Scientific Opinion: SmkN

Smoking and Nicotine

Heishman, S.J., et al. Meta-analysis of the acute effects of nicotine and smoking on human performance.Psychopharmacology (Berl), 2010 Apr 24.

"RESULTS: There were sufficient effect size data to conduct meta-analyses on nine performance domains, including motor abilities, alerting and orienting attention, and episodic and working memory. 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). CONCLUSIONS: The significant effects of nicotine on motor abilities, attention, and memory likely represent true performance enhancement because they are not confounded by withdrawal relief. The beneficial cognitive effects of nicotine have implications for initiation of smoking and maintenance of tobacco dependence."

Xue, Y. & Domino, E.F.,
 Tobacco/nicotine and endogenous brain opioids. Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 32, Issue 5, 1 July 2008, Pages 1131-1138

"Smoking is a major public health problem with devastating health consequences. Although many cigarette smokers are able to quit, equal numbers of others cannot! Standard medications to assist in smoking cessation, such as nicotine replacement therapies and bupropion, are ineffective in many remaining smokers."

Sumner, W., Permissive nicotine regulation as a complement to traditional tobacco control. BMC Public Health. 2005; 5: 18. Published online 2005 February 24. doi: 10.1186/1471-2458-5-18.

"Pharmaceutical grade nicotine is the safest known substance that could replace cigarettes, but inherently addictive products are required to compliment traditional tobacco control policies effectively. The FDA could apply restrictions, similar to those on cigarettes, to an increasingly addictive portfolio of nicotine products, requiring honest portrayals of absolute and relative risks, and expect a significant reduction in cigarette smoking and related illness with modest recruitment of new nicotine addicts at each step. A brief and focused research effort could solidify the already substantial justification for such permissive nicotine regulation."

Sumner, W., Estimating the health consequences of replacing cigarettes with nicotine inhalersTobacco Control 2003;12;124-132

"Prevention of tobacco use is historically dif?¬?cult in spite of clear health hazards. Regulatory responses to the problem are tenuous and subject to reversal or delay as political and economic fortunes change. A lasting reduction in tobacco related illness might result from unleashing clean alternative nicotine delivery systems to compete directly with tobacco products. Even if used very broadly, clean inhaled nicotine might reduce public health problems as much as a very successful tobacco control programme. Additional research should attempt to quantify the health consequences of using pure nicotine. Meanwhile, clinical and marketing trials of clean nicotine inhalers are defensible in populations with a high burden of smoking related illness."

Heavner, K., et al., Survey of smokers' reasons for not switching to safer sources of nicotine and their willingness to do so in the future. Harm Reduction Journal 2009, 6:14.

"One of the barriers to smoking cessation via product switching is misinformation about Smokeless Tobacco (ST) and pharmaceutical nicotine products. Most (67%) people in a telephone survey in the US and 59.8% of a sample of nurses mistakenly believed that nicotine is the main cause of tobacco-related cancers. Surveys of smokers and college students in North America found that fewer than 15% realize that ST is less harmful than smoking. In addition, a study found that most (75%) male US military recruits believe that switching from smoking to ST does not reduce tobacco users' risk. Many smokers have similar misconceptions about the health risks from using pharmaceutical nicotine products... If efforts to actively convince smokers that there is no opportunity for harm reduction were to end, we would expect to see the change begin. If the resources that are currently devoted to misleading smokers about harm reduction were instead targeted at informing them that they have satisfying choices that are almost as good for their health as quitting entirely, a very large change could happen quite rapidly." 

Department of Veterans Affairs Health Services Research & Development Service, November 2010
VA Comparison - Cessation Treatments & Depression - Comparative Effectiveness of Smoking Cessation Treatments for Patients With Depression: A Systematic Review and Meta-analysis of the Evidence