Long-term Nicotine Replacement

Tobacco smoking can cause serious damage. The smoker’s risks are greatly increased for heart attack, strokes, lung disease, and a variety of cancers. What about nicotine, the substance that keeps people coming back to tobacco? Isn’t that the source of tobacco’s harmfulness?
Smoking-related diseases are caused by the carcinogens, tar, particulates, and carbon monoxide in tobacco smoke, not the nicotine. A small percentage of smokers are able to give up nicotine with few ill-effects. Given the negative attitude seen toward smoking today, as well as the well-publicized health risks, it would seem reasonable to assume that those who can easily quit have already done so.

That leaves about 45 million U.S. smokers who experience depression, anxiety, cognitive impairments, and sleep disturbances so severe that they are unable to carry out their responsibilities whenever they totally abstain from nicotine. According to the smoking cessation propaganda, these “withdrawal symptoms” are supposed to disappear as soon as the nicotine is cleared out of the system—a couple of days to a week. But for many, these problems persist for months, and even years. Researchers are starting to find that many people with underlying conditions such as Attention Deficit Disorder, depression, anxiety, and other mental disorders, are keeping their conditions under control by self-medicating with nicotine.

These people could go to their doctors and receive prescriptions for anti-depressants, anti-anxiety medications, and/or amphetamines. But would they be better off?

According to one advertisement for an antidepressant medication, 70% of the people on antidepressants still experience symptoms. For some people, antidepressants trigger suicidal thoughts and/or behavior. Anti-anxiety medications are fine for temporary use during times of great stress, but they can be addictive and can cause dangerous side effects. Older adults who have high blood pressure are not good candidates for amphetamine-like medications. Furthermore, long-term use is discouraged by the FDA. Short-term treatment for a long-term problem is not a practical solution.

None of these medications causes cancer or lung disease, so a tobacco smoker might well be better off using them. But how do these medications compare with nicotine replacement products in terms of safety?

Nicotine, without the tobacco smoke, is a relatively benign drug. There may be a modest increase in heart rate and blood pressure, which poses a problem only for critically ill patients. When compared from a standpoint of safety, nicotine replacement therapy (NRT) would appear to pose fewer risks.

The question is whether society will allow people to medicate their conditions in the way that they find most effective. Chronic conditions call for long-term treatment.