>I've been using 2mg nicotine gum for several years after quitting tobacco products. I haven't noticed any long term effects. If my dosage stays low, are there any long term issues I may experience?

Congratulations on staying quit! By stopping smoking you have significantly reduced your likelihood of long-term harm. There is little and inconsistent evidence for long-term harm from low doses of nicotine from gum in adults. Nicotine - including nicotine from gum - can be harmful for the developing brain, which includes young and pregnant people.

I'm in the same boat. I don't like that I still use nicotine, but it's good to hear I'm not likely to lose my jaw to mouth cancer from it.

I’d recommend searching Dr Attia and Dr Huberman who have both separately spoke on their podcasts regarding the use of nicotine (outside of smoking) and it’s potential benefits and health risks.

>Hello everyone! Thank you for having this AMA. I have a question about strategies on quitting smoking for a family member who has been smoking for 40+ years and has tried quitting countless times, but is unsuccessful. He's unsure about using e-cigarettes and nicotine replacement products. What would you recommend to do?

It’s great that you are thinking about this and how to support your family member. The “gold-standard” treatment for quitting is nicotine replacement products or a prescription for Varenicline. This doesn’t work for everyone and often takes many attempts, but tends to get easier each time someone tries. E-cigarettes are a safer alternative to cigarette smoking, especially for people who have a hard time quitting. E-cigarettes have only been around since 2007 so we are still learning about what their long term effects are. Current research supports harm reduction.

>There's been a few studies about the benefits nicotine can have for dopamine related conditions like
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>ADHD
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> and
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>Parkinson's
>
>. Do you think there's a possibility that the benefits of just nicotine (not tobacco) could outweigh the negatives for these kinds of conditions? How do the costs and benefits of nicotine compare to costs and benefits of drugs like adderall and L-Dopa?

Caveat, the people answering in the room are not experts in ADHD or Parkinson’s and their relationship to smoking. We will try to track down better answers later and respond directly.

Our initial thoughts are that nicotine has similar properties to stimulant medications, like Adderall. Stimulants can actually help smokers with ADHD quit smoking. Research on costs and benefits can be challenging because of the healthcare system and due to ethical considerations (if you have a medication that works you would need a good reason to give someone nicotine instead in a drug trial).

That is very interesting as schizophrenia is linked with nicotine use and ADHD. The vast majority of schizophrenics smoke at some time in their lives, many citing that it helps with symptoms though the research is inconclusive. Schizophrenia and ADHD have high comorbidity rates. Not to mention that psychosis can be a symptom of Parkinson's. Ah, that wiley dopamine!

>I saw you mention in another comment that vape/e-cigs are "less harmful" than smoking? Did I get that right? Can you provide me verifiable information on this? I've smoked on and off for years, and frankly of all the addictions I've quit in my life, nicotine is the hardest. I've been sceptical of vape, because of its relative newness. But the times that I turned to vape, it definitely made my lungs feel "better", relatively to smoking.
>
>If I was confident in its safety, I would definitely return to it as an alternative.

Current research shows that e-cigarettes, especially newer generations, contain less harmful chemicals than combustible cigarettes. However, we do not know the long-term effects of e-cigarettes on health (they’ve only been around since 2007 and issues could take longer to show up). Those who regularly smoke cigarettes and switch to e-cigarettes (even partially) are more likely to quit smoking altogether and have fewer cancer-causing chemicals in their blood. A lot of recent research has been summarized in a recent paper: https://doi.org/10.1186/s12931-021-01737-5 . But this field is changing quickly as we learn more so it’s important to stay vigilant!

>When comparing cigarettes to vaping, how to you do an apples to apples comparison for qty and nicotine levels. For and example a Marlboro red equals X MG of nicotine per cigarette. How may mil of e-juice at what nic level would be equal?
>
>This would be good to know if you are using vaping to quit and lower your nic dosage.

