Nicotine Replacement

[Dr_Hurt]

Nicotine replacement has gotten a ‘bad rap’. People mistakenly think that nicotine causes cancer. It does not. Other chemicals in tobacco and tobacco smoke cause cancer – not nicotine. People mistakenly fear that nicotine replacement can cause heart problems. It does not. Cigarette smoking causes heart attack, stroke, and numerous respiratory problems - not nicotine. People are concerned about becoming addicted to nicotine replacement without realizing that cigarettes are in a league of their own when it comes to addiction. The cigarette is the best drug delivery device for nicotine ever invented. Not even an intravenous infusion can deliver nicotine more effectively than a cigarette. The cigarette is designed to addict those who use it, and as many of you know, it does the job all too well.



Nicotine replacement is a safe and effective method for stopping smoking. It doubles the likelihood that a person will be able to stop smoking in a given quit attempt. There are five different nicotine replacement medications: nicotine patch, gum, lozenge, inhaler, and nasal spray. The U.S. Public Health Service recommends that medication be used in every attempt to quit smoking, unless there is a specific medical reason to not use medication. Learn more about the medications that can help you succeed on BecomeAnEX.org. It works, it’s safe, and it will double your odds of stopping smoking. Why not use it?

Dr. Richard D. Hurt is an internationally recognized expert on tobacco dependence. A native of Murray, Kentucky, he joined Mayo Clinic in 1976 and is now a Professor of Medicine at its College of Medicine. In 1988, he founded the Mayo Clinic Nicotine Dependence Center and since then its staff has treated over 33,000 patients for tobacco dependence. Send your questions directly to Dr. Hurt at AskTheExpert@becomeanex.org

[barbara42]

how can it be so safe, when it is so darn addictive, and in any other way, nicotine can and will kill you. that is what i hear.

[hwc]

Since nicotine is safe, is the US Public Health Service, the Mayo Clinic, Become an EX, or Dr. Hurt prepared to say that ex-smokers could or should use pharmaceutical nicotine indefinitely as a permanent replacement for cigarette nicotine?

[edith2]

I applaud anyone that can quit cold turkey. I quit cold turkey three times. But this time, since I smoked non-stop for 26 years, I decided to use the lozenges. They were a great help. I still went through the physical and mostly mental withdrawals and hated the beginning of my quit. But it was worth every moment. This is the longest I've ever gone without smoking since I tried my first cigarette in 1969. This time I don't like being around smoke or the awful smell of it. I love being a non-smoker.

[Denise28]

I believe there is no right way to quit. We are human and different. Most people are afraid of the first few days/week to quit so if that is what would take to get someone started, then so be it. It is only temporary. I think everyone should quit anyway that will work for them. As long as you get off the stinkarettes, who cares how you did it.

[cindywilson]

did they not ban nicotine as an insecticide, because it was not safe?

[hwc]

Nicotine was banned for use as an insecticide in the United States in 1992. It may still be available in other parts of the world. I think the big safety issue was that it absorbs through the skin, so coming in contact with the liquid nicotine could result in poisoning. Drinking it would be extremely fatal.

I understand that the big CIA plot to kill Castro with a poison pen back in the Kennedy days apparently used liquid nicotine as the poison!

Here's the complete database for the chemical properties of nicotine published by the International Programme on Chemical Safety:

Link to Nicotine reference page

[hwc]

The U.S. Public Health Service recommends that medication be used in every attempt to quit smoking,

On the subject of "bad raps", does it get much worse that the goverment officially advising doctors and quitlines and government sponsored websites such as this one to actively discourage smokers from trying to quit unless they purchase pharmaceutical company products? Considering that 90% of the ex-smokers in the United States successfully quit without purchasing drugs and considering that there is no cost and no risk associated with not taking a drug, this seems like the real "bad rap".

[JonesCarpeDiem]

If the nicotine replacement is a replacement, why keep reminding yourself of what it feels like to smoke?

Seems like an endless circle.

I know people who used the gum and were on it years after they quit.

Isn't that wonderful?

[hwc]

"Isn't that wonderful?"

1 out of 14 people in nic patch clinical trials was quit at six months. Assuming that each of those 14 quitters buys 12 weeks of nicotine patches, that's $3900 in product sales for each successful NRT quitter. What's that? The equivalent of selling an entire houseful of major appliances and TVs?

