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The Quest for Pharmacotherapies to Treat Tobacco Use Disorder

Apr 1st, 2020
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More than Smoke and Patches: The Quest for Pharmacotherapies to Treat Tobacco Use Disorder

http://pharmrev.aspetjournals.org/content/72/2/527.long

Abstract

Tobacco use is a persistent public health issue. It kills up to half its users and is the cause of nearly 90% of all lung cancers. The main psychoactive component of tobacco is nicotine, primarily responsible for its abuse-related effects. Accordingly, most pharmacotherapies for smoking cessation target nicotinic acetylcholine receptors (nAChRs), nicotine’s major site of action in the brain. The goal of the current review is twofold: first, to provide a brief overview of the most commonly used behavioral procedures for evaluating smoking cessation pharmacotherapies and an introduction to pharmacokinetic and pharmacodynamic properties of nicotine important for consideration in the development of new pharmacotherapies; and second, to discuss current and potential future pharmacological interventions aimed at decreasing tobacco use. Attention will focus on the potential for allosteric modulators of nAChRs to offer an improvement over currently approved pharmacotherapies. Additionally, given increasing public concern for the potential health consequences of using electronic nicotine delivery systems, which allow users to inhale aerosolized solutions as an alternative to smoking tobacco, an effort will be made throughout this review to address the implications of this relatively new form of nicotine delivery, specifically as it relates to smoking cessation.

Significance Statement Despite decades of research that have vastly improved our understanding of nicotine and its effects on the body, only a handful of pharmacotherapies have been successfully developed for use in smoking cessation. Thus, investigation of alternative pharmacological strategies for treating tobacco use disorder remains active; allosteric modulators of nicotinic acetylcholine receptors represent one class of compounds currently under development for this purpose.

Posted in: Addiction, Health, Review.

Retail Outlets and Point-of-Sale Marketing of Alternative Tobacco

Apr 1st, 2020
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Posted in: Article, Tobacco Control, Vaping Control, Youth Smoking, Youth Vaping.

Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation

Apr 1st, 2020
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https://journals.lww.com/pccmjournal/Citation/2020/04000/Severe_E_Cigarette,_or_Vaping,_Product_Use.11.aspx

Abstract

Objectives:

To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.

Design:

Case report.

Setting:

PICU in an academic medical center.

Patients:

A 16-year-old girl presenting with gastrointestinal and respiratory symptoms was admitted to our PICU after having progressive respiratory failure and bilateral pulmonary ground-glass opacities on chest CT.

Interventions:

Venovenous extracorporeal membrane oxygenation

Measurements and Main Results:

After extensive infectious workup was unrevealing, she reported a history of vaping e-cigarette containing either nicotine or delta-9-tetrahydrocannabinol oil prior to symptom onset. She was given a presumptive diagnosis of e-cigarette or vaping product use-associated lung injury. The PICU team in consultation with pulmonology and medical toxicology started high-dose IV methylprednisolone 1 mg/kg bid. Despite initial improvements, she continued to require positive pressure ventilation and developed pneumomediastinum with progression to tension pneumothoraces and a persistent air leak. Unable to maintain her oxygenation, she was placed on venovenous extracorporeal membrane oxygenation for a prolonged course and had a tracheostomy placement. The clinical course, severity, and range of interventions in affected patients around the country have varied widely. Respiratory symptoms have been the most severe, but the constellation of symptoms in e-cigarette or vaping product use-associated lung injury include constitutional symptoms (fevers, weight-loss) and gastrointestinal symptoms (nausea, vomiting, diarrhea). In many cases, steroid use led to rapid clinical improvements. However, other cases with severe illness, like our patient, necessitated high-dose IV steroids, intubation, and venovenous extracorporeal membrane oxygenation. The underlying etiology and pathophysiology of e-cigarette or vaping product use-associated lung injury remains unknown. The Centers for Disease Control and Prevention in conjunction with state/local health departments and the Food and Drug Administration is actively investigating the outbreak.

Conclusions:

Clinicians need to be aware of the current outbreak of e-cigarette or vaping product use-associated lung injury and ask about vaping in patients presenting with gastrointestinal and respiratory symptoms. Treatment options are anecdotal and necessitate a multidisciplinary approach.

