FDA Tomorrow's FDA workshop on Biomarkers of Tobacco Exposure to focus on e-cigs

[KattMamma]

The problem is them continuing to obsess over nicotine

^ This!

I think you're onto something with the MAOIs, but I'm sure there's still other addictive substances in cig smoke too. Lowering the amount of one or two substances doesn't change the fact that you're inhaling an addictive cocktail with many addictive substances.

 

[AndriaD]

Yeah... just try stopping ANY psychogenic substance cold turkey, and see what happens. Took me TWO YEARS to withdraw from Effexor, and for some months after it was gone, I STILL got those 'ZZZT!' electrical surges that felt like I'd just stuck my whole body in an electric socket.

Andria

 

[Oliver]

Andria - I don't think that's an addiction. Sorry, it lacks one of the key components which is the "craving" phenomenon and the cessation/relapse that usually accompanies it. That's not to say that I don't accept that withdrawal from SSRIs is profound - I do.

But, consider this: A large number of people go into hospital each year and are given powerful doses, often for a long time, of morphine. These people have to go through a managed withdrawal process, and most do not go on to source street opiates (although many do). They simply have not established the conditioned cue-response to the drug that triggers cravings in addiction.

Were those people "addicted" when in hospital? I don't believe so. Were they neuro-physiologically dependent whilst in hospital? For sure.

 

[Kent C]

Well, this may well be what they're thinking: A Glimpse into the Regulatory Future of Vaping | Vaping.com

FYI, I sat on a panel discussion with Dorothy Hatsukami and Eric Lindblom. It's quite clear to me that the overall desire on their part is for the FDA to be very light touch on e-cigs, while enacting the authority they have to reduce nicotine in smoked tobacco.

The idea being that cigarettes will become less addictive (leading to fewer new smokers), and those smokers who want or need nicotine will migrate to vaping.

Glad to hear that regarding Hatsukami and Lindblom on ecigs, but on cigarettes, given their supposed 'pro-health' view, they should be more concerned with health rather than addiction. One would think that they would know by now, it's the combustion not the nicotine that poses the biggest health problems.

Frankly, they should abandon any 'fix' of the cigarette. They tried 'smokeless' cigarettes (out of concern for the second-hand smoke hoax) that didn't work. Trying to tweak the nicotine is another path doomed to failure. The true fix is to keep the nicotine and find an alternative to smoke - which is the real problem. Something that has been done and now exists as ecigarettes.

If, from the start, the science was true science rather than controlling individual behavior, they would have come up with this solution a lot earlier than Hon Lik did.

 

[Oliver]

Interestingly, the role of MAOIs in the rat models is associated with increased reward-response towards tobacco (Wanting), and not associated with the dependence aspect ("Needing") - the assumption is that the whole tobacco's reward-response leads creates motivated behaviour towards additional exposure to the nicotine, eventually leading to dependence.

Nicotine on its own doesn't seem to be very rewarding.

I believe that the reason some people respond well to WTAs and others do not is that there are marked differences according to whether people are "craving" or "dependent" , and this is likely due to genetic differences in the specific dopaminergic circuits involved in the phenomena.

The primary difference between E-Cigarettes and Cigarettes is the time to maximum blood plasma concentration. MAOIs are an important and interesting part of this, but T-Max is much more important.

 

[Oliver]

Glad to hear that regarding Hatsukami and Lindblom on ecigs, but on cigarettes, given their supposed 'pro-health' view, they should be more concerned with health rather than addiction. One would think that they would know by now, it's the combustion not the nicotine that poses the biggest health problems.

Frankly, they should abandon any 'fix' of the cigarette. They tried 'smokeless' cigarettes (out of concern for the second-hand smoke hoax) that didn't work. Trying to tweak the nicotine is another path doomed to failure. The true fix is to keep the nicotine and find an alternative to smoke - which is the real problem. Something that has been done and now exists as ecigarettes.