That's pretty wonderful for the people sellin' the product, especially there's a near limitless supply of quitters and since 13 of the 14 customers will probably be repeat customers in the future.

[hwc]

BTW, the reality is that the one thing that has proven time and time again to significantly increase quit rates in the real world is education and support. NRT, cold turkey, whatever. Invest in education and support during your quit and your real world odds of success go through the roof. Unassisted, the quit rates for every approach (NRT, cold turkey, anti-depressants, etc.) are all under 1 in 10 attempts.

In a way, focusing on the quitting method is addressing the wrong question. Everyone agrees on the four steps to a successful quit and everyone agrees that education and support gives the best chance of success.

[gmvirtual_gina]

ahhhhh I am so late in this post to this blog that my fellow friends began arguing one side of what I was thinking.....here is the other side that concerned me about Dr. Hurts blog.....and I know he didn't intend for people to see it this way - but we all know our NicoDemon and how it works!!!

here is my 2 cents:
OK, I'm likely the only dingDong that read some of this message in a twisted fashion and I feel compelled to make sure if there are other twisted people out there like me.....this disclaimer to Dr. Hurts blog is important:

Yes Nicotine replacement therapy is helpful to quitting smoking. BUT Dr. Hurt is not condoning the use of smoke free nicotine addiction devices or sources....such as the ever popular e-cig that puts nicotine into your system.....or let's not forget that "chew" is also bad, despite the lack of "smoke" it comes with it's own form of cancer and issues.

So - if using nicotine therapy to QUIT smoking to aid in quitting - AWESOME. But if you are twisted and took Dr. Hurt's blog as a way of letting your addiction or the ever popular NICOdemon tell you getting your nicotine in your system......that is incorrect! Don't do it!! If you are a smoker and replace your addiction with some other form of nicotine addictive....(e-cig, chew, etc) you WILL eventually go back to smoking cigarrettes....it is just part of the addiction and part of the demon winning!!

[sandra5]

Nicotine gum helped me quit along with education and support from wonderful people here! Long term "gum addiction" just isn't an issue for me. In fact it kind of makes me smile - I like cinammon better!! But seriously, it got me through the first while and that was part of the process....

[gmvirtual_gina]

Sandra, that is great news. I wish I could convince my dad to try something, chantix, gum...something. He is just sooo proud and so afraid to fail - he won't try. I won't be the one to push him either. I am hoping my quit just magically makes him want to ask me someday.....how I did it....and then I will be anxious to show him this great site and let him know - it doesn't matter what method he picks....as long as he PICKS ONE!!!

Yay us!!!! Another smoke free DAY!!!

[debbie53]

With commitment, education and great support, both here at EX and in my 3-D world and the NRT Patch's, I've been successfully quit for a bit over a year now. I do know those that are addicted to the patch and some to the gum, but they also have not educated themselves. They still believe it to be a "nasty habit" and refuse to accept it being an addiction! They also have never made a REAL commitment to quitting. So I see both sides here. I do believe the NRT's work, but ONLY along with education, support and true commitment. I do think that rather than the NRT's be over the counter, they might consider making them prescription, like the Chantix. Then maybe, it can be better controlled.
Really and truly it's about WHAT WORKS!!! If NRT's work for you, then by all means use them. If cold turkey is your method of choice, then go for it! WHAT EVER WORKS!!!!!

[hwc]

I'm in favor of permanent use of pharmaceutical nicotine instead of smoking, even if you never stop using the gum or patch. Clearly, breaking the nicotine addiction is the prefered choice, but being addicted to the gum is far preferable to smoking.

I think that's where the marketing of these products is heading. The drug companies are moving that direction, slowly but surely. You can see it in their adverstising. And, they are starting to fund places like the Mayo Clinic to do "harm reduction" studies -- harm reduction being the buzz word (like nicotine replacement) for reduced danger from permanent use of nicotine products compared to smoking. You can see the trend in the presentations to the smoking cessation conferences with a lot of studies on long-term use of nicotine. Maybe by the next Surgeon General's report, the drug companies can get the government to authorize long term use and recommend it two reports from now. That is a huge business -- direct competition with the tobacco companies for the full market.