This is a question our research field struggles with because nicotine content does not equal what gets into the blood. Part of the difficulty is that there are differences between people and products (see our response here: https://www.reddit.com/r/IAmA/comments/10jkffc/comment/j5licye/?utm_source=share&utm_medium=web2x&context=3). The best research on this looks at the actual concentration of nicotine that gets into the bloodstream. For example, the nicotine salts in e-liquid and their concentration were closely designed to match the nicotine delivery of a cigarette (see this chart from the patent filing from Pax labs, the company that spun off JUUL: https://patentimages.storage.googleapis.com/11/28/4a/9dc40046044330/US09215895-20151222-D00004.png).

>It is often claimed that cigarettes have hundreds of addatives. Are these chemicals actually added to the product in manufacturing, or is the number derrived from it chemical change of organic matter (C,H, and O recombining in every permutation?)

Chemicals are added to products during manufacturing to improve the flavor, make smoking less harsh, and help the cigarette burn slowly and not go out, among many other reasons. Additional chemicals are produced when cigarettes, including these added chemicals, are burned.

>I've finally quit nicotine after 5 years of vaping. After being clean for over a month, I still get random and intense cravings for nicotine. Is there any data on how long it will take before these cravings completely go away?

Great question and congratulations on quitting! Craving and other withdrawal symptoms typically peak on the 3rd day and then stay high for 3-4 weeks before starting to taper off. However, it can persist for longer periods of time. For people who experience cravings for a longer time, nicotine replacement products can help people stay quit during difficult times.

>What are your views on tobacco-free nicotine pouches (e.g., On!)? I quit smoking 8 years ago by switching to nicotine pouches, but I am admittedly completely addicted to these and go through a pack a day. I imagine these are safer than regular cigarettes but there is still a risk element to them.

These products are new to the market and there is still a lot of work that needs to be done. Some of that work is being done here at Brown! Preliminary findings show that it is a helpful and acceptable alternative for adults who smoke combustible cigarettes and have not otherwise been able to quit. The few studies that have been conducted on nicotine pouches have found far fewer cancer-causing chemicals compared to other tobacco products like snus but the short- and long-term effects of nicotine pouches aren’t clear.

>Nicotine is used as a nootropic. What is your position on the beneficial effects of nicotine?

Nicotine has stimulant properties and some people who use nicotine and tobacco products do report using them for “cognitive enhancement.” There is limited research supporting these findings in very specific circumstances (like offsetting the negative effects of other substances, see: https://psycnet.apa.org/record/2015-00012-001 or https://onlinelibrary.wiley.com/doi/full/10.1111/add.13342). HOWEVER, while nicotine may provide some of the short-term positive effects that are associated with stimulant drugs like adderall, it is a chemical that can lead to dependence and long-term harm, including to cognition, and therefore we would not recommend using nicotine as a nootropic.

>What are some main differences between salt nicotine E-juices, and regular E-juices?
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>With the rise in vaping globally and not enough long term data or studies to show effects, has the short term data yielded any valuable insights into the effectiveness of the practice as a quit smoking aid or any potential health risks/long term effects?
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>What is your take on new zealands ban on nicotine products for thise born after 2008?

Nicotine salts are less harsh to vape than freebase (traditional) e-liquid. Manufacturers developed these products to increase nicotine concentrations while still making e-cigs enjoyable to use. Freebase e-liquids usually topped out at 24 mg/mL while most nicotine salt e-liquids are 50 mg/mL. Nicotine salts aren’t safer than freebase e-liquid.

E-cigarettes may help assist with quitting for adults who are struggling to quit.

New Zealand’s ban aims to protect minors from becoming cigarette smokers while still giving dependent adult smokers access to products that can reduce harm or help them quit.

>2 questions: first, is nicotine inherently harmful? Second, a light smoker is considered someone who smokes less than 10 per day, is there research on people who smoke even less than this, e.g. "socially?"

