By Danielle Jones
Let’s face it; nicotine doesn’t have a great reputation. It’s widely considered the primary chemical responsible for addiction in tobacco cigarettes, and public health activists have labeled it “as addictive as heroin and cocaine.” This reputation has followed nicotine into the vaping industry, and thus we’re seen as guilty by association. No matter how many studies are released, and science articles are published, nicotine remains the bad word that taints our otherwise noble message: to reduce the harm of smoking.
It’s an inconsistent stance on the part of public health if you consider it objectively. Nicotine in patches and gums is revered as a smoking cessation method, but that same nicotine in e-liquid or a JUUL is vilified by the mainstream media and discounted by public health activists. There seems to be a double-standard in place that favors pharmaceutical products.
It’s become clear to a lot of vapers that the campaign against vaping in the United States is about more than just nicotine. However, since it’s the go-to strategy of public health activists, let’s focus on that. The first thing to understand is that nicotine has largely only been studied in conjunction with smoking. That is to say; it’s been studied in cigarettes. Until recently, there hasn’t been a lot of science looking at nicotine isolated from the other chemicals and compounds in cigarette smoke; and there are a lot of chemicals – more than 7,000 according to the American Lung Association. What if, outside of cigarette smoke, nicotine is actually a lot different than we’ve been led to believe?
WHERE IT ALL BEGAN
The US Surgeon General’s annual report from 1988 “The Health Consequences of Smoking: Nicotine Addiction” was the first major scientific declaration on nicotine and it’s addictiveness. This 618-page report reviewed over 2,000 scientific articles plus the work of more than 50 scientists, and decidedly said that cigarettes are addictive; that nicotine is the drug in tobacco that causes the addiction. The heroin and cocaine comparison was first made here.
In 2010 The Surgeon General put out another report about cigarette smoking, in which it essentially repeated all of the nicotine addiction information from the 1988 report. The following year an article was published in the Harm Reduction Journal by professors from Tel Aviv University that analyzed the science used in both reports. The Tel Aviv professors claim that the conclusions drawn from both reports (that nicotine is responsible for cigarette addiction) are “remarkably biased and misleading.” Both Surgeon General (SG) reports ignored evidence that contradicted what they believed, presented “evidence” that relied on flawed research techniques, and was in fact discarded by the original researchers, and concluded that evidence for nicotine addiction existed where, in fact, it didn’t. The Tel Aviv professors also note that the 1988 and 2010 SG reports are often the only sources cited by the scientific community when presenting facts about nicotine addiction.
Additionally, there is some concern regarding a conflict of interest amongst the scientific editors and authors on the 1988 SG report, specifically Dr. Neal Benowitz and Dr. Jack Henningfield. In 2011, Benowitz and Henningfield, along with Jonathan Samet, were the subjects of a federal lawsuit in which R.J. Reynolds and Lorillard tobacco companies sued the FDA and the U.S. Department of Health and Human Services. The lawsuit claimed that these three men serving on a tobacco-advisory panel to the FDA had massive conflicts of interest and financial ties to pharmaceutical companies. Why is that worthy of a lawsuit? Because those same pharmaceutical companies make smoking cessation products that directly compete with the smokeless tobacco products manufactured by R.J. Reynolds and Lorillard. Imagine this as a referee in a football game betting on one of the teams. You could certainly question their ability to be objective.
The lawsuit revealed that Benowitz had been consulting for pharma companies Pfizer and GlaxoSmithKline on the design of Nicotine Replacement Therapies (NRTs) since the 1980s. Similarly, Henningfield consulted on NRTs for GlaxoSmithKline as well as had financial ownership in a company developing a patented NRT drug.
Based on these obvious conflicts of interest, the judge in this lawsuit ruled that “The committee’s [the FDA tobacco advisory panel] findings and recommendations are at a minimum suspect, and at worst, untrustworthy,” and therefore they could not make unbiased recommendations to the FDA. Benowitz, Henningfield, and Samet were removed from the committee and/or resigned. The judge also banned the FDA from using a report written by them in 2011 recommending that menthol cigarettes be illegal.
Would it surprise you to know that the 1988 SG report was published around the same time that US pharmaceutical companies released their first NRTs? Nicorette gum was the first NRT and is now owned by GlaxoSmithKline. Is it a coincidence that precisely when the SG report declared that nicotine is what addicts smokers to cigarettes pharmaceutical companies released new products to treat that addiction? In fact, in the 618-page SG report, nicotine gum as a treatment appears within the first ten pages. The timing and the overlap of researchers involved are enough to raise red flags and question the relationship between the researchers and the pharmaceutical industry.
NEW SCIENCE VS. OLD THEORIES
More recent research tells a different story. A multitude of studies on animals conducted around the world over the past decade has shown that other chemicals present in cigarette smoke are necessary to increase nicotine’s addictiveness. One of these studies, conducted on rats, presented the animals with the option of self-administering (1) nicotine, (2) other tobacco chemicals, (3) nicotine + other tobacco chemicals, and (4) saline (salt water). If nicotine is as addictive as heroin or cocaine, then presumably the rats would show a preference for nicotine alone and in combination.
Instead, what researchers found is that the animals primarily chose the combination of nicotine + other tobacco chemicals over all other options. This led them to conclude that nicotine needs help from other chemicals to enhance addiction. In the case of this study, it was the chemical acetaldehyde. Acetaldehyde is one of the most abundant chemicals in cigarette smoke. Interestingly, acetaldehyde is also released during the process of metabolizing alcohol. There is already considerable science suggesting that acetaldehyde has addictive properties, plays a role in alcohol addiction, and is responsible for alcohol withdrawal and hangover symptoms. This animal study concluded that low doses of acetaldehyde mixed with nicotine enhance nicotine’s addictiveness significantly. The researchers noted that the adolescent rats seemed to be especially vulnerable to its effects.
