PUBH 460 Drugs of Use & Abuse

-MORE THAN HALF (55.1%) ADULT SMOKERS HAD

MADE A QUIT ATTEMPT IN THE PAST YEAR (CDC, 2019)

-70% of adult smokers say they want to quit (FDA, 2019)

More than 7 out of

every 100 (7.5%)
people who tried to
quit, succeeded
REDUCED RISK PRODUCTS
HISTORY OF FILTERS
Before the 1950s, there was no such thing as a filter-tipped cigarette—or at
least nobody smoked it.
Cigarette companies spent a lot of advertising money trying to convince
everyone that cigarettes were OK.
 That all changed in the 1950s with the release of the first medical
studies that conclusively linked smoking and lung cancer.
One response to these medical studies was the mass-marketing of the filter-
tip cigarette.
 The idea behind the filter was to screen out tar and nicotine to make
the cigarette "safer."
By the 1960s, filter cigarettes dominated the market.
 FILTERS
Low-Tar or “Light, Low, or Mild” Cigarettes
Studies done by the Federal Trade Commission (FTC) on
nicotine, tar, and carbon monoxide (CO) levels in
mainstream smoke.

How are cigarette ratings for tar, nicotine, and carbon

monoxide determined?

Smoking Machine

The methodology was adopted in 1967

Cigarette brands that yielded approximately 1-6 mg of
tar were called “ultra light”

Those with approximately 6-15 mg of tar were called

“light”

Brands yielding more than 15 mg of tar were called

“regular” or “full flavor”

TAR YIELDS (CDC, 2017)

SMOKING MACHINE
Studies issued by NCI show that mortality risk among current smokers has risen in the last 40-
50 years, even though machine-measuring tar and nicotine yields have fallen during the
same period.

Several studies have found that changes in smoking behavior and cigarette design appear
to have resulted in an increase in a type of cancer that occurs deeper in the lung than
the lung cancer traditionally associated with smoking.

Why do smokers of cigarettes with lower tar and nicotine

ratings often end up getting as much tar and nicotine
as smokers of higher rated brands?

Larger & More Frequent Puffs

 Cigarette filter ventilation is one way that tar yields (as measured by the machine test
method) are reduced.
Ventilation holes permit controlled introduction of diluting air into the smoke stream during
puffing.
Holes are placed approximately 12mm from the end of the filter.
Some brands utilize more than one row of holes and place additional rows further from the
end.

CIGARETTE VENTILATION
 What changes have there been to the cigarette
design since the 1960’s?

1. Addition of different size and density filters

2. Ventilation holes
3. Chemical Additives in the paper and/or tobacco
4. Tobacco (i.e., using different types of blends and curing methods)

CIGARETTE VENTILATION (CDC, 2017)

 CIGARETTE VENTILATION
What happens to the ventilation holes when a
human smokes?

Blocked
(Increases the exposure to tar)
 NICOTINE REPLACEMENT THERAPY (NRT)
-First available by prescription in the mid-80’s
-Switched in the mid-90’s to OTC
-Helps reduce nicotine withdrawal and craving by
supplying your body with nicotine.
It contains about one-third to one-half the amount of
nicotine found in most cigarettes.

The consistent use of one of these products doubles a

person's chances of quitting smoking.
 NICOTINE REPLACEMENT THERAPY (NRT)
The growing literature on clinical trials of NRTs leads to the
following conclusions:
1. The research that has compared different NRTs shows NO
differences in their effectiveness.
2. Smokers may have initial preferences for one replacement
therapy over another, but typically they come to adapt to
the one they are using.
3. Combining NRTs with behavioral programs (social support or
skills building) enhances the quit rates that typically are
achieved by either type of treatment alone.
PREMIER
Introduced in 1988 by RJR
Touted as a virtually smokeless cigarette that dramatically
reduced cancer-causing substances inhaled by smokers
Made of aluminum capsules that contained tobacco pellets
The pellets are heated instead of burned—producing less smoke
and ash
PREMIER
True or False: Customers found that Premier
tasted better than traditional cigarettes.

