Emerging Nicotine Delivery Products. Implications for Public Health.
Wednesday, March 12, 2014
Posted by: Natalia Gromov
Ann Am Thorac Soc. 2014
Feb;11(2):231-5. doi: 10.1513/AnnalsATS.201312-433PS.
Delivery Products. Implications for Public Health.
The idea of clean nicotine delivery systems that would satisfy nicotine craving
and promote smoking cessation has been considered as a possible public health
tool for many years. Nicotine medications have been useful for smoking
cessation but have not found widespread popularity among smokers, perhaps
because of slow nicotine delivery and other sensory characteristics that differ
from cigarettes. Traditional smokeless tobacco delivers as much nicotine as
cigarettes and has been advocated for harm reduction but contains carcinogenic
nitrosamines and has not been proven to promote cessation. Furthermore, there
is concern that dual use of smokeless tobacco and cigarettes may inhibit
quitting smoking. Newer oral dissolvable tobacco products contain lower levels
of toxicants than other smokeless tobacco but also deliver much less nicotine
and have not been popular with consumers. Electronic cigarettes that aerosolize
nicotine without generating toxic tobacco combustion products have become quite
popular and hold promise as a way to attract smokers away from cigarettes,
although efficacy in promoting smoking cessation has not yet been demonstrated.
There are concerns about safety of long-term use, and there is evidence that
youth, including nonsmokers, are taking up e-cigarette use. E-cigarettes are
marketed for use when one cannot smoke conventional cigarettes, and such use
might result in more persistent cigarette smoking. Although their benefits and
risks are being vigorously debated, e-cigarettes or other clean nicotine
delivery devices could play an important role as an adjunct to a U.S. Food and
Drug Administration regulatory intervention to make cigarettes less addictive
and in this context could contribute to the end of cigarette smoking and smoking-induced