Wednesday, September 18, 2013

Nicotine Safety

I have asserted for some 20 years that nicotine, while addictive, is otherwise without significant adverse health effects outside of pregnancy.  It is, in other words, safe to consume.  In my 1995 book, For Smokers Only, I compared nicotine to caffeine (here), another addictive drug used safely by millions of people. 

Scientific evidence of nicotine’s safety, however, is hard to document, despite the fact that it is one of the most comprehensively studied drugs.  The problem is that drug safety is primarily established by the absence of adverse effects.  Owing to tobacco prohibitionists’ persistent demonizing of nicotine, only a small number of medical researchers have come forward to express positive views on nicotine safety.

At a 1997 United Nations roundtable on the social and economic aspects of smoking reduction through the use of alternative nicotine delivery systems, nicotine and tobacco experts came to the following conclusions:

"Turning to the long-term use of nicotine replacement, the major causative factors for [tobacco-related diseases] are the carcinogens, carbon monoxide and other toxins contained in tobacco smoke, rather than nicotine per se."

"...long-term use of nicotine replacement appears to be safe and may be necessary for some highly dependent smokers"

"Nicotine per se does not substantively contribute to most of the medical complications of tobacco use...Long-term nicotine use is not of demonstrated harm, with the possible exception of use during pregnancy...Scientific research indicates that nicotine is not a carcinogen."

"There is a widely held misconception that nicotine is implicated in [tobacco-related diseases].  To date, there is still no definitive evidence that nicotine directly contributes to human disease, but several areas of concern remain." (Neal Benowitz, nicotine pharmacologist and member of the FDA Tobacco Products Scientific Advisory Committee)

"The main cause of death with some addictive drugs, e.g. heroin, is exposure to the toxins of the drug delivery system rather than the drug itself; this also applies to nicotine." (Jack Henningfield, tobacco harm reduction opponent and former member of the FDA Tobacco Products Scientific Advisory Committee)

Ken Warner, a well-respected tobacco economist at the University of Michigan, wrote about tobacco harm reduction in Nicotine &Tobacco Research in 2002 (abstract here):

"Although the evidence is not yet definitive, the best scientific judgment to date is that,
outside of pregnancy, long-term use of nicotine, in the doses at which people self-administer it, does not pose substantial risks to health.”  He cited Neal Benowitz’s 1998 book entitled “Nicotine Safety and Toxicity” (available here). 

Finally, Mitch Zeller commented on the spectrum of risks related to various forms of nicotine delivery in a Tobacco Control article published in 2009 (abstract here):

"There is a very pronounced continuum of risk depending upon how toxicants and nicotine, the major addictive substance in tobacco, are delivered. Cigarette smoking is undoubtedly a more hazardous nicotine delivery system than various forms of noncombustible tobacco products for those who continue to use tobacco, which in turn are more hazardous than pharmaceutical nicotine products.  There is potential for an ever-wider range of consumer-acceptable alternatives to the cigarette for smokers who will not otherwise cease their dependence on nicotine."

Zeller, now director of the FDA Tobacco Products Center, acknowledges nicotine’s safety and tobacco harm reduction’s potential.  One hopes that FDA’s regulatory actions will ensure that all Americans are equally well-informed.


Eric Hill said...

Thank you so much for sharing this information Dr. Rodu. The public needs to know that nicotine itself is as harmful as caffeine. There is a lot of hope for smokers with different nicotine replacement products that are available for those wanting to quit. Swedish snus, nasal snuff, and electronic cigarettes for example are great tools.

Anonymous said...

Except that FDA’s Rita Chappelle recently stated “We don’t the public to perceive them (e-cigarettes) as a safer alternative to cigarettes.”

And two weeks ago, CDC Director Thomas Frieden said "Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

In that same CDC press release, FDA's Mitch Zeller was quoted as saying “These data show a dramatic rise in usage of e-cigarettes by youth, and this is cause for great concern as we don’t yet understand the long-term effects of these novel tobacco products,” and

“These findings reinforce why the FDA intends to expand its authority over all tobacco products and establish a comprehensive and appropriate regulatory framework to reduce disease and death from tobacco use.”

Bill Godshall

Anonymous said...

So we're supposed to believe that prescription medication for nicotine addiction, which has been proven to produce suicidal and depressive episodes in patients is safer and more effective than smokeless tobacco? Seems questionable.

--From a former smoker who now uses smokeless.