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Nicotine Delivery Systems

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Because nicotine is not a benign drug, products containing nicotine need to be regulated in a manner commensurate with the harm that they cause.

Nicotine is the addictive agent in cigarettes. Cigarettes kill at least half of lifetime users, and tobacco companies continue to look for “safer” or less harmful ways to provide nicotine to consumers. While the smoke that results from combustion is the deadliest aspect of smoking, this does not mean that nicotine is benign.

Nicotine affects the nervous system and the heart. The effects of nicotine on the body include decreased appetite, mood elevation, increased heart rate, increased blood pressure, nausea, and diarrhea. Symptoms of nicotine withdrawal include intense craving, anxiety, depression, headache, increased appetite, and difficulty concentrating.

The level of harm from nicotine is based on how nicotine is delivered to the body. Combustion is the most efficient method of delivering nicotine to the brain, and because of the tars and carcinogens in smoke is also the most harmful method of consuming nicotine.

Acute exposure to nicotine through the skin or through ingestion can also be harmful. If ingested, nicotine is rapidly absorbed by the small intestine, and typically produces symptoms between 15 minutes and 4 hours after exposure. Death may occur within one hour of severe exposure. Numerous cases of nicotine poisoning have been documented since the early twentieth century when nicotine was used as a pesticide. Exposure to liquid nicotine was relatively rare until the newfound popularity of e-cigarettes.

The risk of nicotine addiction depends on the dose of nicotine delivered and the method in which it is delivered. There are a variety of ways to consume nicotine. Some methods are currently regulated, such as cigarettes, smokeless tobacco, and nicotine replacement therapy. Other methods, such as e-cigarettes and nicotine candy, are currently unregulated in most countries, yet the products are growing in popularity. Because of its addictiveness and the other known harms of nicotine, a framework is needed to regulate all nicotine delivery systems in a manner consistent with the harm that they cause.

Types of Nicotine Delivery Systems: Uncertain Safety

 Continuum of Harm

Many popular tobacco products exist in a research and regulatory vacuum. It is uncertain if these products are dangerous to users and how much exposure must occur for harm to be detected.

E-CIGARETTES

Traditionally sold by entrepreneurial companies, but increasingly e-cigarette companies are owned by tobacco companies. These products contain an atomizer that heats liquid nicotine and other flavors and additives, creating a vapor that is then inhaled.

SNUS

A smokeless tobacco product originally from Sweden. Due to manufacturing and storage processes (see Smokeless Tobacco), snus has lower concentrations of harmful chemicals and cancer-causing agents, yet is still harmful, although less so than other forms of smokeless tobacco.

DISSOLVABLE TOBACCO PRODUCTS

Products such as wafers, lozenges, sticks, strips and orbs often resemble candy or are flavored.

HEAT-NOT-BURN PRODUCTS

These new products are similar to e-cigarettes but contain tobacco. The external heat source for heat-not-burn products, such as Philip Morris’s Heat Stick, vaporizes nicotine from tobacco, purportedly avoiding the toxic compounds from combusted cigarettes.

Types of Nicotine Delivery Systems: Established Harms

Continuum of Harm

SMOKELESS TOBACCO

The use of smokeless tobacco, with the possible exception of snus, increases the risk of oral, head and neck cancers.

WATER PIPES

The risk from using water pipes is similar to that from smoking cigarettes, and the volume of smoke inhaled while using water pipes can be substantially more than that inhaled while smoking cigarettes (see Water Pipes).

COMBUSTED TOBACCO

Cigarettes kill at least half of all lifetime users. There are thousands of toxic chemicals in cigarette smoke, and 69 cancer-causing agents. Other dangerous combusted products include cigars, little cigars and cigarillos.

Both poison control centers and emergency rooms in the USA are receiving increased calls and visits regarding e-liquid poisonings and exposures. Nicotine is a poison and e-liquid is absorbed through inhalation, ingestion and skin contact. Colorful product packaging makes e-liquid bottles attractive to toddlers and children, who are at a considerable risk for e-liquid poisoning.

Variations in Nicotine Levels

Daily nicotine consumption illustrated through select product and usage examples

Nicotine levels vary by product and exposure is based on usage patterns.

Resources

Methods

"Daily exposure to nicotine values were based on the following products names and nicotine per unit levels:
Cigarettes – Marlboro Red; 1.2 mg of nicotine per cigarette
E-Cigarettes – blu disposables; 24 mg of nicotine per disposable e-cigarette
Smokeless Tobacco – Copenhagen Original Long Cut; 13.9 mg of nicotine per gram, or in half of a standard 34g can, 236.6 mg per day
Snus – General Classic; 7.2 mg of nicotine per pouch
Dissolvables – Camel Orbs; 1.0 mg of nicotine per orb
NRT Patch – Nicoderm CQ; Available in 7mg, 14mg and 21 mg of nicotine per patch
NRT Gum – Nicorette Gum; Available in 2mg and 4 mg of nicotine per piece"

Sources

Association for Nonsmokers’ Rights – Minnesota. New Tobacco Products [Internet]. Project Watch. 

blu eCigs®. Disposable E-Cigarette [Internet]. blunation. [cited 2014 Jul 11]. 

Federal Trade Commission. Tar, Nicotine, and Carbon Monoxide of the Smoke of 1107 Varieties of Domestic Cigarettes [Internet]. 1995 [cited 2014 Jul 11]. 

General Snus Online – Portion & Loose Swedish Snus [Internet]. Swedish Snus. [cited 2014 Jul 11]. 

MediLexicon. NicoDerm CQ [Internet]. [cited 2014 Jul 11].

Nicorette. Nicorette Gum [Internet]. [cited 2014 Jul 11]. 

Rodu B. Nicotine Levels in American Smokeless Tobacco Products [Internet]. Tobacco Truth. 2012 [cited 2014 Jul 11].

Nicotine and Caffeine

Some claim that nicotine is as benign as caffeine, but studies show that nicotine is more likely to cause dependence, may help cancers grow, and is considered lethal at a much smaller dose than caffeine.

Dangerous poison

E-cigarettes and liquid nicotine poisoning calls on the rise in the USA

The number of poison center calls involving e-cigarettes and liquid nicotine rose from one per month in September 2010 to 215 per month in February 2014 in the USA. Approximately 50% of the calls to poison centers involving e-cigarettes and liquid nicotine were for children under age 6.

A typical vial (10mL) of liquid nicotine contains a lethal dose if ingested.

Labeling a vial of nicotine with pictures of Gummi Bears and candy can be appealing to children.

“It’s not a matter of if a child will be seriously poisoned or killed [by e-liquid], it’s a matter of when.” – LEE CANTRELL, Director of the San Diego division of the California Poison Control System, 2014

“Nicotine is addictive and very habit forming, and it is very toxic by inhalation, in contact with the skin, or if swallowed. Nicotine can increase your heart rate and blood pressure and cause dizziness, nausea, and stomach pain. Inhalation of this product may aggravate existing respiratory conditions.” – Altria’s MarkTen e-cigarette warning label, 2014

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