Welcome to the third edition of the Knowledge is Power series. Today we are going to take a closer look at nicotine. If you’re like me, then at one point or another you considered the words nicotine and tobacco to be interchangeable. It wasn’t until I was introduced to the wonderful world of vaping that I discovered there is a drastic difference between the two. We all know that tobacco kills, but what about nicotine? Is it a deadly poison? Is it completely safe or even beneficial? Let’s take a look at these questions together.
Opponents to e-cigarettes have been in the news quite a bit lately with negative statements related to nicotine. For instance, Forbes 2posted an article titled The Real Dangers of Liquid Nicotine stating “An awareness of the toxicity of nicotine is an important aspect that the public often is unaware of, and that may lead to toxic symptoms”. It is important to note, however, that the use and exposure effects the possible toxic symptoms. While Forbes seems to be providing a seemingly informational stance, the NY Times 3 takes it a step further in an articled titled Selling a Poison by the Barrel: Liquid Nicotine for E-Cigarettes, stating “These e-liquids, the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.” Obviously a terrifying thought, and something none of us want to see. An even more broad statement regarding the fear surrounding nicotine came from an article in the Huffington Post 4, Liquid Nicotine in E-Cigarettes Could Be Deadly, “Vials of poison are lurking in nearly every corner bodega. According to reports, they’re hidden beneath the flashy exteriors of e-cigarettes.” As you can see, the level of negativity and impression that we should fear all things nicotine seems to grow with each article. So, where is this fear of nicotine coming from? Elliot Antman, M.D.1 President of the American Heart Association (AHA), was quoted as saying “Nicotine is a dangerous and highly addictive chemical no matter what form it takes.” Certainly a source that provides a basis for the types of concerns mentioned in the articles above. Another source of negative nicotine comes from Dr. Armando Peruga 5 of the World Health Organization (WHO) has even stated “The contents of e-cigarettes vary, but the aerosol expelled by their users contains nicotine, which is known to alter brain development.”
So, if nicotine is such a deadly and poisonous substance, what are the WHO and Federal Drug Administration’s (FDA’s) views on Nicotine Replacement Therapy (NRT) such as nicotine gum, nicotine inhalers, and nicotine patches?
The WHO 6 has defined NRT as such, “a class of nicotine delivering medicines which help people to stop smoking by acting at brain nicotine receptors, thus reducing withdrawal symptoms. It is a “clean” form of delivering nicotine, which is not accompanied by the main carcinogens and other toxic substances found in tobacco products and produced by their combustion… Nicotine inhalers can be used for as long as needed.” Additionally, the FDA 7 has released a transcript of their public workshop Risks and benefits of long-term use of Nicotine Replacement Therapy Products and in it, Celia Winchell, Medical team leader for Addiction Drug Products stated “the products [NRT] were originally conceived as a short-term treatment, but there’s a growing sense that longer-term or even chronic use of NRT might be helpful to patients. We have for many years expressed a willingness to consider long-term use of NRT for maintenance of abstinence [from smoking]. It is believed that the benefits may outweigh the risks.” On the FDA’s website 8 they also state “although any nicotine-containing products is potentially addictive, decades of research and use have shown that NRT products sold over the counter do not appear to have significant potential for abuse or dependence.” Based on the statements made by the WHO and FDA, it seems as though the issue they perceive is with the tobacco, not the nicotine itself. If nicotine is as deadly as indicated above, why would they allow long term use of products containing nicotine? Is it possible that nicotine itself is not nearly as toxic as indicated in the terrifying reports as stated above?
According to an article from Archives of Toxicology 9 titled How Much Nicotine Kills a Human? Tracing Back to the Generally Accepted Lethal Dose to Dubious Self-Experiments in the Nineteenth Century the general information regarding the toxicity of nicotine, that is references in the articles I cited at the beginning of this blog, is outdated. The article states,
The mismatch between the generally accepted lethal dose and documented cases of nicotine intoxication raises the question for the genuine source of the [lethal level of nicotine in an adult] 60mg dose. LIterature and internet searches provided circular and often misleading references to databases or textbooks, which either simply state the dose without reference or refer to another textbook and so on. The genuine origin of the lethal nicotine dose we still refer to is more than 100 years old. More recent studies have shown that intravenous administration of up to 5mg of nicotine, corresponding to 25mg orally (50% of the allegedly lethal dose) led to only minor adverse effects, such as coughing and nausea. Nicotine is a toxic compound that should be handled with care, but the frequent warnings of potential fatalities caused by ingestion of small amounts of tobacco products or diluted nicotine-containing solutions are unjustified and need to be revised in light of overwhelming data.
