Nicotine
[4.0] You keep talking about providing a less harmful source of nicotine. But isn't nicotine itself very bad for you?
No. The effects of nicotine itself are very similar to that other popular drug, caffeine. There is no reason to believe that nicotine causes any substantial risk for cancer, and evidence shows that the risk for cardiovascular disease is minimal. Much of the confusion about nicotine comes from anti-smoking activists talking about nicotine and smoking as if they were the same (just as they confuse tobacco and smoking). It is true that people smoke mostly because of nicotine; but nicotine users die mostly because of the smoke.
Neither nicotine nor coffee are completely benign (in particular, both cause a short-term increase in your blood pressure and pulse rate when you use them, which could affect your health). A lot of evidence shows that coffee drinking causes very little health risk. Studying nicotine is a bit harder, because most nicotine users smoke, and the smoking is quite bad for you. But we do have some good evidence: If nicotine were very bad for you then smokeless tobacco, which provides nicotine, would be very bad for you. As we've shown above, that is not the case.
Though nicotine is relatively safe for most individuals, it may have a negative effect on fetal development and as such should be avoided during pregnancy.
[4.1] But isn't nicotine addictive?
That question is a bit tricky to answer, since there is not actually a scientifically accepted definition of addiction. We know that some people try hard to give up nicotine and keep going back to it, which probably meets most people's definition of addiction. Indeed, that is a large part of why we think harm reduction is such an important idea – if everyone who used nicotine could just take it or leave it, then some anti-tobacco advocates' goal of getting everyone to just quit would not be so absurd.
Many people can take it or leave it, so nicotine is clearly not such a strong draw for some people. Many tobacco users have not had too much trouble quitting, and many others use it sometimes, but feel no need to use it regularly. Some of the researchers who produced this website use smokeless tobacco sometimes – we feel it is our professional responsibility to be thoroughly familiar with the products we are writing and talking about – but feel no urge to use it more often. It seems that some people get substantial benefits that keep them using nicotine, while others do not.
Some advocates seem to think that addiction is a terrible disease in itself (despite them not even having a good definition for it). If you are addicted to something, these people think you should give it up, even if it is doing you more good than harm. They apparently would have you suffer the pain of quitting, and possibly ongoing unpleasantness of wanting something you cannot have – just because you are "addicted". We think this is absurd, and even downright cruel. We agree that when someone is obsessed with something and neglects the rest of their life, or is compelled to do something that hurts them, then helping them quit is a worthy goal. But when someone has a habit that is not hurting them much, then why should we make their lives miserable and insist that they give it up. Of course, smoking does hurt people a lot, but nicotine does not have to.
It is sad and frustrating that some people are so obsessed with ending addiction to nicotine, rather than reducing the heath impact of using nicotine, that they tell all tobacco users that they must quit entirely, and if they do not quit, they might as well smoke and die from it. In addition to insisting that people endure the unpleasantness of quitting, this has terrible health consequences. Since many people who try to quit smoking fail, this attitude dooms millions of people to die unnecessarily from their nicotine habit.
[4.2] Does nicotine have any benefits?
Yes, for many people. For quite a few people, nicotine provides the benefits that some people get from caffeine or Ritalin: it helps them focus and be more productive, overcoming attention-deficit-type problems. For some people, nicotine provides relief from stress, anxiety, or panic. For people suffering from some severe mental illnesses, nicotine seems to provide great relief, which probably explains why a very large fraction of psychiatric patients smoke. Nicotine also appears to reduce or delay the onset of Parkinson's disease. Unfortunately, because nicotine is so politically incorrect, there is less information about it than we might want, so we do not have good scientific evidence on all of its possible benefits.
At the risk of being even more politically incorrect, we will state the obvious: Benefits are a good thing. Many people recognize that they get immediate psychological benefits from nicotine – anything from being able to focus in school to not feeling severe distress – and, not surprisingly, keep using it. Think about this: Most everyone in Western society tries nicotine sometime during their childhood or adolescence, but relatively few of them adopt it as a habit. Why is it so hard to realize that those who kept using felt substantial benefits from it, while those of us who chose not to bother with it did not? (We might even speculate that the effective campaigns to reduce youth smoking might partially explain the increase in prescriptions for alternative attention-deficit drugs – not that this would be a reason to want children to smoke, of course.)
One of us had a friend in graduate school who had forced himself to quit smoking because of the health risks. He believed that if anyone ever found a way to provide nicotine without large health risks, then everyone in school would use it. If they wanted to stay competitive, he thought, they would need the increased clear thinking and productivity that nicotine gave him. He did not know that there was, in fact, a way to get nicotine without a huge health risk (none of us did). More interestingly, he did not realize that most of us do not get the same benefit from nicotine that he did – he assumed that everyone was like him. Tobacco policy seems to be made by people who have not experienced any benefits from tobacco, and assume that everyone is like them.
People who get the most benefit from smoking are the ones who are likely to keep smoking (be "addicted") despite high taxes, non-smoking buildings, and all the messages telling them to quit. So, by making smoking more and more unpleasant, while also trying to hide the fact that there are much less risky sources of nicotine, anti-tobacco advocates are just hurting people who get relief from psychological difficulties by using nicotine. Laws against smoking in public places are often praised by anti-smoking advocates for making it easier for smokers to quit. But when you start pretending that smoking has no benefits, it becomes clear that making quitting "easier" really means making smokers' lives so unpleasant that the costs exceed the benefits, even when the benefits were high.
