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Harm reduction in nicotine addiction

Harm reduction in nicotine addiction

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Publicado porBK Ainsworth
A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007
A report by the Tobacco Advisory Group of the Royal College of Physicians, October 2007

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Two questions arise in considering nicotine sources as substitutes for cigarette
smoking. The first is whether these sources will be satisfying to smokers and
prove to be acceptable substitutes for cigarettes. The second is whether the safety
profiles are acceptable. This latter question is discussed in more detail in later

5Sources of nicotine for human use

99

chapters, though, on purely theoretical grounds, the absence of other toxins
found in tobacco and particularly in its combustion products suggests strongly
that these products will be far safer.

Several studies have looked at the question of whether nicotine replacements are

useful for the purpose of reducing cigarette use. Some smokers are able to reduce

their cigarette consumption and exposure to carbon monoxide and some other

tobacco smoke toxins by using various nicotine products. Smoking reduction

studies have examined the use of nicotine gum, nicotine patches, nicotine spray and

nicotine oral tablets.3,46

In general, the extent of reduction of levels of biomarkers of

tobacco smoke response is less than the change expected from the magnitude of

change in the self-reporting number of cigarettes smoked per day.47,48

This may be

due to misreporting of cigarette consumption, and/or to compensation by smoking

each cigarette more intensively. The number of smokers who are able to

substantially reduce their smoking tends to decrease over time during clinical trials,

and questions remain as to whether this approach has long-term viability.

The use of smokeless tobacco as a substitute for cigarette smoking has been of

considerable recent interest.49

Smokeless tobacco does not generate combustion

products, which are thought to be responsible for most of the injurious effects of

cigarette smoking. The safety of smokeless tobacco products is discussed elsewhere.

Smokeless tobacco has been suggested as a way to help people quit smoking, and

some smokeless products have been marketed specifically for use when a person

cannot smoke cigarettes. However, the long-term use of smokeless tobacco as an

alternative to cigarette smoking has not yet been experimentally evaluated.

5.6 Conclusions

HA wide variety of nicotine products are available, delivering a range of

nicotine doses. The cigarette is the most widely used product.

HCigarettes deliver high doses of nicotine into the lungs, where it is absorbed

rapidly and transported directly in the systemic circulation to the brain.

HThe nicotine from cigarettes is carried in smoke which contains thousands of

other chemicals, including many that are carcinogenic or otherwise toxic.

HSome of these toxins are present in tobacco before combustion. Most are

combustion products.

HSmokeless tobacco also contains toxins and carcinogens, but delivers high

doses of nicotine without most of the toxic components in smoke.

HMedicinal nicotine products deliver pure nicotine but in relatively low

doses and, particularly for nicotine transdermal patches, very slowly. They
do not deliver other toxic chemicals.

100

Harm reduction in nicotine addiction

HThe available alternative nicotine products all deliver nicotine more slowly

than cigarettes, and are therefore probably less addictive.

HIt is possible that alternative nicotine products could provide a safer long-

term substitute for cigarette smoking. If so, this could benefit individual
and public health.

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6.1

Introduction

6.2

Population trends in smoking prevalence in the United Kingdom

6.3

Trends in prevalence in other countries

6.4

Health risks associated with active smoking

6.5

Health risks associated with passive smoking

6.6

Effects of smoking cessation

6.7

Conclusions

6.1 Introduction

Cigarette smoking is established as a significant cause of death and morbidity. It
is the largest identified avoidable cause of ill-health and premature death.
Despite a vast accumulation of evidence since the first research studies were
published in the 1950s, and public awareness of the adverse health effects, many
people continue to smoke. Furthermore, smoking is emerging as a significant
public health hazard in developing countries where there is potential for a large
number of premature deaths.

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