Nicotine Wars

It still puzzles me that we use an incredibly addictive drug, nicotine, to help smokers quit their habit. It's like we've given up and decided that Nicorette gum is to the smoking addiction as methadone is to a heroin addiction. To make matters worse, it now seems that the pharmaceutical industry, in its press to promote its products, wants to limit the verbage on the warning label on the smoking cessation drugs.

(WSJ) As evidence mounts that nicotine-laced stop-smoking aids are producing only limited gains, some critics are calling the products over-rated and over-promoted.

But some high-profile public-health experts say the problem may be over-regulation. They say that federal law requires nicotine gums, patches, lozenges and other products to carry so many warnings that smokers are reluctant to use them. Indeed, the warning literature on a package of nicotine gum is about 20 times lengthier than the warning on a package of cigarettes.

So tobacco researchers and policy makers are starting to argue that the federal Food and Drug Administration should tone down the warnings on pharmaceutical nicotine. At a day-long summit last week in Austin, Texas, entitled "The Case for More Flexible Regulatory Policy," public-health experts discussed a number of changes they may seek to current regulations. Among other possibilities, they say they may recommend relaxing the health cautions for pregnant women and eliminating the requirement that teenagers refrain from using over-the-counter nicotine products without the approval of a physician.

"A 17-year-old smoker of 25 cigarettes per day is doing the right thing to use nicotine gum," says Jonathan Foulds, a tobacco researcher at University of Medicine and Dentistry of New Jersey. "Why give him another hurdle to cross to get help?"

Over-regulation as the cause for lack of utilization? How about the methadone/heroin analogy? Maybe the reason people aren't using these meds is because they're expensive and people don't like taking drugs - especially one that is powerfully addictive. And there are even researchers who question the efficacy of these drugs to stop the smoking habit in the first place.

Recent studies of successful quitters have suggested that the significant benefits of nicotine products seen in randomized clinical trials may not apply in real-world conditions. Critics say the public-health experts who favor nicotine medicines are too financially tied to manufacturers to see the products' limitations. And use of nicotine by teens, pregnant women, heart-disease patients and smokers who haven't quit remains controversial.

"The use of nicotine, whose efficacy in treating nicotine addiction is controversial even in adults, must be strictly avoided in pregnancy, breastfeeding, childhood and adolescence," argues an editorial in the current Journal of Health Psychology, written by a group of eight researchers and antismoking advocates.

To think that people actually READ a warning label and that this is the sole cause of the lack of utilization of these smoking cessation drugs belittles any real analysis of human behaviour.

The reality? We have been incredibly successful in the US at educating our population about the effects of smoking and reducing the number of individuals who smoke. Smoking bans have also been remarkably effective. Why make us smoke this lame excuse for "limited gains" of achieving our goals of smoking cessation in the interest of making pharmaceutical companies more money? Maybe, just maybe, the real reason that smoking cessation aides are producing only limited gains (in sales) is because fewer people are smoking.

Smokers' Hand Gel Fix

Smokers rejoice! Your answer to the proliferation of local smoking bans in now at "hand." Now you can put down those nasty cigarettes and matches and reach for Nicogel, the nicotine-containing hand gel! No, don't stop smoking - get a hand job fix, instead!

In response to local smoking bans, it seems smokers now can get their nicotine fix by smearing this rapidly absorbed nicotine-containing gel on their hands. Made by privately-held Blue Whale Worldwide Inc., this gel is marketed to quell the smoker's craving when in tobacco-free zones and will be available soon at your local Walgreens drug store:

Nicogel, which is already sold in 40 other countries including the United Kingdom, France and Germany, could generate $200 million in U.S. sales this year, Whalen said, predicting that sales will reach $1 billion by the end of 2008.

Smoking bans, which have cleared some air in places such as New York, Washington D.C., Louisiana, and Philadelphia, are helping to make cigarette alternatives, like smokeless tobacco, the fastest-growing segment of the industry, according to Charles Norton, portfolio manager of the Vice Fund, which has $75 million under management.

The U.S. moist smokeless tobacco category, which is dominated by Skoal and Copenhagen maker UST Inc., is one-tenth the size of the cigarette market, but is seeing unit volumes grow 8 percent to 9 percent a year, Norton said. By contrast, U.S. annual consumption of cigarettes is falling 1 percent to 2 percent.

What is concerning about this gel, is that it is not an antidote to quit smoking, but rather a cigarette substitute. Nicotine's addictive potential exceeds that of heroin and cocaine. The rapid absorption of the compound through the skin with this gel is marketed as similar to the bolus of the drug one gets with inhalation. And now it'll be available in your local Walgreens drug store.

Amazing. I can't get a Sudafed tablet in Walgreens for my cold without an international investigatory tribunal approving the purchase, but a Nicogel tobacco-fix? It will be easily purchased for about 60 cents a fix - much less than a frappachino at Starbucks!

On the bright side, this new craze might make the caffeine-laden energy drinks passé.

I wonder how long it will be before "Nicogel bars" come to a neighborhood near you. They might be modeled after the latest smoking fad near many college campuses: hookah lounges.

-Wes