well as other contextual cues associated with the act of smoking. However, outside of smoking, the health consequences of nicotine use are very limited.

Risks Associated with Nicotine Use

Nicotine, though not totally benign, is significantly safer to use if delivered in a manner other than combustible cigarettes. Nicotine is not considered to be a carcinogen, and in a healthy adult (one without pre-existing cardiovascular disease risks or who is pregnant), it poses risks at levels similar to the use of caffeine. If an adult chooses to consume any nicotine product, awareness of any potential risks and how different products deliver nicotine should be considered before use. The most risky and harmful manner of consuming products containing nicotine is through the use of combustible products. However, when considering other forms of reduced-risk products, differences in risk should be clearly described. For example, when discussing the potential risk of any nicotine products, scientists have determined that there is a continuum that exists where the most to least risky goes as follows: combusted tobacco products, ENDS and heated tobacco products, smokeless tobacco products, and snus and nicotine replacement therapies.

Summary

Smoking, not nicotine, leads to death. The long-term inhalation of the harmful constituents of smoke causes disease. Though many have conflated smoking and nicotine use as the same problem, there are clear differences that matter when considering the health risks associated with reduced-risk products. Though not completely benign, nicotine carries little risk in healthy adults and may also have properties that positively impact an individual’s cognitive and mood state, as well as general health. In the context of reducing death and disease, it is key that those who strive to reduce the toll of smoking clearly differentiate these characteristics to better inform smokers as to how switching to non-combusted products will have a positive impact on their personal health.

The idea that quitting nicotine use altogether is the only solution to the smoking epidemic is confusing and has prolonged the consequences of smoking-related diseases. There are options for all who choose to smoke that are safer and that deliver similar experiences to a cigarette, with a much lower risk available. The alternative nicotine marketplace is the pathway to saving lives, and the sooner that message is normalized, the faster we will be able to reduce the deaths associated with smoking.