FALSE
One person who tried it immediately declared the cigarette
“tasted like “!@#$%”
and he was the company’s chief executive

RJR scrapped the idea in early 1989

MERIT & NEXT

Introduced in 1976 & 1989 by Philip Morris

 Virtually nicotine-free cigarette—”Ultra Low-Tar”
 Claims “the taste is indistinguishable from regular
cigarettes.”
 The nicotine was removed using high-pressured carbon
dioxide (same way coffee companies remove the
caffeine)
 Tobacco critics complained that Next had higher tar
levels then many cigarettes, and that heavy smokers
would simply smoke more Next cigarettes to deal with the
cravings.
ECLIPSE
RJR began testing in 1994
 More like an ordinary cigarette than its
predecessor Premier because it
contains tobacco and reconstituted
tobacco.
 It also includes a charcoal tip that,
when lighted, heats glycerin added to
the cigarette but does not burn the
tobacco.
 The result is a cigarette that emits
tobacco flavor without creating ash
and smoke.
 ECLIPSE
RJR touted Eclipse as a safer
cigarette and a more socially
acceptable product—less
offensive to non-smokers.
Questions have also been raised
about the effects of heating
glycerin. When burned,
glycerin is known to be
carcinogenic.
 1998: Philip Morris
A smoker sucks on a Kazoo-like box. A microchip
senses the puff and sends a burst of heat to the
cigarette
 Theprocess gives the smoker one drag and does
not create ashes or smoke
 Anilluminated display shows the number of puffs
ACCORD remaining, and the batteries must be recharged
after every pack.
Vector/Liggett (2001) OMNI
 Chemically treated tobacco in a way that
reduces certain cancer-causing elements in
cigarette smoke
 New Filter

 Claimed that certain cancer-causing agents

lowered by as much as 51% in mainstream smoke
and 66% in side-stream smoke compared to the
leading brand.

The studies as of 2004 showed no difference or truth

to the percentages.
ARIVA Compressed tobacco—a pellet
STAR SCIENTIFIC, INC.
flavored with mint and eucalyptus
 Looks like candy—(Tic Tac)
 Sold in childproof boxes
 Star calls it a “cigalett”
A cigarette substitute for smokers
stuck in places where they are not
allowed to light up.
 Don’t have to spit
 Canlawfully only be sold to those 18
and over
Bottled water spiked with NICOTINE WATER
nicotine

Not classified as a tobacco

product but as a “DIETARY
SUPPLEMENT”

Sold as both a cigarette

substitute in smoke-free
environments and as an aid to
quitting.
 FDA approved it for prescription sale in
NICOTINE GUM  1984

Sales without a prescription have been

allowed since…
 Since 1996

Dosage Levels
 2mg (If you smoke fewer than 24 cigarettes per day)
 4mg (If you smoke 24 or more cigarettes per day)

How is the nicotine absorbed?

 Absorbed through the mucus membranes
 Chew
Slowly

Chew again
Stop till you notice a
till taste
tingle and pepper taste
fades

Park it

NOT TO BE CHEWED LIKE ORDINARY CHEWING

GUM!!
Does not need to be chewed vigorously—each piece lasts about
30 minutes—but this varies from person to person.

Most people find chewing 9-12 pieces a day controls their urge
to smoke.

The maximum dosage that can safely be chewed in one day is

between 20 and 30.

NICOTINE GUM
Can the gum be swallowed?
 NO

Symptoms of too much

nicotine:
 Dizziness, lightheadedness, nausea, vomiting,
irritation of the mouth, and hiccups

NICOTINE GUM
 NICOTINE PATCHES/
TRANSDERMAL NICOTINE

Available in U.S. by prescription since 1992 and OTC since 1996

OTC brand names are Nicoderm CQ , Habitrol and Nicotrol

Provides a measured dose of nicotine to the bloodstream

through skin absorption.
 How long does smoking cessation usually take?
 8-12 Weeks

What is the dosage for a nicotine patch?

◦ Smoking more than 10 cigarettes per day:
 Step 1: Use one 21mg patch per day for weeks 1-6 then,
 Step 2: Use one 14mg patch per day for weeks 7-8 then,
 Step 3: Use one 7mg patch per day for weeks 9-10 then stop.
◦ Smoking 10 or less cigarettes per day:
 Do not use Step 1 (21mg)
 Start with the Step 2: Use one 14mg patch per day for weeks 1-6 then,
 Step 3: Use one 7mg patch per day for weeks 7-8 then stop

NICOTINE PATCHES
Where should the patch be applied?
 Clean, dry area above waist and below the neck

Can a patch be applied to the same site each day?