[hwc]

BTW, the e-cigs are history. The FDA has barred the import of the cigarettes and the supplies are drying up. I really hate the things so I don't really care, but it is kind of raw deal. The e-cigs are essentially the same as the nicotine inhalers sold in every drug store. I guess the e-cig companies couldn't afford to line Congress' pockets like pharma and tobacco can....

[jan__tx]

I see both sides but I think the Dr. knows best - I don't see MD behind my name.

[cory7]

i know i wouldn't have been able to quit smoking without the patch and the gum. however, i do know that i also needed EX along with education, support and true commitment. praying also helped me.

[david-hibling]

My two euros worth!!!! I failed to quit using patches - I had to do it cold turkey - but my sister quit a 60 day habit three years ago and swear she would not have done so without patches - I think the danger and its perhaps what happened to me is that I decided I wanted to stop and thought using patches would be some sort of miracle cure and within a week of using them would not want a cig - so I did not educate myself in my quit - it was educating myself about the power of addiction caused by smoking the freed me - i agree with Debbie whatever works is whatever works but with education always - have a good non smoking day everyone!!

[hwc]

David:

It's an insidious danger. Not only is it a temptation to want something to quit for you, but there's also a risk of believing that you can't quit without something. Both of those mental outlooks tend to undermine a successful quit. IMO, it really helps to believe that you can quit smoking and it's even more important to draw strength and motivation from doing it.

If anyone is unsure of how to quit after reviewing the nature of nicotine addiction and the options for qutting smoking, I would recommend trying the patches and the gum first.

[linda53]

thank you i have used lozenges for 23 weeks before i gradually went to 1 then to none this is my 7th and last quit thanks to them im 58 and smoked on and off for 44 years god bless you thanks for you peace and love the ar. hippie

[JonesCarpeDiem]

ok





its the loose socks

[jan__tx]

lol jones:)

[callmebreeze]

There is such an anti-drug backlash in this country (America), which probably comes in part from our government's foolish "war on drugs" mentality of the past couple of decades. Why should anyone care if somebody else wants to be addicted to nicotine? i can partly understand the compulsion to outlaw smoking, as that drug delivery system certainly is not user-specific and does "bleed-over" with second-hand smoke. However, this really only makes sense if the person proposing the banning of smoking also proposes a total ban on gasoline-powered automobiles, and they are infinitely worse for our lungs then someone's second hand smoke. IMO, if you want to ban cigarettes but still drive a car, you are a serious hypocrite.
But I digress. Again, i wonder - why do people want to stop other people from taking drugs? Personally, i have no desire to be addicted to any substance, so nicotine is out of my life. But why would I care if someone else wants to use it? I remember that it certainly did the job I asked it to do, just like Tylenol does. Speaking of which, someone was talking about how dangerous nicotine is, and there was a warning about it which mentioned a concentration of forty percent! I would call that an overdose in anyone's book, but that's a problem with any drug, including Budweiser. (Alcohol-induced hazing deaths?)
Here is an overdose description from a poison control website
"Overdose of this drug causes liver damage with symptoms that include loss of appetite, tiredness, nausea and vomiting, paleness, and sweating. The next stage of symptoms indicates liver failure and includes abdominal pain and tenderness, swelling of the liver, and abnormal blood tests for liver enzymes. In the last stage of this poisoning, liver failure advances and the patient becomes jaundiced , with yellowing of the skin and whites of the eyes. They may also experience kidney failure , bleeding disorders , and encephalopathy (swelling of the brain). "
Whoa. Better ban that Tylenol.

To be honest, I very, very rarely use any drug, including Tylenol, but I couldn't care less if other people want to use them. I also enjoy helping people break the nicotine/smoking habit, but I want to do it with honesty, not some overblown fears of nicotine. I remember when I was in 7th grade or so, the government told me smoking pot would at the very least ruin my life, probably lead me into heroin, and possibly kill me.
30 years and quite a few joints later, I'm an honorably discharged vet, we're running a company making six figures, I'm writing a book, waiting for grandchildren, and definitely NOT hooked on heroin. They lied to me, and I've never quite trusted them since. I won't do that to people about smoking. Just quit because it's not good for you. Period, end of sentence.

[JonesCarpeDiem]

hey
nicotine is expensive, unless you own the company. Couldn't that money be used for something more constructive than feeding the receptors in your brain forever? Period, end of sentence

[JonesCarpeDiem]

Its like taking money from your family

[JonesCarpeDiem]

maybe grow your own and set up a nicotine refinery?