We are not suggesting that we know whether the benefits of using nicotine outweigh the possible costs (the financial costs of buying it, the effort that goes into using it, and the possible very small health costs) for any particular person. This is a decision that people must make for themselves, and should do so based on mature judgment, a complete understanding of the costs (the true costs, not the shameless anti-nicotine propaganda), and knowledge of their own personal benefits.
Advocates should keep in mind that some nicotine users are getting benefits that make them willing to accept the huge costs from smoking. The obvious humane response to this is to try to lower the high costs of nicotine use, by providing a substitute for smoking. The opposite strategy, continuing to increase the costs until they exceed the benefits, making people so miserable that they quit, is puritanical and cruel.
[4.3] But isn't nicotine...?
But isn't nicotine used as an insecticide? But isn't pure nicotine highly toxic? But isn't the nicotine in a pack of cigarettes a lethal dose? Yes, yes, and yes. But so what?
A lot of anti-nicotine advocates try to scare people by saying things that while scientifically accurate, are just designed to confuse. Nicotine is produced by the tobacco plant as a natural insecticide, and people have discovered that they can concentrate it and use it as an artificial insecticide. This should not come as a shock – many of the chemicals in plants that we like are part of the plants' defense mechanisms. Pretty much every plant we eat or do anything else with contains natural insecticides. We would not expect the plants to be making chemicals for our benefit. It just happens that this chemical, which sometimes poisons insects, sometimes also provides an effect that some people like.
It is also true that a drop of pure nicotine can be deadly, and that if you concentrated the nicotine from a pack of cigarettes (or a can of snuff, or a box of pharmaceutical nicotine products) and put it into your body all at once, it would likely be fatal. But, again, so what? Nicotine users do not consumer these quantities all at once and are never exposed to pure nicotine. If you took an entire meal's worth of food and stuffed it in your mouth all at once, that would probably kill you too, even though it would be harmless if you took twenty minutes to eat it. That may seem like a silly thing to say, but it is no more silly than pointing out that a huge dose of nicotine, delivered all at once, would be deadly. Neither one says anything about the safety of normal consumption.
Keep in mind the truism in toxicology: "The dose makes the poison." Enough of anything, delivered fast enough, is deadly (including food or water). For many medicines you have on your shelf, ingesting the entire bottle at once would be deadly. In fact, for nicotine you would have to use roughly fifty times the usual dose for it to be deadly, something no one is likely to do accidentally. For some popular drugs, like alcohol or acetaminophen (Tylenol), the fatal dose is a much closer amount to the dose commonly consumed.
In any case, it is always most useful to go back to the scientific evidence. Long term users of nicotine who do not smoke (smokeless tobacco users) suffer very little ill effect from their habits, as we describe above. If nicotine were deadly, we would expect to see a lot of these people die prematurely. We do not see that.
[4.4] Does smokeless tobacco act as a "gateway", causing people to take up smoking?
There is no real evidence that anyone who would not have otherwise smoked takes it up because of smokeless tobacco use. But to the extent that people do switch, the best thing we could do is tell them the truth. This is a case where the anti-tobacco literature actually encourages some people to smoke.
Some anti-smokeless-tobacco advocates have realized that they have no legitimate scientific basis for arguing that there are major health impacts associated with smokeless tobacco use. But instead of seeing that as a reason to devote their attention to more dangerous exposures, they just decided to search for other arguments. One that became popular is the "gateway" hypothesis, that the use of smokeless tobacco leads people to later take up smoking.
Whether true or not, this claim is not relevant to harm reduction, which is aimed at people who are already smoking. But it is also pretty clearly not true. It is no surprise that many people who like to use one tobacco product will like to use another, in particular because they like nicotine. The evidence shows that many people use one product and then switch to the other. This does not mean that the first product caused them to use the second (i.e., that if the first product did not exist, they never would have tried the second). Quite likely they would have tried the second product in the first place. The gateway argument assumes that some people never would have thought to try cigarettes were it not for smokeless tobacco, which seems rather unlikely in a society where cigarettes are so common.
In any case, if the gateway claim were true, we would have to eliminate smokeless tobacco entirely to keep it from happening, which would be a terrible option, leaving tobacco users without a good reduced-harm alternative. No one is talking about doing that.
Most important, if there is a gateway effect, the harm reduction message is actually the best way to do something about it. The dominant misinformation, that smokeless tobacco is about as unhealthy as smoking, tells smokeless tobacco users, "you might as well smoke". This terribly irresponsible message translates to something along the lines of"if you use nicotine, and you like cigarettes a bit more than smokeless tobacco, then go ahead and smoke". Many people try both products and settle on cigarettes. If people are going to use one product or the other, we want them to settle on smokeless tobacco.
Anti-tobacco advocates tend to treat tobacco users as if they are complete idiots – helpless children who cannot make a rational decision and need to be manipulated. We think otherwise. We think that many tobacco users will choose a product that is 99% less harmful, as soon as someone can break through the propaganda and let them know about that comparative risk. The "gateway", then, will be an exit, not an entrance to smoking.
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