Posted in: Health Risks, Study, Youth Vaping.

FTC Sues to Unwind Altria’s $12.8 Billion Investment in Competitor JUUL

Apr 1st, 2020
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Posted in: Companies, Law Suits.

Third of NZ students have tried vaping, despite most being non-smokers

Mar 31st, 2020
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http://www.voxy.co.nz/health/5/361613

New research shows that more than a third of New Zealand high school students have tried vaping even though nearly two-thirds of those doing so have never smoked cigarettes.

Vapes, or electronic cigarettes, are not recommended for non-smokers, as the long-term effects are not known, and vapes containing nicotine are likely to be addictive.

“Vaping is not as harmful as smoking, but it is not harmless. Taking up vaping is not a good idea for people who are not otherwise smokers, particularly young people,” says study co-author Dr Terry Fleming from Te Herenga Waka-Victoria University of Wellington’s School of Health.

The study is the first in New Zealand to look at vaping in high school students of all ages. It found 65 percent of teenagers who had tried vaping reported they had never smoked cigarettes, as well as 48 percent of those who said they vaped regularly. Overall, 38 percent of teenagers reported they had tried vaping, 10 percent said they vaped regularly, and 6 percent vaped weekly or more often.

The research also shows vaping is relatively common for students in all school deciles, whereas smoking is now rare in higher decile schools.

“Vaping seems to appeal to a wider range of young people than smoking and unlike smoking it is more common in boys than girls,” says Dr Fleming.

Recently published data from another New Zealand study shows the long-term decline in smoking among Year 10 students that began in 2000 stalled from about 2015 and may even be reversing, particularly in MÄori and low decile schools.

“When you put these findings together, it calls into question the idea that vaping is displacing smoking. The alternative possibility, that vaping is fuelling smoking, must be taken seriously by communities and policymakers,” says study co-author Associate Professor Terryann Clark from the University of Auckland.

Researchers say measures to protect youth, particularly MÄori and disadvantaged youth, from both vaping and smoking harm are needed, such as limits on where vapes and tobacco can be sold and a ban on vaping advertising and sponsorship, including online and social media promotion.

The research is timely, as the Government is currently consulting on new vaping regulations announced earlier in the month.

“New Zealand has fewer restrictions on promoting vaping and on vape flavours than many other countries. Supporting smokers to step down to vaping and non-smokers to stay that way are both important-this is possible with good policy and leadership,” says Dr Fleming.

The research is part of the Youth19 survey, which aims to collect data on a range of issues affecting New Zealand youth. Further results from the survey will be available over the coming year. This survey is a collaboration between Te Herenga Waka-Victoria University of Wellington, the University of Auckland, the University of Otago, and AUT.

Posted in: Gateway Drug, New Zealand, Vaping Control, Youth Vaping.

Analyzing big tobacco’s global youth marketing strategies

Mar 31st, 2020
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Posted in: Nigeria, Research Paper, Tobacco Advertising, Tobacco Control, Youth Smoking.

Quit smoking immediately to reduce the risks of COVID-19

Mar 31st, 2020
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https://www.smokefree.hk/en/content/web.do?page=news20200331

In view of the latest epidemic development of Coronavirus Disease 2019 (COVID-19) across the globe, Hong Kong Council on Smoking and health (COSH) advised the general public to stop using any kinds of tobacco products including conventional cigarettes, electronic cigarettes, heat-not-burn tobacco products and waterpipe tobacco immediately. Mr Antonio KWONG, COSH Chairman said, “Study of COVID-19 cases revealed that smokers are associated with higher risk of getting severe symptoms than non-smokers. Also, smoking at home increases the risk of secondhand smoke (SHS) exposure among family members, especially young children. COSH reminded the public not to initiate smoking and smokers must quit smoking now to safeguard their health.”