[larry13]

I think NRT *should* get a bad rap, but for different reasons. There's a book you all should read: "Easy Way to Stop Smoking" by Allen Carr. There's even a community on this website of people who used his book to escape from the nicotine trap. Here's an excerpt regarding NRT:


In particular avoid any product that contains nicotine, whether it be gum, patch, nasal spray or the
latest gimmick, the inhalator which is similar to a plastic cigarette. It is true that a small proportion of
smokers who attempt to quit using nicotine substitutes do succeed and attribute their success to such
use. However they quit in spite of their use and not because of it. It is unfortunate that many doctors
still recommend nicotine replacement therapy (NRT),
This is not surprising because, if you don't fully understand the nicotine trap, NRT sounds very
logical. It is based on the belief that when you attempt to quit smoking, you have two powerful
enemies to defeat:
1 To break the habit.
2 To survive the terrible physical nicotine withdrawal pains.
If you have two powerful enemies to defeat it is sensible not to fight them simultaneously but one
at a time. So the NRT theory is that you first stop smoking but continue to take a nicotine
replacement. Then, once you have broken the habit, you gradually reduce the supply of nicotine,
thus tackling each enemy separately.
It sounds logical, but it is based on the wrong facts. Smoking is not habit but nicotine addiction
and the actual physical pain from nicotine withdrawal is almost imperceptible. What you are trying
to achieve when you quit smoking is to kill both the little nicotine monster in your body and the big
monster inside your brain as quickly as possible. All NRT does is to prolong the life of the little
monster which in turn will prolong the life of the big monster.
Remember EASYWAY makes it easy to quit immediately. You can kill the big monster
(brainwashing) before you extinguish your final cigarette. The little monster will soon be dead and
even while it is dying, will be no more of a problem than it was when you were a smoker.
Just think, how can you possibly cure an addict of addiction to a drug by recommending the same
drug? One eminent and highly respected doctor has actually stated on national television that some
smokers are so dependent on nicotine that if they did quit they would have to take a nicotine
substitute for life. How can a doctor get so confused as to believe that the human body is not just
dependent upon food, water and oxygen, but on a powerful poison?

[JoAnne5-14-2008]

I believe that the best way for a person to quit, first is to make up their mind that they've had enough of being a smoker and set their mind on becoming a non-smoker. A person can slow down on how many cigarettes they smoke and eventually quit. Why replace one drug with another drug. They all have side effects. Just because it is recommended by a DR. does not make it safe. Please do your own research before you decide to use a nicotine replacement. PLEASE READ THE FINE PRINT AND THE WARNINGS. Here's to becoming smoke free and healthy. YOU CAN DO IT.

[larry13]

Beware of cutting down.
Many smokers resort to cutting down either as a stepping-stone towards stopping or as an attempt to control the little monster, and many doctors and advisers recommend cutting down as an aid.

Obviously, the less you smoke the better off you are, but, as a stepping-stone to stopping, cutting down is fatal. It is our attempts to cut down that keep us trapped all our lives.

Usually cutting down follows failed attempts to stop. After a few hours or days of abstinence the smoker says to himself something like, 'I cannot face the thought of being without a cigarette, so from now on I will just smoke the special ones or I will cut down to ten a day. If I can get in the habit of smoking ten a day, I can either hold it there or cut down further.'

Certain terrible things now happen,
1 He has the worst of all worlds. He is still addicted to nicotine and is keeping the monster alive not only in his body but also in his mind.
2 He is now wishing his life away waiting for the next cigarette.
3 Prior to cutting down, whenever he wanted a cigarette he lit one up and at least partially relieved his withdrawal pangs. Now, in addition to the normal stresses and strains of life, he is actually causing himself to suffer the withdrawal pangs from nicotine most of his life. So he is causing himself to be miserable and bad tempered,
4 While he was indulging himself, he didn't enjoy most of the cigarettes and he didn't realize he was smoking them. It was automatic. The only cigarettes that he imagined he enjoyed were after a period of abstinence (e.g. the first in the morning, the one after a meal, etc,).

