MD Stein - Nicotine Nonsense
For heavy smokers, good mood and clear-thinking begin to deteriorate within an hour after their last cigarette. These symptoms worsen over the next twenty-four hours. In daily life, there are more and more places where smokers are obliged not to smoke. To light up, smokers have to leave work, restaurants, and often their own homes. But sometimes they can’t leave to light up, and abrupt cessation of smoking can have meaningful effects on decision-making.
Twelve hours of smoking abstinence has been shown to influence a pilot’s flying ability. Surgeons (yes, some doctors smoke) lose concentration hours into an operation. Most smokers don’t have plans to quit; on any given day, nine out of ten are simply not motivated. But smokers are interested in controlling these withdrawal symptoms, and are increasingly turning to nicotine replacement products to relieve the disturbances of temporary abstinence.
About one in five smokers purchases over-the-counter nicotine replacement specifically to deal with short-term symptoms and craving. This was not what these products were approved for: they are licensed to assist with quitting. In fact, consumer brochures and package labels suggest that use of a patch, gum, lozenge, or spray might be unsafe on the same day as one smokes. In truth, using these aids to take a required (or voluntary) smoking break is not unsafe at all. It’s just that nicotine replacement has not been approved specifically for the indication of treating withdrawal in the United States (as it has in Australia and England).
More smokers should try these products (rather than smokeless tobacco products like chewing tobacco or electronic cigarettes—see my next blog), but reading the labels puts them off. Some public health activists are concerned that using a nicotine patch or lozenge that enable smokers to feel more comfortable in smoke-free environments may blunt the effects of smoke-free legislation that prompts smokers to quit.
But it’s an unanswered empirical question whether using nicotine replacement to manage temporary abstinence increases or decreases motivation when the time comes to actually quit smoking.It may be that when smokers learn they can more easily function in smoke-free environments without cigarettes, they may be more likely to quit smoking.
It’s a myth that nicotine replacement can’t be used on smoking days to reduce the number of cigarettes. It’s healthier to quit altogether of course, but tolerating short-term abstinence may well make you more likely to be successful later when you’re ready to save nine dollars a pack—and your health.