Copying part of our response above, there is little and inconsistent evidence for long-term harm from low doses of nicotine in adults. Nicotine - including nicotine from gum - can be harmful for the developing brain, which includes young and pregnant people. For your second question, yes there has been research focused on light, intermittent smokers, sometimes called ”chippers” in our field. Check out some of the research by Saul Shiffman.

>How come some people get lung / throat cancer after barely smoking/ vaping, but my uncle Scott has smoked for like 60 years and is seemingly invincible?

Uncle Scott won the genetic lottery! 50% of people who smoke will die from a smoking related cause. 80-90% of lung cancer is related to smoking.

>Is it known what percentage of cravings a person has in a typical day for tobacco is the result of actual withdrawal vs habit?

This is a great research question! It can be helpful to think about craving, withdrawal and habit as “motives” for smoking (in other words: what drives people to use). Some other motives include: automaticity (smoking mindlessly), coping with negative emotions, affiliative attachment (seeing cigarettes as a ‘friend’), among others. There is a lot of research looking at how these motives relate to each other and to smoking (for example: https://journals.sagepub.com/doi/full/10.1177/2167702620978614) but there is still a lot of work to be done.

>Hi there thank you for answer any and all questions. My question is regarding cigar smoking. I enjoy on average 3-4 cigars a month, summer time maybe closer to 7-8 a month. Obviously with any type of smoking I understand that I have a higher chance of lung cancer than not smoking at all, but what type of long term negatives should I be aware of and how dangerous is it to have on average 3-4 cigars a month? Thank you

Regular cigar smokers have increased rates of oral cancer, esophageal cancer, and laryngeal cancer. More research on intermittent cigar smoking specifically would be helpful, but in its absence we can talk about light and intermittent cigarette smoking. Light and intermittent smoking has nearly the same impact on cardiovascular health as daily smoking. The risk for cancer is more dose-dependent, but there is still a large jump in risk versus non-smoking.

>Hello! How unhealthy are nicopods? They're these nicotine pouches that you put under your upper lip. Usually the substance in the pouch is just glucose powder, sometimes with a flavour but usually flavourless. + The nicotine of course.

We answered a similar question above: https://www.reddit.com/r/IAmA/comments/10jkffc/comment/j5ld6ug/?utm_source=share&utm_medium=web2x&context=3

>Are pipe tobacco and cigars less damaging than cigarettes? I’ve heard people say they don’t have all the additives (I don’t know if that’s true).

No, pipe tobacco and cigar smoke still contain many harmful toxicants and carcinogens, and regular cigar smokers have increased rates of oral cancer, esophageal cancer, and laryngeal cancer.

>I smoke the lightest of the lightest available. It's like smoking air. Anything higher than that, I can't deal with. Does it make any difference?

We're back answering some lingering questions.

Unfortunately, no! “Light” cigarettes aren’t any safer than regular cigarettes. This was a marketing technique used by tobacco companies to make cigarettes appear safer, but research shows that tar exposure from a light cigarette can be just as high from a regular cigarette.

>I have seen nicotine inhalers sold over the counter in Canada (Amazon search) yet they are not sold in the US, from what I can tell. Are these inhalers effective and if so, do you know why they are not sold in the US?

We’re trying to answer some lingering questions! In the U.S. you need a prescription from your doctor for nicotine inhalers but they are available. Nicotine inhalers are a useful NRT because many people who smoke are used to receiving nicotine hand-to-mouth which can reduce craving separately from just the nicotine that is delivered.

>Cold withdrawal doesn't work for me, i also tried nicotine gum, vaping and patches.
>
>I won't try questionable methods like hypnosis either.
>
>What alternatives do you suggest for giving up smoking long-term?

