Nicotine Containing Chewing Gum - Some Facts

A nicotine containing chewing-gum has been developed for use in the treatment of cigarette smoking. The idea was proposed by a Swedish company in the early 1970s and the gum was extensively tested in the United Kingdom and other countries before being marketed as an aid in giving up smoking. Studies showed that the proportion of smokers who could stop was doubled when they were given nicotine gum instead of a placebo. The gum is now available as prescription only medicine in a large number of countries, including the United Kingdom, Canada, Australia, New Zealand and the United States.

Chewing the non-nutritive gum, called Nicorette®, releases nicotine, and the amount of the drug released indirectly relates to the rate and intensity of the chewing. The maximum amount of nicotine that may be extracted from one piece is two milligrams, approximately the same amount obtained from a cigarette. The gum is buffered so that the nicotine is well absorbed through the buckle mucosa (lining of the mouth and under the tongue). Its effects can be felt within a few minutes of active chewing. While other products have been advertised as substitutes for cigarettes, this is the only one that actually is known to deliver nicotine. The gum is a “methadone” for cigarette smokers. As such we might make a few observations: firstly, it could be the most important new advance in the treatment of cigarette smoking in decades; secondly, its effectiveness will be disappointing unless we learn from the methadone experience; thirdly, the gum is useful because it delivers a powerful drug. Each of these observations deserves brief elaboration.

Many smokers say that they would like to stop if they could do so without excessive discomfort. The gum may well be the biggest single step in giving people the freedom of that choice. Many studies have shown that the gum significantly reduces the discomfort and desire to smoke that accompany stopping. Additionally, the gum may replace some of the pleasure and benefit derived from smoking.

Just as simply giving methadone to drug abusers without consideration of their particular problem and without supplementary treatment is not terribly effective, we can expect that similar use of the nicotine gum would produce disappointing results. The first and most obvious consideration is that the gum will probably be of little use to people who smoke only a few cigarettes. In their case the nicotine itself is relatively unimportant. Here, a simple test such as the Fagerstrom tolerance questionnaire appears to be a useful predictor.

It is likely that persons who score highly on the questionnaire (in other words, are highly dependent on nicotine itself) will be better candidates for effective treatment by the gum. There is, however, a vast array of non-nicotine factors that should be considered. For instance, it may do little good to alleviate a few days of discomfort if the person gains too much weight or becomes ineffective at work. Such people are likely to relapse. The gum should be given in conjunction with a complete program for the treatment of smoking, perhaps tied to some of the more conventional treatments listed in the appendices.

The last point is that the gum itself should be used with caution. It contains nicotine, and as we have seen, nicotine is a powerful psychoactive drug. While it is in a form that appears safer and more manageable than the nicotine delivered in conjunction with tar, CO, cyanide, and so forth, nicotine is nonetheless a drug with its own toxic effects. Persons with cardiovascular problems, and women who are pregnant, in particular, should be aware that chewing the gum involves some of the same health risks as smoking cigarettes.

The gum should not be viewed as a long term substitute. In fact, there is the proven possibility of persons becoming dependent on the gum itself. While it can be argued that these people are probably better off than they were while smoking, clearly they are still exposing themselves to an environmental toxin.