Authoritative Source on Nicotine Use

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Wally

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I post this here because it is useful background and source for those lobbying for nicotine use.

This is a book called "Nicotine Safety and Toxicity", edited by Neal L. Benowitz M.D., who is a professor of medicine and Chief of the Division of Clinical Pharmacology at the University of California, San Francisco. The book is from Oxford Press, 1998, and is available from Amazon (used) for as little as five dollars ($75 new).

To give you an idea of the relevance of this book, I quote from the front of the dust jacket:

" Nicotine has been developed as a medication to assist smoking cessation and is being considered as a drug for the possible long-term maintenance of non-smoking. It is also undergoing evaluation as a possible treatment for several medical disorders, including ulcerative colitis, Alzheimer's disease, Parkinson's disease, Tourette's syndrome, attention deficit disorder, spasticity, and sleep apnea." (Depression is also mentioned as a condition for possible nicotine treatment later in the book.)

The book is 18 chapters and discusses the issues complexly, but the bottom line is quite positive:

"Nicotine as a medication for the treatment of diseases other than smoking cessation shows considerable promise . . . it appears to be well tolerated during weeks and months of nicotine medication therapy without evidence of serious adverse health effects. . . the benefits of nicotine maintenance therapy [i.e. long term] almost certainly outweighs the risks [as compared to tobacco smoking]."

I highly recommend this book for those who want detail on this subject. I would caution that the data is not derived from study of the inhalation of vaporized nicotine, but from oral and transdermal administrations.
 
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davidb

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Im going to do a little bit of looking for maybe an updated type of book, anyone know of any others. Or journal articles that that show the continued use of this drug for those treatments.

Also does he say anything about the risk of addiction to the oral/transdermal. Im just curious because some of those conditions don't seem to warrant a drug that has been shown over and over again to be very addicting(sleep apnea, depression, and Tourette's).
 

seminolewind

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I think that vaping nicotine is the fastest way to the bloodstream. Oral may be the slowest way. Transderm I don't know. But I know that rectally is also very fast. I think it depends on how close the capillaries are to the skin surface, and darn, the caps in the lungs and colon are really really close.
 

Wally

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Im going to do a little bit of looking for maybe an updated type of book, anyone know of any others. Or journal articles that that show the continued use of this drug for those treatments.

Also does he say anything about the risk of addiction to the oral/transdermal. Im just curious because some of those conditions don't seem to warrant a drug that has been shown over and over again to be very addicting(sleep apnea, depression, and Tourette's).

David,

Yes, the addictiveness is discussed, but what exactly is the problem with being addicted to something per se? Also, sleep apnea, depression and Tourette's can be completely incapacitating conditions, so I think the trade off would be very worthwhile for many people. I would also add something very important about the addictiveness of nicotine. Unlike many addictive substances it has little tolerance effect, which is one of the most serious problems with addiction. People develop tolerance and doses must be continuously escalated to maintain both subjective and treatment effects. It is well known that smokers find a nicotine blood level and pretty much stay with it. And in treating some of these conditions, the treatment effects do not diminish with adaptation over time. Public health has made much of the addiction to smoking in order to dismiss any subjective benefits people get from it: "The only reason you smoke is that you are addicted." Smoking is about much more than addiction to nicotine and many people derive significant benefits.

This book is ten years old and it would be nice to have something newer, but this isn't exactly ancient history. Please let us know if you find something more recent.

Wally
 

Wally

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I think that vaping nicotine is the fastest way to the bloodstream. Oral may be the slowest way. Transderm I don't know. But I know that rectally is also very fast. I think it depends on how close the capillaries are to the skin surface, and darn, the caps in the lungs and colon are really really close.

SW,

Inhalation is the fastest absorption for most substances (leaving out intravenous injection) because of the air to blood transfer in the lungs, which is what the lungs do. Fast blood level increases make the experience more attractive to most people and generally increase dependency on the substance more than slower administrations would. Absorption in the mouth (through mucosal tissue) varies with the substance and I think that nicotine is actually quite rapidly absorbed here. Pharmaceutical nicotine for oral use (e.g. the Commit losenge or Nicorette MicroTab) is probably bound in material that deliberately slows the absorption. Rectal absorption is probably fast because of the cellular structure of the tissue there--it is not unlike the mucosal lining in the mouth and throat. The absorption is in the rectum, not the colon. I'm not sure about transdermal absorption but, again, the carrier on the nicotine patch deliberatly slows absorption. Transdermal absorption tends to be erratic (varying with skin temperature, moisture, oiliness, etc.) and it is often used to take control away from the "patient."

Wally
 

Wally

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Wally,

It seems like a good read, I might actually grab a copy. I did however notice most of the references you quote come off as a bit speculative.

Eric,

That language is very typical of research science and I wouldn't be concerned about it. The language I cited is about as affirmative as anyone in pharmaceuticals gets about anything--unless they're selling it. The only way to be more affirmative about long term nicotine use would be to have *everyone* on it *forever* and then bake the data. Otherwise we have results only for some people, for some limited period of time, in a limited set of circumstances, with a limited number of variables. The conclusions is this book--all the prejudice about nicotine and its association with tobacco aside--suggest that this could be a very useful substance.

Wally
 
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