Now that he waits an extra hour for each cigarette, he 'enjoys' every one. The longer he waits, the more enjoyable each cigarette appears to become because the 'enjoyment' in a cigarette isn't the cigarette itself; it's the ending of the agitation caused by the craving, whether it be the slight physical craving for nicotine or the mental moping. The longer you suffer, the more 'enjoyable' each cigarette becomes.

[hwc]

The longer he waits, the more enjoyable each cigarette appears to become because the 'enjoyment' in a cigarette isn't the cigarette itself; it's the ending of the agitation caused by the craving, whether it be the slight physical craving for nicotine or the mental moping. The longer you suffer, the more 'enjoyable' each cigarette becomes.

Sorry, I just had to repeat this part of the quote. In bold, for emphasis. Carr perfectly describes only true enjoyment we ever get from cigarettes -- relieving the craving for nicotine.

[sandee]

This was SO TRUE for me on my other quits..I did it for years..and smoked more each time I gave in.
I did enjoy them more and more each time. Got rid of the craving, and have been doing great for over a year. Cold turkey.

[callmebreeze]

"Couldn't that money be used for something more constructive...?"
Sure. So could money spent on cable television, ice cream, building model cars, or pretty shoes. But who am I to tell someone how to spend their money? And we don't have the right to tell another free adult not to use a legal drug.

[JonesCarpeDiem]

So could money spent on cable television, ice cream, building model cars, or pretty shoes.

There are so many people who don't have the money for any of these things and yet they smoke while their kids may be going without.
Yes maybe its a moral judgement but I say its a selfish habit that gives you no room for anything but wanting more.

[JoAnne5-14-2008]

Well, cutting down and eventually not have the desire for cigarettes worked for me. It may work for someone else too.

I have been quit for 1 Year, 1 Week, 4 Days, 12 hours, 9 minutes and 15 seconds (376 days). I have saved $423.56 by not smoking 1,882 cigarettes. I have saved 6 Days, 12 hours and 50 minutes of my life. My Quit Date: 5/14/2008 8:15 PM

[larry13]

Before we start the nicotine chain, our bodies are complete. We then force nicotine into the body, and when we put that cigarette out and the nicotine starts to leave, we suffer withdrawal pangs - not physical pain, just an empty feeling. We are not even aware that it exists, but it is like a dripping tap inside our bodies. Our rational minds do not understand it. They do not need to. All we know is that we want a cigarette, and when we light it the craving goes, and for the moment we are content and confident again just as we were before we became addicted. However, the satisfaction is only temporary because, in order to relieve the craving, you have to put more nicotine into the body. As soon as you extinguish that cigarette the craving starts again, and so the chain goes on. It is a chain for life - UNLESS YOU BREAK IT.
The whole business of smoking is like wearing tight shoes just to obtain the pleasure you feel when you take them off. There are three main reasons why smokers cannot see things that way.

1 From birth we have been subjected to massive brainwashing telling us that smokers receive immense pleasure and/or a crutch from smoking. Why should we not believe them? Why else would they waste all that money and take such horrendous risks?

2 Because the physical withdrawal from nicotine involves no actual pain but is merely an empty, insecure feeling, inseparable from hunger or normal stress, and because those are the very times that we tend to light up. we tend to regard the feeling as normal.

3 However the main reason that smokers fail to see smoking in its true light, is because it works back to front. It's when you are not smoking that you suffer that empty feeling, but because the process of getting hooked is very subtle and gradual in the early days, we regard that feeling as normal and don't blame it on the previous cigarette. The moment you light up, you get an almost immediate boost or buzz and do actually feel less nervous or more relaxed, and the cigarette gets the credit.

It is this reverse process that makes all drugs difficult to kick. Picture the panic state of a heroin addict who has no heroin. Now picture the utter joy when that addict can finally plunge a hypodermic needle into his vein. Can you visualize someone actually getting pleasure by injecting themselves, or does the mere thought fill you with horror? Non-heroin addicts don't suffer that panic feeling. The heroin doesn't relieve it. On the contrary, it causes it. Non-smokers don't suffer the empty feeling of needing a cigarette or start to panic when the supply runs out. Non-smokers cannot understand how smokers can possibly obtain pleasure from sticking those filthy things in their mouths, setting light to them and actually inhaling the filth into their lungs. And do you know something? Smokers cannot understand why they do it either.

