Twice as many high school students used nicotine-tinged electronic cigarettes this year compared with last year, an unprecedented jump in a large annual survey of teen smoking, drinking and drug use. (Dec. 17)
As federal regulators and state legislators race to restrict electronic cigarettes – the most effective means to quit smoking – at least two other companies are introducing alternatives that involve nicotine without the need to inhale.
Vaping, the most criticized smoking cessation option, will have a version of tobacco-free snuff to compete with starting this month. At the same time, the makers of Camel cigarettes are bringing back dissolvable nicotine lozenges.
Swedish Match’s Zyn, a flavored nicotine powder packet designed to be stuck inside a person’s lip, will be in stores across the U.S. after successful distribution in 11 states. Think chewing tobacco without the tobacco. Until now, the company was known for its “snus,” the Swedish name for snuff – or moist tobacco placed in the mouth.
The news comes as the Food and Drug Administration released more potential bad news for vaping Wednesday with reports of 35 seizures, most of them in young users.
Snus is popular in Sweden but banned in Europe because of safety concerns. It’s still safer than lighting up with tobacco. Swedish Match’s General brand is the first and so far only snus product to be approved under the Food and Drug Administration’s Pre-market Tobacco Application process, which allows companies to sell products that are less harmful than smoking.
It is awaiting possible approval under another FDA process governing labeling of new tobacco products that have an overall benefit to health.
The introduction of tobacco-free snuff is especially notable because it offers people who want to quit smoking another option that doesn’t require standing in the cold outside office buildings. That’s a practice that even vapers often have to do now.
There’s also the risk of scary side effects of the now-generic prescription medication known as Chantix.
States and companies are increasingly relegating vapers to the outdoors.
“They treat vaping exactly the same as cigarettes here,” says Diana Franklin of Oregon City, Oregon, who is about to quit vaping.
The potential market for smoking cessation products is “immense,” says Boston University public health professor Michael Siegel, an epidemiologist: About 97% of the 38 million people who smoke say they want to quit.
Swedish Match isn’t allowed to market Zyn as a quit-smoking product, but University of Louisville professor Brad Rodu calls its introduction “fantastic.”
“It’s a great opportunity for smokers who need a palate of products available to give them every opportunity to quit,” says Rodu, whose research is supported by unrestricted grants to the university by tobacco companies. “As an oral pathologist, I want to help as many smokers as I can to step away from the fire and don’t care if they use nicotine for the rest of their lives.”
Vaping was far more effective in getting people to quit smoking among over-the-counter nicotine replacement therapies, a randomized trial including nearly 900 people in the February issue of the New England Journal of Medicine showed.
After one year, the tobacco-free rate for the vaping group was 18%, while it was just under 10% in the group that used therapies including patches, gums and lozenges.
Vaping also doesn’t come with the mental health side effects of prescription drug Chantix or generic varenicline for tobacco cessation.
Clinical trials have shown far higher effectiveness rates for prescription and over-the-counter tobacco cessation products because companies create “the best possible environment” for use, Rodu says.
His 2017 analysis of smokers who tried to quit in 2013 and 2014 found vaping was 43% more effective in getting people to stop than going cold turkey and far higher than any other product – including prescription drugs.
The report was published in the International Journal of Environmental Research and Public Health. “Other tobacco products” were almost as effective, but there were so few people using snuff, chewing tobacco and other types of tobacco that the success rate was not statistically significant, Rodu says.
“Many people are unhappy with their smoking habits, and fewer people are finding satisfaction with products,” says Gerry Roerty, Swedish Match’s general counsel in the U.S. “Even though we are able to tell cigarette smokers (snus) is a much better alternative, the product has tobacco, and tobacco has a stigma.”
Zyn also addresses FDA’s push for products that doesn’t attract kids.There’s no evidence – yet – that young people are attracted to snuff, and Zyn purchasers have to be 21 rather than 18, which is the age requirement for e-cigarette purchases in most states.
Nicotine is highly addictive, and quitting presents its own risks of anxiety and depression. Vaping is more addictive than smoking because the concentrated liquid form is more quickly metabolized, says Dr. Malissa Barbosa, the area medical director at CleanSlate Outpatient Addiction Medicine in Orlando,
But its use wasn’t a big concern at the FDA until the spike in vaping among non-smoking teens. FDA Commissioner Scott Gottlieb called it an “epidemic” for the first time last fall.
Public health officials fear vaping could erase the huge public health gains in reducing smoking by turning a new generation of young people into nicotine addicts.
Buddy Mixon, who quit smoking the day after he started vaping eight years ago, spends much of the day in his truck working as a construction safety specialist. So, on-the-job nicotine use is not a problem now – but he acknowledges it has been in the past.
He says he understands why people might want Zyn.
“I can certainly see its attractiveness,” says Mixon, of Snellville, Ga. “If i was ever concerned vaping would get me fired, I would think about it, but vaping is so easy to hide. I would stealth-vape at my desk.”
The Campaign for Tobacco-Free Kids recommends people who are trying to quit smoking consult with their doctors and stick to methods “approved by the FDA as safe and effective, such as the nicotine patch and gum,” spokesman Vince Willmore said.
The FDA has been more flexible, which prompted health groups to sue the agency over changes to the deadlines for enforcing the stricter marketing approvals. Willmore says the FDA should require new products to undergo FDA review and “demonstrate a public health benefit in order to stay or get on the market.”
“The FDA is envisioning a world where cigarettes can no longer create or sustain addiction, and where adults who still need or want nicotine can get it from alternative and less harmful sources,” Gottlieb said last fall. He has criticized e-cigarette companies and proposed tough restrictions on the sale of flavored versions.
• Prescription drugs. Chantix, now available in generic form as varenicline, was the most widely used prescription drug in Rodu’s study. But it comes with such serious side effects that drug safety advocate Kim Witczak fought the removal of its “black box” warning about the risk of suicidal thoughts, violence and aggression. The drugmaker persuaded the FDA to remove the warning after it settled what Witczak estimates were about 2,700 lawsuits for about $300 million. Wellbutrin, available in generic form as bupropion, is prescribed for smoking cessation as well as depression.
• Nicotine replacement therapies. Nicotine gum, patches and lozenges were no more effective in turning people into former smokers than going cold turkey, Rodu’s research found. Franklin says she didn’t have any luck with gums and lozenges either. She still found herself “anxious and surly and grrrr.” It wasn’t withdrawal, she says, as much as the mental challenge of not having “that satisfying signal” when smoke or vapor creates “a throat hit.”
Now, however, Franklin has only a few days before she has to quit vaping a month ahead of her scheduled knee surgery on May 6. The doctor recommended she do so to improve her vascular function and she has almost reduced the amount of nicotine in her vape to zero.
Franklin’s motivation extends far beyond her knee, however. Her mother was a lifelong smoker who needed a heart valve replacement about three years ago. Franklin tried to persuade her to quit smoking and try vaping, but her mother couldn’t commit to it.
She died in January 2016.
Says Franklin: “Tobacco is a very strong drug.”
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