 NO

A patch should NOT be worn for more than…

 16-24 hours (Loss of effectiveness & skin irritation)

Cost ranges from 3-5 dollars a day

NICOTINE PATCHES
24-HOUR Patch
 Provides a steady dose of nicotine avoiding peaks and troughs.
 Helps with early morning withdrawal
 May be more side effects such as disrupted sleep patterns and skin irritation.

16-HOUR Patch
 Recommended for light-to-average smokers
 Less likely to cause side effects
 Does not deliver nicotine during the night, so it is not helpful for early morning withdrawal
symptoms

HEAVY SMOKERS
NICOTINE NASAL SPRAY
Approved by FDA in 1996
 It is available over-the-counter
 Costs about $5-$6 a day
 Quickly delivered to bloodstream as it is absorbed through
the nose
 Gives immediate relief to withdrawal symptoms
 Can use up to 5 times an hour & 40 times a day.

What is the most common side effect?

Nasal and sinus irritation

 Not recommended for those with asthma and allergies

NICOTINE INHALER
Approved in 1998 only available by prescription
A device is made up of a cartridge containing nicotine and a
mouthpiece
Provides a nicotine vapor when air is inhaled through the device
Nicotine is absorbed through the lining of the mouth and upper
esophagus
6-16 cartridges can be used throughout the day

Common Side Effects:

Coughing, mouth & throat irritation
 NICOTINE LOZENGE
• The lozenge comes in the form of a hard candy, and releases
nicotine as it slowly dissolves in the mouth.
• Like the nicotine gum, the nicotine lozenge delivers nicotine to
the brain more quickly than the patch, making it easier to tailor
dosage according to need.
• Each lozenge will last about 20-30 minutes
• The manufacturer recommends you use at least 9 lozenges per
day for the first 6 weeks, and that you not use the lozenge for
more than 12 weeks in all.
• Do not eat or drink 15 minutes before using or while it is in your
mouth.
BUPROPION (ZYBAN)
PRODUCTS NOT CONTAINING NICOTINE

Approved by FDA in 1997 as a smoking cessation aid (Prescription only)

 Also sold as the prescription antidepressant called Wellbutrin.

 NOTE: If you take Wellbutrin for depression, do not also take Zyban to quit smoking.

 How does it work?

 It is an extended-released antidepressant pill that can alleviate nicotine withdrawal symptoms.
 It works by acting on brain chemicals associated with cravings for nicotine.

 Common side effects:

 Dry mouth, sleep difficulties, skin rash, and shakiness
VARENICLINE (MARKETED AS CHANTIX)
-May 2006 (Prescription only)
-Used together with behavior modification and counseling
support to help you stop smoking.

 How does it work?

 Itinterferes with the receptors in the brain that respond to
nicotine.
 Twobenefits: (1)It reduces the amount of physical and
mental pleasure a person receives from smoking (2) it
weakens the symptoms that come with nicotine withdrawal.
Known as Nico Shot
Launched in 2007

Each beer contains 3 mg of nicotine

and 6.3% alcohol

Nautilus (the German maker) claims

the beer is designed to help smokers
quit the habit rather than make the
drink addictive.

NICOTINE BEER
Which of the preceding is the best way for a teenager to
stop smoking?
 NONE (Do not start)

Counseling for smoking cessation by a doctor or other

health care provider has been shown to increase
quitting among youth by about 80%

TEEN SMOKING CESSATION

 GOVERNMENT REGULATIONS

Law protecting children and adolescents. Effective June 22, 2010:

 Prohibits the sale of cigarettes or smokeless tobacco to people younger than 18,
 Prohibits the sale of cigarette packages with less than 20 cigarettes,
 Prohibits distribution of free samples of cigarettes,
 Restricts distribution of free samples of smokeless tobacco
 Prohibits tobacco brand name sponsorship of any athletic, musical or other social or
cultural events.
 GOVERNMENT REGULATIONS
There are some other changes coming for all smokers, including
adults:
 Tobacco companies will be prohibited from using terms such
as “low tar,” “light” or “mild” – so-called light cigarettes make
no difference to a smoker’s health
 Cigarette packages will carry larger warning labels, up to 50%
of the surface of one side
 Depending on the results of upcoming FDA studies, tobacco
companies may be required to reduce the amount of
nicotine in cigarettes
GRAPHIC WARNINGS ON BOXES