There is a misleading claim that “smoking could help prevent COVID-19”. The World Health Organization had already clarified that the statement is false, and scientific evidence has also emerged to show that smoking may increase the risk of the infection. According to a review study on COVID-19 cases in China, smokers were 1.4 times more likely to have severe symptoms of COVID-19 and approximately 2.4 times more likely to be admitted to an Intensive Care Unit, need mechanical ventilation or die compared to non-smokers. Since smokers are unable to wear a surgical mask or avoid contact with the mouth and nose while smoking, it might increase the risk of spreading COVID-19 and viral infection.

According to COSH’s Tobacco Control Policy-related Survey conducted from February to June 2018, among all respondents, 15.1% lived with at least one smoker and 13.8% reported SHS exposures at home in the past seven days. Evaluation Study on “School Interactive Education Theatre Programme 2018-2019” reflected that 34.6% of children exposed to SHS at home in the past seven days. Members of the public are urged not to smoke at home to protect family from SHS exposure, as well as to minimize the risk of smoking-related fire accidents while staying home for prevention of COVID-19.

Some of the recent confirmed COVID-19 cases in Hong Kong traced to visits to bars, expert in communicable diseases warned that the use of waterpipe tobacco in bars might increase the risk of infection transmission among users. Smoke of waterpipe tobacco contains numerous toxicants including tar, carbon monoxide, heavy metals and carcinogens. A research found that one-hour waterpipe smoking session exposes the user to 100 to 200 times the volume of smoke inhaled from a single cigarette. COSH emphasized that there is no safe and harmless tobacco product. All people should reduce social activities, maintain good personal hygiene and develop healthy habits for reduction of disease risk. COSH highly recommended smokers to stop smoking as soon as possible to maintain a healthy lifestyle. Smokers can call the Integrated Smoking Cessation Hotline (Department of Health) 1833 183 for professional assistance if necessary.

Posted in: COVID-19, Health, Health Risks, Hong Kong.

Big Tobacco criticised for ‘coronavirus publicity stunt’ after donating ventilators

Mar 30th, 2020
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Posted in: COVID-19, Philip Morris.

Raise Hong Kong tobacco tax to protect youth against lifelong addiction

Mar 30th, 2020
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Posted in: Hong Kong, Tobacco Tax.

Vaping Could Compound Health Risks Tied to Virus, FDA Says

Mar 28th, 2020
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https://www.bloomberg.com/news/articles/2020-03-27/vaping-could-increase-health-risks-tied-to-covid-19-fda-says?sref=vEQJzSks

Vaping Could Compound Health Risks Tied to Virus, FDA Says

By

Anna Edney

and

Angelica LaVito

March 28, 2020, 4:28 AM GMT+8 Updated on March 28, 2020, 7:19 AM GMT+8

  • Heart, lung problems increase risk of Covid-19 complications
  • FDA says in email that e-cigarette use can damage lung cells

Vaping may leave users with underlying health conditions at higher risk of serious complications if they contract the respiratory disease caused by the novel coronavirus, the Food and Drug Administration said.

“People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from Covid-19,” Michael Felberbaum, an FDA spokesman, said in an email Friday in response to questions from Bloomberg. “This includes people who smoke and/or vape tobacco or nicotine-containing products.”

“E-cigarettes can damage lung cells,” Felberbaum said.

Some health experts have speculated that vaping is causing younger patients in the U.S. to be hospitalized with Covid-19 at a higher rate than anticipated. Felberbaum declined to comment on whether the FDA was investigating a possible connection.

Earlier this week, Nora Volkow, director of the National Institute on Drug Abuse, wrote a blog post warning that the coronavirus “could be an especially serious threat to those who smoke tobacco or marijuana or who vape.”E-cigarettes have been touted by some as less risky than smoking. But any increased harm associated with Covid-19, and the FDA’s direct language linking the products to lung damage, could boost detractors who have raised questions about the potential that vaping can lead to health problems.

Last year, some vapers began coming down with a mysterious and sometimes deadly lung illness. Those cases have been linked to products containing THC, the active ingredient in marijuana.

The FDA under President Donald Trump originally took a largely hands-off approach to regulating e-cigarettes, but began to change course in 2018 to stem an epidemic of youth use. After multiple delays, e-cigarette makers have until May to apply to the FDA for clearance to continue marketing their products. None have received FDA approval to market themselves as less risky than smoking.

Posted in: COVID-19, Health Risks.

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