Trading One Nicotine Fix for Another
Even before she gets out of bed in the morning, she’s ready for her first fix.
Eyes closed, sleepy fingers fumbling at the bedside table, she seizes the silver packet, expertly extracts a single white tablet and places it in her mouth.
Ah, nicotine gum.
Dana Yudovin quit smoking 12 years ago, after a quarter-century of puffing a pack a day. But now she’s hooked on the gum, gobbling up a dozen or more pieces a day. Sometimes she sleeps with the gum in her mouth, tucking it into a gap between her teeth where a removable dental bridge usually goes.
Yudovin, 57, of Cambria, Calif., is among a growing number of Americans who have kicked one nicotine habit for another, albeit safer, one.
Nicotine gum was intended as a temporary regimen for smokers as they attempted to wean themselves from cigarettes. But for nearly 10% of those who use the gum to quit smoking, it has become a habit of its own, according to Dr. John R. Hughes, a professor of psychiatry at the University of Vermont Medical School in Burlington who has studied nicotine addiction.
Hughes and other doctors stress that with one exception, there is no evidence that regular use of nicotine gum poses any health risk. The exception is pregnant women, who risk exposing their fetuses to brain-cell loss and other developmental disorders.
In large doses, nicotine can damage the cardiovascular and circulatory systems by raising the heart rate and blood pressure. Taken in the small, slowly delivered doses present in nicotine gum, however, the product “seems to have very few side effects,” said Dr. Neal Benowitz a professor of psychiatry and medicine at the UC San Francisco medical school.
Nicotine gum (which has been available over-the-counter as the brand name Nicorette since 1996 and was recently approved for sale as a generic product also) works by releasing nicotine into the bloodstream through the mucous membranes in the mouth. The amount of nicotine is small compared with the massive rush from a cigarette and is absorbed into the bloodstream much more slowly, but it’s enough to reduce nicotine cravings in smokers trying to kick the habit, said Dr. Jack Henningfield, an associate professor of psychiatry at Johns Hopkins University Medical School in Baltimore. Many doctors, including Hughes, say the benefits of nicotine gum far outweigh the risks. Giving up smoking can add years to a person’s life, while the chance of getting hooked on nicotine gum is fairly small and, for most, free of adverse medical consequences.
Because ex-smokers can use the gum in the same way they once used cigarettes, turning to it when they are stressed or hungry or want to satisfy an oral fixation, researchers speculate that nicotine gum may be more habit-forming than other stop-smoking products, such as patches, that are available over-the-counter.
The U.S. Food and Drug Administration approved nicotine gum for sale as a prescription drug in 1984. Sales of the gum rose from $60 million that year to $328 million in 1998. Three months ago, Watson Pharmaceuticals, a Corona-based company, received FDA approval to market a generic brand of nicotine gum. The company has said the gum will be sold under various names by large retailers at a slightly lower price than Nicorette.
Nicorette costs about $60 for 108 pieces, and some regular users report spending more than $200 a month on their habit. (The gum does carry labels advising consumers that the product is not intended to be used for longer than 12 weeks without consulting a doctor. But many people ignore the advisory.)
Meanwhile, researchers are developing an array of other products to assist smokers in quitting.
Kenneth Warner, a professor of public health at the University of Michigan in Ann Arbor who studies the tobacco industry, says there are as many as 100 U.S. patents registered for non-cigarette, “nicotine-delivery systems,” many intended to help smokers quit.
Doctors still are uncertain whether nicotine gum produces a physical addiction or a psychological dependence. Patients may fear that if they stop chewing the gum they will resume smoking, Hughes said.
“We see no problems from long-term nicotine gum use,” said Mitch Nides, a psychologist and president of Los Angeles Clinical Trials, a private company that works with doctors on medical trials.
Nides was a lead researcher in a 1987 study by the National Institutes of Health that set out to discover whether quitting smoking could slow the effects of chronic obstructive lung disease. As part of the study, Nides gave 350 local smokers unlimited supplies of nicotine gum for five years.
About 40% of the ex-smokers who tried the gum were still chewing a year later, he said. About 10% were still using it after five years.
Researchers were surprised initially to discover that some patients had transferred their nicotine habit from cigarettes to gum. They had believed that the very small amount of nicotine in the gum, plus the slow rate at which it entered the bloodstream, would not make it habit-forming. And scientists intentionally gave the gum an unpleasant taste to discourage long-term use.
The patients didn’t like the taste at first, Nides said. But over time, “they were like, ‘Hey, this stuff tastes pretty good.’ ”
For ex-smokers like Yudovin, the bother--and expense--of being hooked on nicotine gum is a trade-off she’s willing to make to stay clear of cigarettes.
“I tried several other nonsmoking programs, which did not work,” Yudovin said. “I could not quit smoking and I was just about ready to give up, and then I found this.”
Yudovin, who began using nicotine gum as a participant in the NIH study, said she can’t imagine giving up her chewing habit. “I am just so thrilled that I don’t smoke. . . .” she says. “I plan to be on this for the rest of my life.”
