Monday, January 31, 2011

My Way or the Die Way

An Open Letter to New York Assemblymember Linda Rosenthal:

“If I can do it, anyone can do it.”

In 1990, there were 43.8 million cigarette smokers in the U.S. Twenty years later, the number of cigarette smokers stands at 46 million. Ooops. Maybe it isn’t as easy to quit as you want to believe. Maybe all human beings do not have bodies that are exact duplicates of yours.

Do you inject insulin every day? No? Do you feel morally superior to those who do, simply because your pancreas works better than theirs? Of course not. Then why are you so smug about having quit smoking 20 years ago and so scornful of those who are not able to quit by using your method?

All of the FDA-approved “smoking cessation” products are based on a model of weaning smokers totally off nicotine. You used the patch. You may not be aware of the fact that the success rate for nicotine weaning products such as the patch, when used as directed, is only 7% at six months, 5% at one year, and down to 2% after two years. When treatment ends, relapse begins. Now here is an eye opener: 30% of the smokers who have stopped smoking altogether by using nicotine gum are still using the gum, years later. They managed to stop smoking only because they ignored the directions. Instead of practicing the recommended nicotine weaning therapy, they are practicing self-directed nicotine maintenance therapy.

Let’s talk about nicotine “addiction” for a moment. Have you ever heard of a motorist being charged with “Driving under the Influence of Nicotine”? No. And you never will. All of the drugs that result in a DUI charge (e.g., alcohol, marijuana, heroin, etc.) impair the driver’s ability to concentrate, pay attention, use good judgment, and react quickly.

What are the effects of nicotine? Here is what a meta-analysis revealed: “We found significant positive effects of nicotine or smoking on six domains: fine motor, alerting attention-accuracy and response time (RT), orienting attention-RT, short-term episodic memory-accuracy, and working memory-RT (effect size range = 0.16 to 0.44).” (Heishman SJ, Kleykamp SA & Singleton EG. 2010. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology 210 (4): 453-469

Nicotine also has positive effects on mood. Unlike drugs such as alcohol, it does not create a false state of euphoria. Instead, it helps to relieve depression and anxiety. If you don’t have depression and anxiety, it does not have much effect on your mood.

Think about this: If you were someone who had problems concentrating, remembering things, staying awake in boring situations, or who had a family or personal history of depression and/or anxiety, and nicotine was keeping the symptoms under control, what would happen to you if you stop using nicotine? Those symptoms would go out of control, wouldn’t they? All of these conditions are caused by imbalances in brain chemistry. And since none of these can be 100% controlled by sheer will-power, they would not be likely to magically go away on their own.

So just because you get along fine without nicotine does not mean that everyone is better off without it. Harmful effects of nicotine are trivial, on a par with the harmful effects of caffeine – a temporary increase in heart rate and blood pressure that normalizes 20 minutes later. Nicotine does not cause cancer, heart attacks, strokes, or lung disease. Smoke does. So doesn’t it make sense to help those who become dysfunctional without nicotine by changing the method that delivers their nicotine to something that does not involve inhaling tar, carbon monoxide, particles of partly burned paper and tobacco, and thousands of chemicals created solely by the process of combustion?

I smoked for 45 years and tried over and over again to stop. I used the patch 20 years ago, too. The difference between you and me is that you did not become dysfunctional after following the directions. I did, and stayed that way for 6 long, miserable months, during which I wanted to commit suicide. Antidepressant medication relieved the mood impairments to a large extent, but I was told there was nothing they could prescribe that would relive the cognitive impairments, and I was about to lose my job. The patch at that time was only available by prescription, so it was not a long-term maintenance option. But when it became available OTC, I tried that. However, I developed a nasty rash wherever I put the patch. When they finally began manufacturing Nicorette gum in pleasant flavors (instead of the original flavor that tasted like an ashtray), regular use of the gum helped me to reduce the number of tobacco cigarettes I smoked. Unfortunately, it has a tendency to upset my stomach if I chew more than 4 or 5 pieces a day. When I discovered the electronic cigarette, it was literally the answer to a prayer. I used to lie in bed at night, kept awake by the sound of my wheezing, and pray to God to send me a way to stop smoking without becoming dysfunctional. I switched over to inhaling vapor on March 27, 2009. The wheezing is gone, as is the “productive” morning cough.

If self-medicating to remain a functioning, productive member of society is somehow immoral, then I guess everyone who buys a double latte at Starbucks every morning, and everyone who pops some Advil when they pull a muscle should admit to being immoral. But IMHO it is immoral to take away a tool that can save the health and the lives of millions. I ask you to reflect on the information I have provided and then to consider amending A1468 to remove Section 2. Allow former smokers who rely on these products to remain abstinent from smoking. Do not deny continuing smokers access to an extremely effective tool that can save their health and their very lives. “Quit (my way) or die” is an inhumane stance.

Elaine Keller