If, from the start, the science was true science rather than controlling individual behavior, they would have come up with this solution a lot earlier than Hon Lik did.

I agree with all of that

 

[Kent C]

Nicotine on its own doesn't seem to be very rewarding.

I believe that the reason some people respond well to WTAs and others do not is that there are marked differences according to whether people are "craving" or "dependent" , and this is likely due to genetic differences in the specific dopaminergic circuits involved in the phenomena.

I like this. I might add 'individual differences' (choices) either, instead of, or along with "genetic differences'. I've always considered the smoke/vapor as a big part of the 'addiction/dependence', as a relaxing/calming aspect (way before ecigs). Sound can be relaxing in the form of music - but depending on one's preferences - classical eg., can either sooth or irritate Sight can also relax - in the form of smoke or vapor (or other stuff). One could add "touch" as another perceptual aspect - hand to mouth/feel in throat but I think that's less. If nicotine alone would 'cure', then patches and gum would work - they don't. :- )

 

[AndriaD]

Andria - I don't think that's an addiction. Sorry, it lacks one of the key components which is the "craving" phenomenon and the cessation/relapse that usually accompanies it. That's not to say that I don't accept that withdrawal from SSRIs is profound - I do.

But, consider this: A large number of people go into hospital each year and are given powerful doses, often for a long time, of morphine. These people have to go through a managed withdrawal process, and most do not go on to source street opiates (although many do). They simply have not established the conditioned cue-response to the drug that triggers cravings in addiction.

Were those people "addicted" when in hospital? I don't believe so. Were they neuro-physiologically dependent whilst in hospital? For sure.

I dunno about morphine; I've only ever had it once. But my mom is entirely dependent on Oxy; she quit drinking when they discovered her cirrhosis, but i can't consider her "sober" or "recovering" because when they gave her Oxy for some surgery, she just transferred to that as her "drug of choice." Now she takes 4-6 Oxy pills every day. Sure, she has pain -- but I'm reasonably certain that at least half her pain is manufactured by her brain, to get her to continue taking those pills -- because that's what addiction does.

Andria

 

[Kent C]

Thanks Kent.

When I saw the Empty Room, I thought it was showing the End of the Workshop and not the Beginning.

Both videos (morning and afternoon) are now available. Although it says "Event not active", the videos are active. For those who want to go right to the main ecigarette discussion go to around 2:28:30 in the afternoon session starting with Goniewicz.

Biomarkers of Exposure: A Public Workshop - Day 1, Afternoon Session - 1071713

Biomarkers of Exposure: A Public Workshop - Day 1, Morning Session - 1071711

 

[pennysmalls]

Thank you Kent! I haven't had a chance to watch these yet.

 

[Oliver]

I like this. I might add 'individual differences' (choices) either, instead of, or along with "genetic differences'. I've always considered the smoke/vapor as a big part of the 'addiction/dependence', as a relaxing/calming aspect (way before ecigs). Sound can be relaxing in the form of music - but depending on one's preferences - classical eg., can either sooth or irritate Sight can also relax - in the form of smoke or vapor (or other stuff). One could add "touch" as another perceptual aspect - hand to mouth/feel in throat but I think that's less. If nicotine alone would 'cure', then patches and gum would work - they don't. :- )

I see where you're going. But the whole thing about cessation/relapse is the "hijacking of motivation" notion - and in this case, choice becomes somewhat irrelevant.

That is NOT to say that choice is one important reason people continue to smoke, but it's unrelated to addiction, as far as I can see.

Addiction, choice, free-will/determinism - the whole thing's incredibly difficult.

My view is this: If someone says they're addicted, I take them at their word. If someone says they smoke because they choose to, I take them at their word.

 

[Kent C]

I see where you're going. But the whole thing about cessation/relapse is the "hijacking of motivation" notion - and in this case, choice becomes somewhat irrelevant.

