“How many more people would have lived longer, productive, happy lives if only we had been able to reduce nicotine use in society sooner.” (Brick et. Erickson, 2013, p. 95)
While taking this course, I have been able to understand the use of medications in the treatment of alcohol and drug dependence. New medications are being used for “less potential for addiction”, while the impact is detrimental by having a direct impact on the neurochemistry of addiction. I have reviewed clinical models of interventions and differential diagnosis while acknowledging how neuroanatomy and neurophysiology will determine insight for medications such as psychotropics, antipsychotics, antidepressants, etc. The focus of this paper will be a medication-assisted treatment for specifically Nicotine.
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Nicotine is a chemical that is produced synthetically. According to the Academy of Addiction Psychiatry, approximately 60% to 80% of current smokers fulfill classic criteria for drug dependence; they have difficulty stopping, withdrawal is tolerant, and continue despite knowledge of personal harm. Tobacco use is the most preventable cause of death in the United States. “Smoking causes more than 443,000 premature deaths annually among U.S. smokers alone. In addition, over 49,000 deaths per year among U.S. nonsmokers are associated with environmental tobacco smoke exposure.”(Academy of Addiction Psychiatry, 2018) When discussing nicotine one must also discuss the benefits and risks associated. There should be a changing worldview and openness to new ways Tobacco use can be dealt with it will contribute to how one must provide medications and treatment options.
According to Brick, J., Erickson, C. K. (2013), Nicotine is absorbed from the respiratory tract, membranes in the mouth, and skin. There has been incidences in which severe poisoning has occurred due to accidental contact with nicotine on the skin. This in fact shows how strong this substance is. “An average cigarette has 9 milligrams of nicotine and 12 percent goes into the bloodstream”. (Center of Disease Control, 2019) That is a substantial amount in as little as 20 seconds. Smokeless tobacco, also known as ( chaw or chew) has 5 milligrams of nicotine and it has a slower time before entering the bloodstream. The blood levels are similar due to the slow absorption. Cigars are different in a sense, they do not require inhalation, but rather smoke to be kept in the mouth. Most people tend to hold an unlit cigar in their mouth. If kept in the mouth for too long more nicotine will be absorbed, then someone who holds a cigar in their hand.
Elimination of Nicotine consists of a process of metabolizing in the body, specifically the liver and kidney. This process is about 40 minutes. (Brick, J., Erickson, C. K., 2013) About 5 percent of nicotine is excreted in the urine. The acute fatal dose of nicotine for an adult is 40-60 milligrams of pure nicotine. Within on cigarette 0.2 -2.4 survive even after combustion. Toxicity has been seen in tobacco harvesters as a result of the absorption of nicotine through the skin. (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health 2014)Nicotine can also be excreted in the milk of lactating women, which is why smoking is never advised for pregnant women as results can range from preterm birth to low birth weight. According to Brick, J., Erickson, C. K. (2013), many of the consequences may be due to a decrease in the supply of oxygen to the fetus.
According to the Academy of Addiction Psychiatry, The prevalence of Tobacco use disorders is seen in persons with alcohol and other drug use disorders (e.g., over 80% of alcoholics are current smokers). Evidence in literature indicates treating tobacco does not worsen other treatment outcomes. “Over half of the persons with alcohol/drug use disorders want help to stop smoking but do not receive such help.” (Academy of Addiction Psychiatry) According to The United States National Library of Medicine, men who use any kind of tobacco in urban areas to be 39.2 %. “The prevalence of parental smoking was 42.2% in tobacco users. There were 74.4% smokers reported who were influenced by peers for their initiation into tobacco use.” ( Fast Facts, 2019) The prevalence of tobacco use among the sample of male industrial workers were comparable to the general population.
A significant number of males in young age group are being initiated into the habit by peer influences and later becoming dependent on nicotine. (National Institute for Clinical Excellence, 2002) Restrictions on the use of tobacco products in work sites, Awareness programs on the harmful effects of tobacco, and the options available for treatment of Nicotine dependence are required to be implemented. Although with the vast majority of programs on the harmful effects of tobacco there are some ideas, such as tobacco use disorder is better left untreated. This lacks empirical support and evidence.
Nicotine causes withdrawal symptoms in many people who choose to stop. Most people can stop smoking once they make a decision to stop. People may choose to stop cold turkey ( stopping with no tapering of nicotine dose). Chemical dependence is seen within this particular substance due to the extreme difficulty in trying to stop. (Brick, J., & Erickson, C. K.2013) There is substantial scientific evidence that smoking cessation helps recovery. Research has shown that tobacco cessation does not disrupt alcohol abstinence and can increase longer-term recovery from alcohol and other drugs. (Nicotine Replacement Therapy for Quitting Tobacco) Several forms of smoking cessation include Nicoderm which is a skin patch, nicotine inhaler, and nasal sprays.
