My journey into vaping

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Day 139: A few more home truths about nicotine.

Disclaimer: I am not a doctor, or a medical expert, I am giving my opinion and backing it up with the research I’ve found. Please draw your own conclusions and do your own research. My opinions should never be taken as medical advice. I am not a scientist, or researcher and I might be wrong.  I’m not suggesting that any non-smoker should take up the habit of either smoking or vaping, nor am I suggesting that anyone should self medicate with any recreational substance.

Nicotine has not been proven to cause addiction in non smokers when used to treat disease. This is the most robust statement that I can make with scientific evidence to back me up for one simple reason. There has never been a single study done that directly measured the addictive nature of nicotine (separate from tobacco smoke) in never-smoking human beings.

Nicotine is a highly addictive drug, as addictive as heroin or cocaine when delivered by means of tobacco products.[…] The addiction risk of nicotine in medications has proved to be very low compared to the risk posed by tobacco products (USDHHS, 1998; Benowitz, 1998; Royal College of Physicians, 2008) probably because nicotine medications produce a slow onset of very low levels of nicotine. [Sourceemphasis mine.]

So NRT supposedly works without risk of addiction because NRT introduces it slowly and at low serum levels. Is nicotine therefore more addictive at high serum levels, and because of the fast onset of serum levels? Professor Robert Molimard summarizes the scientific knowledge on the actual effects of nicotine on smokers in this document

The basis of the entire development of the “nicotine replacement therapy”, is based on a syllogism:

  • Premise 1: Tobacco causes a powerful addiction;
  • Premise 2: Tobacco contains nicotine, a neurotropic poison rare in other plants;
  • Conclusion: Nicotine is responsible for tobacco dependence.

But this is in fact pure sophistry. Tobacco contains so many other substances, which may act in synergy, possibly with nicotine, that we can not draw such a conclusion. Moreover, in this huge book with 3,200 references, we would look in vain for a single article showing that Man can be dependent on nicotine only. On the other hand, the “Treatment” chapter focuses immediately on the “Nicotine replacement therapy”. But then we did not have any hindsight about the efficiency of this new treatment, because the FDA had just approved the marketing of the 2 mg gum.

But the case was launched. The “Test of Nicotine Dependence” developed by Karl Fagerström was universally distributed, including in the 2003 AFSSAPS recommendations. [11]. He contributed to implant the idea that tobacco dependence was caused by nicotine. This justified treating with a drug that, while satisfying the need of the smoker, had none of the dangers of smoking.

Professor Molimard goes on to explain why the fast serum level onset/high overall serum level explanation isn’t enough to explain nicotine addiction.

It has been pointed out that it takes 7 to 9 seconds only for the nicotine inhaled from a puff to get to the brain. A peak of blood nicotine would be renewed every breath, creating repeated cerebral “shots” of nicotine. These peaks are considered critical to the establishment and maintenance of addiction, and explain the success of cigarette. However, positron tomography showed that these peaks do not exist in the brain. Labelled nicotine accumulates very gradually to reach a maximum in about 5 minutes [8]. More simply, the tobacco chewers or snuffers are extremely dependent, without such peaks.

Here at last is a rational explanation of the fact that I never got a “high” from smoking and never really wanted one. “Nicotine has a satiating, but not a rewarding effect.”he says. So I don’t need the peaks, and a slow onset to satiation would be as satisfying as a cigarette. Without tobacco smoke there is nothing to suggest that my nicotine use is evidence of addiction. My addiction was to tobacco smoke, and I’m no longer inhaling it. This is why vapers are scoring less on that very same Test of Nicotine Dependence. If nicotine itself was going to create dependence in non smokers (including non smoking vapers) that would have been seen in the studies done on the safety of nicotine for NRT. You see that it is pretty well tolerated, with few side effects. If Nicotine itself is not addictive when you take it out of tobacco smoke, it follows that it is the tobacco smoke (the delivery system) that should be being described as addictive, not the nicotine. Remember, “Nicotine has a satiating, but not a rewarding effect.”

Yet it is a manifest semantic abuse, because none of the six items of the Fagerström’s test refers to nicotine. One in the first 8 items test, later withdrawn as irrelevant, referred to the nicotine yield of cigarettes. A factorial analysis showed quickly that most of the variance was explained by two orthogonal factors: 1 – the precocity of the first cigarette of the day and 2 – the number of cigarettes smoked daily [12]. So this test is a test of cigarette addiction only.

As far as I can see there was never any real evidence that nicotine was actually addictive in the first place. As for other associated health risks: It isn’t carcinogenic – yes this includes the nicotine inhaler, so it’s relevant.  The risks of nicotine use for those with underlying cardiovascular disease, are small. If you look at the review of the evidence on the effects of Swedish Snus on smoking and ill health in Sweden you see that long term lower-risk recreational nicotine use is also relatively safe. All of my perceived benefits of nicotine use have been documented here. Carbohydrate cravings and weight gain on cessation of nicotine, stimulation and relaxation during use – the mechanisms by which each of them work are explained.  I missed these positive effects of nicotine enough to relapse to smoking over and over again, having gone through the withdrawal of the addiction to tobacco smoke. The one thing that will allow me to be healthier and happier overall without tobacco smoke in the long term is to replace the nicotine I like and enjoy, and not be denied it because misguided prohibitionists can’t see beyond the “evil Nick O’Teen.” There are others who have seen a positive potential for nicotine. We have the beginnings of nicotine the wonder drug where the positive effects of nicotine use could have been capitalised on, had vapers not come along with a recreational consumer product that put nicotine back in the spotlight too soon, too cheaply, and far too readily available.

If you are a researcher or a journalist or anything to do with putting information out about smoking, can you please check your prejudice about nicotine? If you find yourself about to say something negative about the effects of nicotine, stop, think and substitute the words “tobacco smoke.” 99% of the time I’ll bet it’ll be far more accurate. Unless you’re talking about third hand exposure as if it were real. In that case you are beyond any help I can give with facts.

The post I just wrote finishes above that line. I shall be adding this paragraph to every post on this blog. This is an appeal from me for you to stand with my vaping crowd and support us in staying off cigarettes. Please go and sign this legal challenge to EU law; it is not just another petition and we need YOUR help whether you vape or not. Thank you:

WARNINGS: Nicotine is classed as a poison in its pure form.  Keep your Electronic Cigarette and cartridges / fluids locked away and out of the reach of children and pets. Toxic if swallowed. Very toxic in contact with skin. After contact with skin, wash immediately with plenty of water. In case of contact with eyes, rinse immediately with plenty of water and seek medical advice. In case of accident, or if you feel unwell seek medical advice immediately, show the label to the medical practitioner.