Meaning, that statements such as “ A teaspoon of even highly diluted e-liquid can kill a small child.” as made by the NY Times, is based on outdated and unjustified information. In fact, Dr. Carl V. Phillips of the Independent Research institutes’ website titled Tobacco Reduction Harm10has stated “The effects of nicotine itself are similar to that other popular drug, caffeine. Nicotine users are never exposed to pure nicotine (like coffee drinkers are not exposed to pure caffeine) and never take in that much all at once. Keep in mind the saying from toxicology: the dose makes the poison. Enough of anything, delivered fast enough, is deadly (including food or water).” The outdated information regarding the lethality of nicotine utilized by the media in the e-cigarette opposition indicated above, would explain why both the FDA and WHO are willing to utilize nicotine as a primary ingredient in their efforts to combat tobacco usage through NRT. It appears, that nicotine is not quite as dangerous as previously stated. However, can it be good for you?
Health, How Stuff Works 11 website published an article regarding the current nicotine treatments being considered and tested for various health issues. Their website states,
New research has taught us more about how nicotine affects the brain and body, for example, a lower incidence of alzheimer’s disease. In one study, a group of alzheimer’s patients were given nicotine patches, they maintained their cognitive abilities longer and sometimes even recovered lost cognitive function. Contrary to popular opinion, nicotine actually boosts the growth of new blood vessels. This discovery may lead to new treatments for diabetes. People with depression who were treated with nicotine patches reported a decrease in their depressive feelings. Nicotine may carry some health benefits with it, but the problem has been the delivery system. The variety of conditions being studied reflects the excitement felt in the scientific community for the potential of nicotine: anxiety, depression. Alzheimer’s, Tourette Syndrome, ADHD, Parkinson’s Disease, diabetes, and schizophrenia. One day we may look at nicotine like we do opium, foxglove, and nightshade. In one form they’re highly dangerous substances; in another, they’re vital, even life-saving medical treatments.
For years, nicotine and tobacco have been thought to be the same thing. It wasn’t until the NRT’s were created that we starting looking at nicotine individually, outside of it’s tobacco delivery system. As such, there still seems to be a tobacco-esque stigma applied to the mention of nicotine. Yet, as indicated by Health, How Stuff Works there are many promising and potentially life changing positive effects that can be derived by utilizing nicotine. As they stated, the issue has been the delivery system. Nicotine being used without the carcinogens associated with burning tobacco can be a positive thing, if used appropriately. Are we saying nicotine is completely safe, NO. There is an addictive component, and it is dangerous in it’s purest form. Much like one grain of concentrated caffeine can kill you, so can contact with pure nicotine. Yet, the diluted and minimal amount of nicotine in e-liquid is relatively safe, if utilized appropriately. We utilize child proof caps, and encourage vapers to keep their e-juice out of reach of children or pets. However, vaping nicotine appropriately as a responsible adult appears to be a promising possibility of a relatively safe way of utilizing nicotine.
I strongly encourage everyone to take a look at the references listed below. Read, educate yourselves, and never take what is blasted all over the news at face value. Check back next week when we will be taking a closer look at what is really in e-juice. Until then, let us know your thoughts on the information we have found regarding nicotine.
Written by: Michelle Harnden
(1)American Heart Association (AHA)
(2)Forbes “The Real Dangers of Liquid Nicotine”
(4)Huffington Post “Liquid Nicotine in E-Cigarettes Could be Deadly”
(5) Dr. Armando Peruga, of the WHO’s Tobacco Free Initiative
(6) World Health Organization (WHO)
(7) Federal Drug Administration (FDA) “Risks and benefits of long-term use of nicotine replacement therapy products public workshop”
(10) Tobacco Harm Reduction by Dr. Carl V. Phillips’s independent research institute
(11)Health, How stuff works