We're trying to answer some lingering questions! Have you talked to your doctor about trying Varenicline (Chantix, see our comment here for a description: https://www.reddit.com/r/IAmA/comments/10jkffc/comment/j5l61a5/?utm_source=share&utm_medium=web2x&context=3) or using multiple NRT methods like the patch for general all-day nicotine abstinence relief and possibly nicotine gum during times where you need more immediate craving relief? The biggest predictor of long-term quitting is the number of quit attempts. Quitting takes practice, and many individuals have to try multiple times before being successful. The most important thing is to keep trying. Every attempt matters! Another possiblity is working with a psychologist specializing in substance use or someone certified in tobacco cessation. As we noted in another comment (https://www.reddit.com/r/IAmA/comments/10jkffc/comment/j5l7zvf/?utm_source=share&utm_medium=web2x&context=3), there are many things that can make quitting more difficult in your everyday life and a lot of work has been done developing strategies that can help.

>I recently quit vaping after 7 years, and I currently use 6mg pouches. My question is, how would you say vaping’s health consequences compare to smoking, or say patches/gum?

We are still in the very early stages of understanding the long-term health consequences of vaping (it has only been around for 15 years) and are nowhere near that for oral nicotine pouches (although data on Snus can provide some insights). To the best of our knowledge, without going too deep into the nuances: gum / patch > oral nicotine pouch (leaf free) > vaping > oral pouches with leaf > smoking.

>I’ve never been a big tobacco user, but lately I’ve been using camel snus pouches. How bad are these for me?

See our response here: https://www.reddit.com/r/IAmA/comments/10jkffc/comment/j5uw831/?utm_source=share&utm_medium=web2x&context=3

>Now that nicotine and smoking are declining, has lung cancer dropped in a similar rate?
>
>I heard from a cancer nurse HPV is now one of the suspected causes of lung, but especially throat, mouth cancers that used to be blamed on tobacco.

Smoking and lung cancer rates are declining. Some but not all of the decline in cancer rates is likely due to smoking. However, some groups of people, such as women and some racial/ethnic groups (e.g., Black/African Americans), still have high rates. Smoking is still the number one cause of preventable disease and death in the US (450,000 last year). 80-90% of lung cancer deaths are attributable to smoking.

>I (M58) and I'll have stopped smoking 3 years ago in the summer after 40 years of 20ish a day habit. I do still use nic salt vapes.
>
>Does the effect\damage of smoking stay with me (and my lungs) for life?

Congratulations on 3 years of staying quit! Your lungs begin to heal and improvements can be seen as soon as a few weeks after quitting. 20 years after quitting, the risk for most cancers in former smokers is equal to the risk for cancer in people who have never smoked.

>It's often said that smoking relieves stress, is this true? What factors make it so difficult to quit smoking other than addiction?

This is a great question! Stress relief is one of the main reasons people continue to smoke. On the other hand, nicotine is a stimulant that actually increases how “activated” your body is. In other words, it can relieve stress in the short term, but long term use can increase stress (which is one of the reasons it is related to anxiety and depression). There are a lot of things that can make quitting difficult. Craving, stressors, reminders in your everyday life, habit, routine, having a partner/peers/family member who smokes, loneliness, and smoking to cope with other challenges can all make quitting more difficult.

>I've found that nicotine patches provide a kind of topical anti-inflammatory function. I use them on my knee when it gets sore and it works like a charm.
>
>Is there any evidence that would support this concept?

Nicotine can be anti-inflammatory in some situations, but it can also make things worse in other situations (especially oral inflammation). It’s always important to weigh the beneficial and harmful effects in a conversation with your medical provider.

>What's inherently so bad about nicotine? Yes it's toxic but so is caffeine. Why don't we have nicotine drinks or something similar to wean people off nicotine in a slow controlled manner?

Copying part of our response above: you are right that there is little and inconsistent evidence for long-term harm from low doses of nicotine in adults. However, nicotine can be especially harmful for the developing brain (which includes young people and the developing fetus). The biology of nicotine dependence is different from caffeine. Brain changes from nicotine are larger than from caffeine. Nicotine replacement therapies (such as patch, gum) help people wean off nicotine in a slow and controlled manner. A nicotine drink is an interesting idea!