I am not a fan of smoking, although I recognize that it is only one of many poor health decisions that people make. It’s easier to start smoking; nearly one in five American adults currently smoke cigarettes according to the CDC. It’s harder to stop smoking; cigarettes are a leading cause of preventable disease. Later on, I’ll tell you about some smoking news that may make it easier to cut back and quit.
My dad smoked; he died of lung cancer about 15 years ago. I still miss him. Antismoking zealots often downplay that smokers are people too. For my dad’s generation, smoking was actually encouraged, particularly in the military. In his book, Marine Rifleman, Col. Wesley Fox describes his 1950 US Marine Corps basic training in which only smokers got a smoke break; after a few days almost everyone was smoking just to get to rest. Those who smoke today have to adjust their lives around their nicotine habit or addiction.
Nicotine is the active drug in cigarettes.
It stimulates nicotinic receptors, proteins that mediate the response to the nicotine. There are two broad types of nicotinic receptors.
- One is located at the junction between nerves and muscles; here nicotine sensitizes the muscle to stimulation and can increase resting muscle tone.
- The other type of nicotinic receptor is located at ganglia, a sort of switchboard for nerves; here nicotine makes it easier for nerve signals to pass through.
- There are also nicotinic receptors in the brain, some of which are associated with pleasurable feelings and reducing stress and anxiety.
Nicotine can enter the body by any number of routes. Smoking is a popular dosage form because nicotine enters the body very quickly and because patients can control how much nicotine they absorb by inhaling from a cigarette more or less. High exposure to nicotine causes nausea and vomiting.
Because individuals smoke to get nicotine and control their nicotine levels by inhaling more or less from each cigarette, it sounds like low-nicotine cigarettes might encourage smoking more cigarettes – it should be a BAD idea. Not so, according to a recent paper in the New England Journal of Medicine.
The multi-state study of smoking enrolled individuals over 18 years old who smoked at least 5 cigarettes each day. Participants were randomly assigned to receive cigarettes that contained more or less nicotine than typical commercial brands. The study measured the number of cigarettes smoked during the 6th week of smoking the study cigarettes. With regular strength cigarettes, participants smoked 21-22 cigarettes each day; with low nicotine cigarettes (less than 15% of regular nicotine strength), participants smoked 15-16 per day.
Based on the idea that patients smoke to achieve a personally-chosen nicotine level, I expected the low nicotine cigarette group to be smoking a lot more than the normal cigarette group. But that was not what happened. Patients with the lowest-nicotine cigarettes smoked fewer cigarettes, puffed less and were about twice as likely to attempt to quit smoking during the study period. Perhaps it was just too much work puffing to get the little nicotine that was available.
This is GOOD news for smokers and those who love them.
Really low-nicotine cigarettes encourage less tobacco exposure and may make it easier to quit.
Take care of yourself! Your prescriber and pharmacist are happy to keep you around. Talk to them about your medications and smoking cessation. When you or your smoker are ready to quit, your pharmacist is ready to help.
- Donny-EC et al: Randomized Trial of Reduced-Nicotine Standards for Cigarettes. New England Journal of Medicine (October 1st, 2015) 373: 1340-1349.
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