Tobacco/nicotine Dependence and Cessation Therapies

Article excerpt

Nicotine dependence is the most common form of chemical dependence in the United States.

-American Society of Addiction Medicine, 1997

INTRODUCTION

Nicotine, an alkaloid, has been a part of human culture for unnumbered centuries, but recently it has appeared in new forms. It was Ions encountered as a component of the leaves of the tobacco plant, Nicotiana tabacum. Now it has appeared on shelves of pharmacies, first as the active agent of prescription medicines, and now even in nonprescription products for self-medication. A highly remarkable aspect of this event is the fact that nicotine clearly is the agent having the highest intrinsic acute lethality of all the OTC products in a pharmacy. At least one death has been attributed to the excessive effects of an OTC nicotine product. This alone should signal that pharmacists need to be knowledgeable about the pharmacology and toxicology of nicotine and alert to instructing users of such products on the proper conditions for their safe use.

Pharmacists should be so aware of the varied hazards to health from tobacco use as to be persuasive educators against its use. Smoking tobacco has long been recognized as a major cause of morbidity and mortality, responsible for an estimated 434,000 deaths annually in the United States. Moreover, it is not merely the smoker, but indeed all persons breathing environmental tobacco smoke (ETS), who are at risk.

The initiation of smoking by adolescents is now of great concern, but smoking also has become an important issue of women's health. A 1996 report from the Addiction Research Center, National Institute on Drug Abuse, dealing with nicotine dependence in women, declared that cigarette use is women's most preventable risk of death in the United States, accounting for the deaths of about 140,000 women annually. Despite the publicizing of health risks, women continue to start smoking and to persist at high rates.

In 1566, tobacco was sent to the Queen of France to treat her migraine headaches. In a few more years it had gained the reputation of a wondrous panacea. By 1610, the English writer Sir Francis Bacon stated that nonmedical "tobacco use is increasing" and that it is "a custom hard to quit."

Soon there was a rampant spread of nonmedical tobacco use from Europe to the Mideast and Asia. By 1647, a Turk wrote that tobacco had joined coffee, wine, and opium as "four cushions on the sofa of pleasure." Thus, tobacco properties that we now call reinforcement and psychological dependence were recognized quite early.

WHY QUIT?

Acute pharmacology and toxicology In 1665, an experiment was reported to the British Royal Society in which it was observed that a cat quickly died when fed "a drop of distilled oil of tobacco." However, it was not until 1828 that the fully purified alkaloid from tobacco, nicotine, became available. This allowed two medical students at Heidelberg, Germany, to study its pharmacology and soon reach the conclusion that it was indeed a dangerous poison.

Confirmation of potential for acute lethality of tobacco to human beings has issued from various unfortunate episodes, such as the use of enemas of an infusion of tobacco as an anthelmintic remedy for children. Additional acute poisonings occurred with the former availability and use of nicotine as an agricultural poison; for example, a 40% solution of nicotine sulfate was used as an insecticide ("Black Leaf 40").

Fatalities likely resulted from paralysis of the respiratory muscles. In current times, the so-called "green tobacco illness" still occurs among laborers in tobacco fields. As a consequence of skin contact with green tobacco leaves, there may be excessive exposure to and cutaneous absorption of nicotine, with resulting acute toxic manifestations.

Early in the development of the concept of receptors, certain ones were found to respond to nicotine and thus came to be termed nicotinic receptors. …