1. Griffith Health Institute
Nicotine replacement the controversy that no one talks about?
My position is that it is time to move beyond talk, to recognize that the health gains that can be achieved are truly enormous and that consumers have a right to the least toxic products that a sensibly regulated market can provide.
What is nicotine replacement therapy?
NRT is a way of getting nicotine into the bloodstream without smoking. There are nicotine gums, patches, inhalers, tablets, lozenges, and sprays. You can buy most of these from pharmacies and other retail outlets. They are also available on prescription.
The beneficial or underlying that influence the extent of NRT use among smokers.
1. Nicotine may play a role in smoking-related cardiovascular disease through hemodynamic effects and
possibly through the acceleration of atherosclerosis
However, tobacco smoke contains many chemical constituents that can harm the cardiovascular system, including combustion products such as carbon monoxide and nitrogen oxides. So it is generally believed that the benefits of nicotine pharmacotherapy use in terms of smoking cessation outweigh the risks, even among smokers with stable heart disease.
2. Cigarette smoking produces a higher peak and average dose of nicotine than does NRT, suggesting that smoking would lead to greater nicotine-related risk than would NRT use.
3. The dose–response relationship between nicotine intake and hemodynamic effects appears to be flat suggesting that concomitant use of cigarette smoking and NRT would not result in increased risk attributable to nicotine.
4. It has been shown that smokers tend to titrate their nicotine intake to achieve a relative constant dose, which could lead to a reduced intake of combustion products and a favourable risk–benefit profile.
5. Nicotine is not considered to be a carcinogen, but in vitro and animal studies have suggested that nicotine may play a role in tumor promotion through processes including angiogenesis and inhibition of apoptosis.
Although these data suggest that nicotine may act as a tumor promoter, nicotine supplementation is undoubtedly safer than the continuation of smoking.
Several short-term clinical trials of NRT use among smokers with coronary heart disease and a meta-analysis of nicotine patch randomized trials found no excess of adverse cardiovascular events among participants. But larger volume of participants and further research is required to further assess the effect of NRT.
Concerns of NRT use among smokers: insight into the potential harms of nicotine.
Main reason smokers may not use NRT, or use less of it than advised to by the product usage instructions, is that they are skeptical of its effectiveness (Hammond D, McDonald PW, Fong GT, Borland R (2004)).
Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behavior.
Studies of smokeless tobacco products provide nicotine dose similar to that from cigarette smoking but without the combustion products of smoking.
Snus (Swedish moist snuff) has garnered attention as a potential harm reduction product because of its lower concentration of tobacco-specific nitrosamines and other contaminants and because of ecological observations, studies have reported mixed responses in relation to CVS disease, there was an increase of oesophageal cancer and other malignancies were observed in users of smokeless tobacco products compared to non users of both smokeless tobacco products and smokers.
Studies of NRT risk, still found that the benefits in terms of reduced premature mortality outweighed the risks associated with active smoking in a heavy smoker.
Griffith Health Institute
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succinct overview