Nicotine gum addiction: Is it harmful?
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Imagine becoming addicted to the treatment that’s designed to break your addiction. It happens to former heroin users on methadone. It happens to people on anti-depressants. And it happens to former smokers on nicotine gum. The gum is not recommended for use past 12 weeks, but many people use it far beyond that, some for years. Is that necessarily a bad thing?
Dr. John Hughes, professor of psychiatry and psychology at the University of Vermont, with a specialty in nicotine addiction, says, given the alternative, no.
“Our studies show that less than 3 percent of nicotine gum users are truly addicted to the gum, in the sense of not being able to stop. And there’s nothing harmful about using it longer than [12 weeks]. The nicotine itself is not harmful; what’s harmful is the carbon monoxide, tars and [other chemicals] in cigarettes.”
But some research indicates that nicotine in any form raises blood pressure and heart rate. Hughes says that may be true for lab animals given large doses, but in humans, there’s only a moderate effect, if any at all. He says recent studies show no danger for heart attack or angina survivors, either. As for rumoured mouth lesions or oral cancers, those are caused not by the nicotine, but by the carcinogens in cigarettes. He does not, however, recommend pregnant or breastfeeding women use nicotine in any form because it has been linked to crib death. But if it comes down to a choice between the gum and the smokes, he prefers the gum, which contains one-tenth the nicotine of cigarettes.
Phil Emberley, Director of Professional Affairs with the Canadian Pharmacists Association, agrees pregnant and breastfeeding women should avoid the gum, but if they can’t, he recommends breastfeeding before using the gum. “That helps to minimize the amount of nicotine that would possibly pass through to the infant.”
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Still, isn’t it a drag to be controlled by any substance? “If you want to stop smoking because you don’t want to be addicted to something, then yes,” says Hughes. “If you want to stop smoking because you want to see your grandkids grow up, then it doesn’t matter.” Hughes says long-term gum chewers are those who have tried to quit smoking many times using many strategies and had success only with the gum. “They’re scared to stop, [fearing] that if they go back to smoking they’ll never be able to quit again.”
And unless you’ve been living in a dense, carcinogenic haze all your life, you know that smoking is deadly. Lung cancer remains the leading cause of cancer death among both men and women in Canada, according to the Canadian Lung Association. But nicotine, along with its deep physiological and psychological hold, is so powerfully addictive — as addictive as heroin and cocaine, and more so than alcohol — that quitting is extremely difficult. “If you take people with alcohol or tobacco addiction, most will say stopping cigarettes is more difficult,” says Hughes.
Janice Taylor, who smoked her last cigarette roughly a decade ago, quickly transferred her dependence onto nicotine gum, and has been chewing ever since. “From the beginning, while still smoking but wanting to quit, I used nicotine gum to substitute for cigarettes,” says Taylor, 62, who started smoking in her teens growing up in the Vancouver area. “So there are two parts to the quitting smoking project: 1) ending the habit of smoking cigarettes, and 2) overcoming the addiction to nicotine. I have succeeded only in the first.”
Taylor estimates she chews about 10 pieces of gum a day. “It depends on the kind of day I’m having,” she says, noting she tends to chew more on emotionally distressing days and when she’s not being “mindful.” She says she intends to quit, primarily because the gum is expensive — roughly $15 for a 30-pack, twice that for added benefits such as teeth-whitening. But the challenge, she says, is that, “Nicotine is effective at helping you cope in garden-variety life situations. The downside of the nicotine products is that they make it easy to continue an addiction to nicotine. There are no restrictions on the use of these products as there are with smoking. You can use them anywhere, any time, without impact on others, and with no negative change in your functioning. It’s an addiction without heavy adverse consequence, except to your bank account.” Taylor started smoking the usual way: peer pressure. “Everyone I hung out with smoked,” she says. “This was the height of the ‘60s youth revolution. All information about the dangers of smoking and the evils of addiction were derided as false and ridiculous.” As she matured, those beliefs disappeared, and she eventually understood the serious health consequences.
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Still, quitting, she says, was, “A process of doing many practice runs where I would lengthen periods between cigarettes or not smoke in certain settings. I never quit cold turkey. I bummed cigarettes for years afterward whenever I was around smokers. Eventually they became physically repulsive to me and I lost even the psychological craving to light up.” Nicotine gum, she says, helped her focus on disrupting the habit aspect of smoking. “A classic example would be ‘coffee and a cigarette.’ Or smoking after a meal, having smoke breaks, cigarettes and alcohol. The gum lets you quite painlessly break the association between cigarettes and commonly occurring situations. Until finally you can be in all those situations and not smoke. Instead, you use the gum.”
Wicked withdrawal symptoms from butting out are why most people, including Taylor, don’t quit cold. Dr. Hughes says giving up nicotine gum produces the same withdrawal symptoms: irritability, sleeplessness, loss of focus, headaches, depression. Taylor says, “I get in a very cranky state and I can’t think clearly. So I almost never run out.” She says she intends to crack the gum habit, one way or another. “I’m trying to be mindful of how much I chew. I’m trying out breathing techniques and kundalini yoga to alter mood and energy. But I’m a haphazard newbie at this alternative stuff.”
Even so, she’s doing all the right things, according to Hughes. He says he’d prefer people use nicotine gum in conjunction with other therapies, such as yoga, breathing exercises and cognitive behaviour therapy. Emberley says, “If someone has been using the gum for a prolonged period of time, it may be a sign that they’re failing on that form of smoking cessation and maybe another form would be more appropriate.” He says drugs, such as Zyban and Champix, have been shown to have a higher success rate — 30 per cent — than the gum, and even higher when used in combination with the gum. “We typically tell people to, every six months or a year, try to taper down [their gum use] and see if they still need it,” says Hughes. Some do, some don’t, but in the end, he reiterates, nicotine gum is far preferable to lighting up. So if you’ve been chewing on that for a while, you can finally exhale.