That is NOT to say that choice is one important reason people continue to smoke, but it's unrelated to addiction, as far as I can see.

Addiction, choice, free-will/determinism - the whole thing's incredibly difficult.

My view is this: If someone says they're addicted, I take them at their word. If someone says they smoke because they choose to, I take them at their word.

The only reason I introduced 'choice' was to show that certain aspects of the senses can differ in individuals ("preference" may be a better description rather than volition) - hence the classical music sooth/irritate situation. It could be rock, heavy metal, or any type of music - but sound was the point, not the choice. And in the case of smoking/vaping - sight of the cloud so to speak. And hence without that - as in patches and gum, no change occurs. With vapor, change of habit and, as our science has shown - better health, occurs.

The main point is how certain perceptions - sound, sight, taste, touch can add to the dependence. It brings it down to the relationship between the substances/actions of a person and reality.

edit: in reading back I see I did also say preferences :- ) I hope this communicates it better.

 

[zoiDman]

...

I believe that the reason some people respond well to WTAs and others do not is that there are marked differences according to whether people are "craving" or "dependent" , and this is likely due to genetic differences in the specific dopaminergic circuits involved in the phenomena.

...

Do you believe that the "Placebo Effect" can also play a role in the Reduction of Cravings when some people use an e-Liquid that contain WTA's?

Also, How is the Amount of WTA's in an e-Liquid Measured? mg/ml? ug/ml?

 

[Oliver]

Do you believe that the "Placebo Effect" can also play a role in the Reduction of Cravings when some people use an e-Liquid that contain WTA's?

Also, How is the Amount of WTA's in an e-Liquid Measured? mg/ml? ug/ml?

Definitely it can! For all I know, it might be the sole effect.

I'm not aware of anyone testing for WTAs. I'd think it was in the ug/ml region, and would need specific calibration to test for it.

 

[Oliver]

I dunno about morphine; I've only ever had it once. But my mom is entirely dependent on Oxy; she quit drinking when they discovered her cirrhosis, but i can't consider her "sober" or "recovering" because when they gave her Oxy for some surgery, she just transferred to that as her "drug of choice." Now she takes 4-6 Oxy pills every day. Sure, she has pain -- but I'm reasonably certain that at least half her pain is manufactured by her brain, to get her to continue taking those pills -- because that's what addiction does.

Andria

I should have been clearer - lots of people given medical opiates DO go on to be dependent, especially if they're prescribed in a home setting.

Sadly, the "associative cue-response" aspect of addictive drugs is not understood by most prescribers. I think almost all smokers understand it, intuitively at least - "coffee and cigarettes", "post-coital cigarettes" etc etc

 

[Kent C]

Also, How is the Amount of WTA's in an e-Liquid Measured? mg/ml? ug/ml?

I use (sparingly) Aroma Ejuice:
Alkaloid dosage is 24MG

Like when starting ecigs, I was curious :- ) I went off cigs within the first week of vaping 6 years ago (no cigs since) and haven't felt the need for anything else but recently (4 months ago?) I tried unflavored Aroma ejuice and liked the "flavor" it added - it's unflavored as far as there is no particular flavor but it seem to enhance flavor for me. I put about 10 drops in a 30ml bottle of my regular flavored eliquids and at present only one of the 5 flavors I use. It's rather expensive. Still, I like what it does to that one flavor and really haven't sensed anything biological with regards to it.

Not currently available - I just checked ....but this is what I get:

Unflavored WTA Whole Tobacco Alkaloid 24 MG

 

[Lessifer]

@Lessifer Well, they're conducting studies right now at tcors centres.

It's true that low-tar/low-nicotine cigarettes are just as addictive and dangerous as full-strength. But we're talking about nicotine levels massively lower than found in the current smoking market.