In addition, cigarette smoke has substances in it that act as monoamine oxidase inhibitors (MAOIs). MAOIs you may recognize as being a class of anti-depressants. Monoamine oxidase is an enzyme which removes serotonin and dopamine from the brain. MAOIs inhibit these enzymes, effectively increasing levels of serotonin and dopamine – the neurotransmitters most associated with happiness and pleasure. Cigarette smoke literally makes you happy on a chemical level and makes your brain feel like it’s being rewarded. As with acetaldehyde, researchers found in additional animal studies that MAOIs, in combination with nicotine, make nicotine dramatically more addictive to rats. What these studies seem to have in common is the researchers observed that nicotine, on its own, has poor reinforcing (addictive) properties, until combined with other chemicals present in cigarette smoke.
EXPLORING THE BENEFITS
Now it’s true that animals are quite different than humans, and addiction is a very complex issue with a lot of external factors to consider. Multiple researchers have begun to test nicotine on its own for its potential therapeutic effects in humans. A human study done in 1994 examined whether nicotine patches affected the treatment of people with ulcerative colitis (a disease that affects the large intestine). The subjects included both former smokers and never-smokers. In addition to finding that it helped more patients achieve remission, the researchers also noted that none of the patients reported any cravings or a desire to smoke. In fact, in 2013 The Michael J. Fox Foundation decided to sponsor a clinical trial testing the potential benefits of nicotine on Parkinson’s disease in humans. Nicotine is also being looked at for its ability to help with Alzheimer’s, ADHD, Tourette’s, schizophrenia, and dyskinesia. So far the therapeutic uses of nicotine don’t seem to result in the feared withdrawal and addiction that was previously assumed.
The evidence for nicotine’s lack of strong reinforcing properties continues to be born out in larger human studies. One such study conducted at the Center for Global Tobacco Control at Harvard School of Public Health studied 787 adult smokers in Massachusetts who had recently quit smoking. Researchers found that, long-term, nicotine gums and patches are no more effective at helping smokers quit than going cold turkey. If nicotine alone isn’t powerful enough to be the primary addictive component in cigarettes, then it holds that NRTs won’t be very effective; they only provide nicotine – not the other components in cigarette smoke that seem to make it so much more addicting.
VAPING: WHY IT WORKS IS WHY IT’S DEMONIZED
This brings us to vaping. Vapor products, unlike pharmaceutical NRTs, actually mimic the behavior of smoking – inhaling and exhaling a cloud of vapor. It looks like smoking, feels like smoking, and it tastes much better than smoking (thanks to the variety of available flavors). It also comes with a community of adults struggling with the same issue, like a support group. Physicians have often recommended supportive counseling alongside traditional NRTs for smoking cessation, and vaping essentially comes with a supportive community. Between the Facebook groups, cloud competitions, trade shows, podcasts, YouTube channels, and more there is an entire support system of people to talk to and share with. There are cultures and rituals associated with smoking, and there’s also a culture and ritual associated with vaping – it fills a void in your life left by quitting smoking.
And therein lies the rub. Vaping looks like smoking. And smoking is bad.
Since the dawn of vaping, public health activists have been wringing their hands in collective worry over the “renormalization” of cigarette smoking. Meaning, if vaping becomes publicly acceptable, and vaping looks like cigarette smoking, then it will encourage people to smoke. Their preferred method is to ostracize and shun smokers (and addicts) in order to convince them to quit, even though there is significant evidence that it actually does the opposite.
QUESTIONING THE STATUS QUO
But scientists and public health activists alike have learned that attempts to correct these wide-held beliefs on the basis of real science are met with hostility and often lead to being professionally ostracized themselves. Dr. Michael Siegel recounts his experiences disagreeing with the science used to justify smoking bans in a blog post from 2016...
it was my expression of … opinions about these studies back in the mid-2000's that led to my ‘expulsion’ from the tobacco control movement, including being … ostracized by many of my colleagues, accused of being a ‘tobacco mole’ … no longer being invited to speak at tobacco conferences … not being able to obtain further research grants, and having colleagues refuse to appear with me at conferences to discuss these or any other scientific issues...”
An emerging theory holds that nicotine isn’t the real reason public health activists vilify vaping – they’re perfectly fine with nicotine in gum, patch, inhaler, or lozenge form. The problem for them is that vaping looks like, and even sounds like, smoking (electronic “cigarettes”). Nicotine is simply the easiest, and most science-sounding excuse to wield. It doesn’t even matter if vaping can actually help people stop smoking. The real issue is that their preferred method to deal with addiction is shame and guilt. Look at the resistance to needle exchanges and decriminalizing drugs. At some point, as a society, it was decided that drugs and smoking are bad, that if you do them you are a bad person, and you deserve any bad things that happen to you. Yet time and time again we’ve seen that mindset doesn’t stop or prevent addiction. Many argue it makes it worse.
Vapers are an affront to this public health strategy. We aren’t ashamed; we’re proud that we aren’t smoking anymore, and we enjoy vaping. Public health in this country needs to check their preconceived notions at the door, look objectively at the emerging science, and embrace the things that do, in fact, improve the public’s health.