The skin patch is placed directly over the skin. It releases a low and steady amount of nicotine over time. Side effects include redness on skin, racing heartbeat, muscle pain or problems sleeping. A nicotine inhaler is a plastic mouthpiece with a replaceable nicotine cartridge inside, which is sucked on like a cigarette. Nasal sprays require a prescription. The medicine reduces cravings to smoke when a measured dose of nicotine solution is sprayed into the nose. The spray is absorbed into the bloodstream through the nasal mucous membrane. For smokeless tobacco users, certain types of NRT(Nicotine Replacement Therapy) may help more than others. If you look at the way the tobacco is used, nicotine gum and lozenges are most like using smokeless tobacco. They also let you control your dose to help keep nicotine cravings down. NRT products roughly match the amount of nicotine you typically took in through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users since NRT products are labeled for smokers. Those who use 2 to 3 cans or pouches per week would usually try the moderate doses. Those who use less than 2 would start with the lowest doses of NRT. Studies show that all forms of nicotine replacement therapy can help you quit smoking for good, and can more than double your chance of success. How helpful it depends on how much additional support you get around quilting. (Nicotine Replacement Therapy for Quitting Tobacco)
There is a medication called bupropion, which can be used as a cessation program. It is an antidepressant and reduces depression. (Brick, J., & Erickson, C. K.,2013). A new innovation in clinical studies includes a nicotine vaccination. This vaccine is able to block the drug from entering the brain. Nicotine replacement therapies also known as NRT are not as effective in reducing smoking alone. Ongoing counseling sessions to help the smoker stop is required. NRTs are useful in reducing the symptoms of withdrawals. Withdrawal symptoms include intense craving for nicotine, anxiety, weight gain, and depression. (Nicotine Replacement Therapy for Quitting Tobacco, 2018 )Symptoms of tobacco/nicotine withdrawal can be confused with or exacerbate alcohol withdrawal and caffeine intoxication; i.e., both produce irritability, restlessness, anxiety, depression. Caffeine metabolism is affected by tobacco smoking. Although with this substantial amount of means of helping an individual the best advice to give someone. (Nicotine Replacement Therapy for Quitting Tobacco, 2018 )Many pharmacologists believes that nicotine can produce serious effects on the heart even after one has gone through receiving help. Sadly the consequences of nicotine and tobacco use is severe.
There are a few cases of nicotine-induced deaths. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States. According to the CDC, more than 41,000 deaths result from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day. Smoking causes cancer, heart disease, and stroke, which includes chronic bronchitis. For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness.
According to Brick et Erickson, postmortem blood concentrations of 11-63 mg/l were seen in five adult subjects who swallowed 20-25 grams of nicotine sulfate solution. In 1967, nicotine was a major drug used in suicides in Hungary. On average, smokers die 10 years earlier than nonsmokers. (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014)Smoking continues at the current rate among U.S. youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die prematurely from a smoking-related illness. (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014)This represents about one in every 13 Americans aged 17 years or younger who are alive today. In the United States the percentage of adults aged 18 or older who are current smokers nearly 15 of every 100 non-Hispanic Blacks (14.9%), about 15 of every 100 non-Hispanic whites (15.2%), and about 21 of every 100 people with mixed-race heritage (non-Hispanic) (20.6%). (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014)This information indicates forensic considerations that should be acknowledged when speaking about this substance.
Studies of smokeless tobacco products provide some insight into the potential harms of this substance. These products provide a nicotine dose similar to that from cigarette smoking, but without the combustion. There is evidence that some smokeless tobacco products may pose less cardiovascular risk than cigarette smoking. According to The CDC, In particular, snus (Swedish moist snuff) has garnered attention as a potential harm reduction product because of its lower concentration of tobacco-specific nitrosamines and other contaminants and because of ecological observations regarding the trends in tobacco-related diseases in Sweden. ( Tobacco Use Disorder, 2017 ) NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown using NRT can nearly double the chances of quitting smoking. It hasn’t been studied as much for quitting smokeless tobacco, but the NRT lozenges may help.(National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. 2014) All forms of NRT is effective and having an understanding to which suits each lifestyle may help with the process of therapy. Tobacco may be the leading cause of preventable death in the United States but with the right resources and treatment, the mortality rate will be lowered.
Works cited
- Brick, J., & Erickson, C. K. (2013). Drugs, the brain, and behavior: the pharmacology of abuse and dependence. S.l.: Routledge Member Of The T.
- Fast Facts. (2019, February 6). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm.
- National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24455788.
- National Institute for Clinical Excellence. (2002). Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. London.
- Nicotine Replacement Therapy for Quitting Tobacco. (n.d.). Retrieved from https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html.
- Tobacco Use Disorder DSM-5 305.1 (Z72.0) (F17.200). (n.d.). Retrieved from https://www.theravive.com/therapedia/tobacco-use-disorder-dsm--5-305.1-(z72.0)-(f17.200).
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