Nicotine, tobacco, and harm reduction

Harm reduction.

A reader wrote me the following:

I’ve been following your website for about 2 years now and I am very grateful for your recommendations, as they have improved my health. I’m in my early 30s, male, 6’3″, 195 lbs. I was in great shape until last year when I started a pack a day smoking habit. Since then my energy levels and mental clarity have plummeted. I find it hard to push through my workouts and I smoke immediately afterwards. I believe you mentioned that you were a former smoker so I would be grateful for any tips on how to quit (cold turkey doesn’t work for me) and how to overcome the stress on my body if quitting is not possible.

I am indeed a former smoker, although I quit cigarettes decades ago. I smoked from the ages of about 15 to 30 – and for those of you not around back then or if you’ve forgotten, just about everyone smoked back then.

Harm reduction

Harm reduction is the attempt to minimize harmful effects of tobacco (and other drug) use, recognizing that many people have a difficult time quitting, and that methods for dealing with drug use are not “one size fits all”, since everyone is different.

Harm reduction occurs when a practice that is healthier, or not as unhealthy, is substituted for the original habit. For example, substituting methadone for heroin in addicts is an example of harm reduction. (Which doesn’t mean I’m wholeheartedly endorsing methadone use. Just an example.)

Harm reduction in tobacco use occurs when a smoker substitutes a different source of nicotine for cigarettes.

Cigarettes, a dirty delivery system

Let’s get one thing out of the way: cigarettes are bad news. Besides the long-term effects of possible cancer and heart disease, they also emit carbon monoxide, which makes the smoker feel lousy. This is probably what’s causing our correspondent to have low energy.

The bad health effects of cigarettes can be virtually 100% traced to products of combustion, not nicotine. The act of setting fire to tobacco creates a witch’s brew of chemicals and particles, which are then inhaled to do their damage.

Cigarettes are a very dirty nicotine delivery system; the smoker wants nicotine, but along with it gets a dose of hundreds of different chemicals and particles, most of which are toxic and carcinogenic.

Cigarettes are also incredibly addictive. Folk wisdom has it that cigarettes are more addictive than cocaine, but that appears not to be the case. (Addiction.) Nevertheless, even having to make the comparison shows the power of cigarettes. One reason they are so addictive is that nicotine can enter the brain within seconds after inhaling, thus providing a powerful psychological reinforcement mechanism, similar to injecting drugs, which are more addictive when injected.

Nicotine

Nicotine, by itself, can improve cognitive function (Biological Psychiatry) and may prevent Parkinson’s disease (Trends in Neurosciences). It can be toxic, although apparently not nearly as much as has been described. (Archives of Toxicology.) The idea that nicotine is toxic in tiny doses traces back to “dubious self-experiments in the nineteenth century”.

What about adverse health effects of “normal” doses of nicotine? This is hard to untangle from the effects of cigarettes or other sources of nicotine, but some sources claim that nicotine by itself is no more harmful than caffeine – which can also be toxic in higher doses and can cause mental health problems. (CNS Spectrums.)

Lies about tobacco

A lot of lies are told about tobacco that has the effect of making it difficult to quit cigarettes.

The biggest lie is one that you can see on various tobacco products other than cigarettes, something like “This product is not a safe alternative to cigarettes.” Yes, that’s a lie. Some tobacco products have less than 1/1000 the health risk of cigarettes.

Smokeless tobacco – snuff or snus – “has not been definitively linked to any deadly disease”.

“There is overwhelming evidence that any risk for oral cancer (cancer of the mouth) from ST is very low.” – (Source.)

E-cigarettes appear to be quite safe, and in any case, much safer than cigarettes. (Source.)

There are also sources of nicotine such as gum and patches, but these apparently do not have as good a record at helping people quit smoking as do other sources of nicotine, the reason being that the user can’t manipulate them very well in order to control nicotine intake.

As my correspondent said, “cold turkey” or quitting altogether and abruptly, doesn’t work for him. Some studies have suggested that only about 27% of those who went cold turkey succeeded, and that after the third attempt.

Using the principle of harm reduction, it would be better for a cigarette smoker to use other forms of tobacco, such as smokeless, or other forms of nicotine, such as e-cigarettes, than to continue smoking.

The problem is that the government and anti-smoking groups are staunchly against any message that some forms of tobacco or nicotine might be safer than cigarettes, the idea being that that would encourage people to use them.

If those who use them do so instead of cigarettes, then that’s a good idea.

Needless to say, I’m not encouraging the use of tobacco, but I am discouraging the use of cigarettes.

For a full account of tobacco harm reduction, see the website Tobacco Harm Reduction, as well as the review article, Tobacco harm reduction: an alternative cessation strategy for inveterate smokers.

Leave a Comment:

4 comments

George Ironthumb says August 24, 2015

Great article bro!

BTW, I already tried the classic chewing tobacco – Its very powerful and that stuff really “kicks” and I literally felt “overdosed” with nicotine with that and my heart was pumpin like crazy – and I smoked a lot when I tried that! So needless to say that chewing tobacco is a great option. The only setback is that it doesn’t offer the same rituals as smoking.

However you are right. The harm is never in the tobacco and never in the nicotine – but its in the chemicals and the combustion

The only problem is that I really can’t get my lungs to get used to vapes, but I guess I’ll get used to it

How to replicate the anti-aging effects of parabiosis and young blood transfusion - Rogue Health and Fitness says August 30, 2015

[…] and Cellular Neuroscience.) Just a reminder: nicotine itself is a relatively benign compound, it’s the combustion products of tobacco that cause disease. In other words, it’s smoking, not nicotine, that causes health […]

Rob says September 28, 2015

Just found your blog and I’m glad I did. This is a very under-discussed topic and your post digs into the weeds on it.

I have been flirting with smoking and other forms of nicotine addiction on and off for my entire adult life (20 years). I get hooked after smoking one cigarette or even a cigar. I’ve gone through periods of up to 5 years without smoking or even using any other form of nicotine, but I have always manage to start up again at a moment of weakness, even if its just for a month or two.

For the past couple of months I’ve been using nicotine gum. I got a Costco sized box of 2mg gum and its lasted awhile, though I usually go for two pieces of gum rather than one for the past week or so. I have all my old symptoms of nicotine addiction: feeling crappy or not myself until I get my gum, focusing on ensuring I get nicotine, ect, but it definitely doesn’t have the same negative social stigma and crappy feelings as smoking. Also, I did snuff in college and it eroded the gums around my lower teeth and they never returned. Disposible e-cigarettes affected my breathing, made me cough, and generally made me feel like crap. Nicotine gum has been side effect free other than the actual nicotine addiction side effects.

I haven’t found any long term negative effects to nicotine gum researching online. I really hate being utterly dependent on a substance. Maybe I just accept that I’m a gum addict. I don’t have the mental stamina reserves to go through quitting nicotine again and its so hard to stay off it long term. I’ll consider quitting if I ever go on vacation for a week, but I can’t bear the thought of doing it while I’m working and trying to be productive.

Nicotine Self-Test - Rogue Health and Fitness says March 24, 2016

[…] Nicotine by itself is relatively harmless, and may in fact be a net benefit. It’s the combustion products of smoking that cause damage. […]

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