The two questions are: would lowering nicotine in cigarettes to the extent allowed by FSPTCA prevent new users becoming addicted, and would the level be low enough that existing smokers would not be able to compensate by smoking more/inhaling more deeply and would instead chose alternative sources of nicotine?

If, for example, it's decided that the first is true (although it can't be empirically derived for obvious ethical reasons), but the net effect is that smoking becomes more dangerous for existing smokers, would they still push for it?

Here's a great, open access, article by Lynn Kozlowski on the current situation: Elsevier: Article Locator

That is definitely an interesting article. I'm curious as to why there is no mention of the ethical concerns in forcing a population into withdrawal, since nicotine addiction is recognized as a medical condition.

 

[zoiDman]

Definitely it can! For all I know, it might be the sole effect.

I'm not aware of anyone testing for WTAs. I'd think it was in the ug/ml region, and would need specific calibration to test for it.

Agreed.

BTW - Played a Nasty Trick on someone awhile back. They were having a Hard Time switching from a PAD+ 20 Year Habit and approached me for thoughts on WTA.

I told them that I had tried it, but Hadn't seen any Difference between WTA and Non-WTA e-Liquids. But that some people Swear by it. And if She Wanted the Bottle of WTA I had, I would give it Her. She Said that would be Great.

Unfortunately, when I pulled out the Bottle, it was Empty.

So I Made a Batch of 50:50 36mg/ml Unflavored and put it in the WTA Bottle. I then told here to Add 5 ~ 10 Drops of the "WTA" to Her Regular e-Liquid. And to Let me know how it worked for Her.

(I Know. I Know. It was a Sneaky Thing to do. Don't Judge Me. - LOL)

I got an e-Mail from Her about a week Later and She was Thrilled with How Well the "WTA" Worked. That her Cravings had Greatly Diminished. And that She was now Smoke Free for 5 Days!

She did make a Successful Switch after One Small Slip. And Today She is has been Smoke Free for about a Year.

I'm by No Means saying that WTA's can not have an Effect on some People. But in my Friends case, Her Belief in it Can Work seemed to play a Major Role in Reducing Cravings using the "WTA" I provided to Her.

 

[zoiDman]

I use (sparingly) Aroma Ejuice:
Alkaloid dosage is 24MG

Like when starting ecigs, I was curious :- ) I went off cigs within the first week of vaping 6 years ago (no cigs since) and haven't felt the need for anything else but recently (4 months ago?) I tried unflavored Aroma ejuice and liked the "flavor" it added - it's unflavored as far as there is no particular flavor but it seem to enhance flavor for me. I put about 10 drops in a 30ml bottle of my regular flavored eliquids and at present only one of the 5 flavors I use. It's rather expensive. Still, I like what it does to that one flavor and really haven't sensed anything biological with regards to it.

Not currently available - I just checked ....but this is what I get:

Unflavored WTA Whole Tobacco Alkaloid 24 MG

I am presuming that the "24mg" is 24mg/ml

And that this 24mg/ml is Independent of the Nicotine Level. Correct?

 

[DC2]

and contrary to what I thought when I first got here, MAOIs are not added; they occur naturally in tobacco, and those would be my bet for what makes smoking so addictive -- anything that exerts that strong an effect on brain chemistry nearly HAS TO BE addictive -- look at the withdrawal syndrome of SSRIs!

Andria, have you ever read this?
Nicotine - Wikipedia, the free encyclopedia

Tobacco smoke contains anabasine, anatabine, and nornicotine. It also contains the monoamine oxidase inhibitors harman and norharman.[57] These beta-carboline compounds significantly decrease MAO activity in smokers.[57][58] MAO enzymes break down monoaminergic neurotransmitters such as dopamine, norepinephrine, and serotonin. It is thought that a powerful interaction between the MAOIs and nicotine is responsible for most of the addictive properties of tobacco smoking.[59] The addition of five minor tobacco alkaloids increases nicotine-induced hyperactivity, sensitization and intravenous self-administration in rats.[60]