[callmebreeze]

"...maybe its a moral judgement..."
That's exactly what it is, and I only judge myself. I was raised Christian and remember John 8:2-11, the parable of the adulteress. Does "He that is without sin among you, let him first cast a stone at her" ring any bells?

On the other hand, if someone is actually starving a child, as you may be implying, the child should certainly be removed from the parents and probably criminal charges brought.

[JonesCarpeDiem]

well I can't think of any smoker I know who was not or is not controlled by their need to smoke. They may not realize it or want to admit it but they devote their lives to it.

[nicole]

i know that i wouldnt have been able to quit had it not been for the gum. I know that the recommended usage was for a certain time then step down to the lower amount for a certain time and i used it for 4 days....then as i felt the urge for a cig and honestly i havent had the nic gum since like 2 months into my quit. so i guess if nrts are so bad than my quit should be considered a failure i guess....... i just didnt quit right i guess.... although i have been smoke free for almost 5 months.

[callmebreeze]

"... can't think of any smoker I know who was not or is not controlled... they devote their lives to it..."
That is a very good point, especially in the past 10-15 years with all the restrictions and the massive penalty taxes placed on smokers. Trying to find a place to smoke or afford the smokes required MUCH more effort the last few years that I smoked than when I started. When we could smoke anywhere except gas stations and elevators and when we weren't financing America's debt with out cigarette taxes, it wasn't such a hassle and didn't require much "devotion". It was just part of life back then.

[nicole]

i dont know if mine was perceived wrong. I AM defending NRTs to the point of using to quit smoking. I didnt use it the way the label told me to.... I used it for 4 days then as needed when i felt the urge to smoke, i have not used the gum in over 3 months so.... i am not addicted to smoking or to the NRT. The point i was making is that IMO i dont think NRTs (only the ecig do i not agree with) are bad or wrong to use. I may have been mistaken when i thought that the point of this site was to help people to quit smoking and if the gum helped me, and the patch helped her....and this helped so and so, then the over all goal was reached right? I dont know just my opinion.

[nicole]

i see what your saying. I didnt understand it that way lol. I see what youre saying now. I have to give credit to the nrt to help me. LOL If i could have done it by myself it would have been done a long time ago lol. My friend and i had a debate a few months ago about the "poor" smoker deal. She is a social smoker that can smoke one day and not the next. I am an addict i cant do that...but we were talking about the smoking ban and that type of thing. We agreed to disagree. LOL.

[Dr_Hurt]

hwc - If the choice is between smoking and using a nicotine replacement product, yes continue using medicinal nicotine as long as you need to stabilize your abstinence from smoking. When I am asked the question, ”How long do I need to use this medication to stop smoking” the answer I give is: “As long as it takes” The fact is that very few people continue to use nicotine replacement for more than a few months. The concern is that fear of nicotine replacement has kept many people smoking cigarettes: a product that causes over 5 million deaths worldwide every year.

Since nicotine is safe, is the US Public Health Service, the Mayo Clinic, Become an EX, or Dr. Hurt prepared to say that ex-smokers could or should use pharmaceutical nicotine indefinitely as a permanent replacement for cigarette nicotine?

[Dr_Hurt]

Hi Barbara - The mechanism by which a drug is delivered is a big factor in determining the addictive potential of a substance. The cigarette delivers nicotine very rapidly to the brain in very high doses, much more quickly then medicinal nicotine. Go to becomeanex.org and search out my video sessions on “re-learn Addiciton”. The nicotine patch, because it delivers nicotine in a steady state has virtually no addictive potential. The gum, lozenge, inhaler, and nasal spray have some potential for addictive use. However, they are relatively extremely safe when compared with cigarettes and are effective in helping people to stop smoking.

how can it be so safe, when it is so darn addictive, and in any other way, nicotine can and will kill you. that is what i hear.

[Dr_Hurt]

Hi Cindy Wilson - I think you can still purchase nicotine sulfate which is an insecticide. Certainly nicotine in high doses can be toxic. Nausea is the most common sign that a person may be using too much nicotine. People who smoke usually have higher levels of nicotine than people using nicotine replacement medicines; but the people who smoke also take in more than 4000 other chemicals, many of which can kill, so that they can consume the nicotine that is in the cigarette.

- did they not ban nicotine as an insecticide, because it was not safe?