CASA: Thank you Colin Mendelsohn
for making time to be with us. Kindly introduce yourself, for those that may not be familiar with your work.
Colin: Hi. I am a medical practitioner,
tobacco treatment specialist, Associate Professor in the
School of Public Health & Community Medicine at Uni of New South Wales, Sydney and founding chairman of the @ATHRA_AU. I am especially interested in tobacco harm reduction.
CASA: Our first question for today, what is Nicotine?
Colin: Nicotine is a natural chemical found in tobacco plants which may have a role as an insecticide. It is also in some other plants in smaller doses eg tomatoes. Nicotine is the main addictive chemical in tobacco smoke but has only minor harmful health effects.
CASA: Where do nicotine vapor liquids, nicotine patches and nicotine gum get their nicotine from?
Colin: Nicotine is extracted from the leaf of tobacco plants grown on tobacco farms. It is purified and used in nicotine patches and gum etc and vaping liquids. Synthetic nicotine made in a laboratory is now available but is still too expensive for widespread use.
CASA: What causes the most harm in cigarette smoking? Is it the nicotine or combustion?
Colin: Many people incorrectly think nicotine is the harmful chemical in smoke. In fact, almost all the harm is caused by the thousands of toxins produced by burning tobacco. Nicotine is a mild recreational stimulant with few significant health effects, like caffeine.
CASA: Interesting. Which brings us to the next question. Does nicotine cause cancer?
Colin: Nicotine has been associated with tobacco smoking and people have incorrectly assumed it is the toxic component. This is a persistent myth which has been around for decades. No. Nicotine is not believed to be a carcinogen in humans. There is some laboratory evidence that it may promote an existing cancer. However long-term studies in humans using nicotine in snus (oral pouches) or patches have NOT found any increased cancer risk
CASA: There have been those that allege Nicotine causes heart disease. Does nicotine cause heart disease?
Colin: Nicotine does have some cardiovascular effects, but these are relatively minor compared to smoking. A recent study funded by British Heart Foundation found smokers who switch to vaping have significantly reduced heart attack and stroke risk within one month.
CASA: Is nicotine harmful in pregnancy?
Colin: Nicotine patches, gum, vapes or oral pouches are always safer than smoking in pregnancy but may have some risk. Nicotine has been linked to harm in animal studies eg low birth weight, effect on brain & lung development, but no good evidence of harm in humans
CASA: Right. So is nicotine addictive?
Colin: Nicotine is the main addictive chemical in tobacco smoke as it is delivered rapidly in high doses to the brain. There are other chemicals in smoke eg MAO inhibitors which make nicotine more addictive. Nicotine from vaping is less addictive than from smoking
CASA: Does nicotine have beneficial effects?
Colin: Nicotine has positive and enjoyable effects. It improves concentration, memory, alertness and can give short-term relief of anxiety and depression. It also helps with weight control. It is beneficial for schizophrenia, Parkinsons dis, ADHD, ulcerative colitis
CASA: The @WHO recommends nicotine gum and nicotine patches! Can nicotine help wean smokers off cigarettes?
Colin: Nicotine replacement products are safe and are recommended as first line treatments for quitting. They reduce cravings and nicotine withdrawal. However, success rates are low. They do not help with the smoking ‘habit’ and relapse rates are high.
CASA: Not all smokers are ready to quit. There are individuals who want to reduce harm without giving up nicotine! What would you recommend?
Colin: They should consider switching to safer nicotine products eg #vaping. They can continue to enjoy nicotine and the smoking habit and sensations, without most of the toxins in tobacco smoke. It is important to stop smoking completely for the full health benefit.
CASA: Can nicotine containing e-cigarettes and nicotine pouches help smokers quit smoking
Colin: Yes. There is now convincing evidence that these products can help smokers quit. Vaping is twice as effective as nicotine patches and gum. Nicotine pouches (#snus) are increasingly popular and have been shown to be much more effective than other quitting aids
CASA: Lastly, are nicotine containing electronic cigarettes and nicotine pouches safer than traditional cigarettes?
Colin: Nicotine vaping and pouch products are not risk-free but are much safer than smoking, probably at least 95% safer. Smokers who switch get far fewer toxins compared to smoking and at much lower doses. They are healthier, feel better and save a lot of money!