Clear The Air News Tobacco Blog Rotating Header Image

Swapping one vice for another? Ex-smokers who end up becoming ADDICTED to nicotine gum

• Under new legislation, cigarette packaging is to be stripped of its bright colours and will, in future, be a uniform green-brown colour
• To go by the experience of other countries, this will lead to many more smokers switching to nicotine replacement therapy (NRT) such as gum
• These effective products will inevitably see many become addicted to them

My childhood was peppered with my father’s euphemisms for smoking. Every evening after our family meal, he’d get up from the table and inform us he was ‘just going to check on the weather’ — or ‘the oven’, or even ‘a giraffe’ he had apparently seen in the garden.

Each of these was actually an excuse for my dad to have his after-dinner cigarette. My father, Anthony, now 68, smoked more than 20 a day for 40 years — and this was a routine almost every night for the 20 years I lived at home.

But three years ago, he quit smoking. Instead of going out for a cigarette, he now fishes in his pocket for a packet of nicotine gum and pops a small, white square into his mouth, like a petit four.

Around an hour later, he will have another, then an hour after that we’ll hear the rustle of the packet again. For while he has given up cigarettes, he is now addicted to nicotine gum. He can’t go anywhere without it.

‘I never wanted to give up cigarettes,’ he says. ‘I enjoyed them too much. But the doctor said it was crazy to keep smoking. I thought about an e-cigarette, but I didn’t want to be one of those sad people outside buildings blowing apricot smoke over everyone, so I decided to use the gum.’

That was three years ago. Initially, the gum was prescribed by the NHS — you’re given a 12-week course (in fact, the manufacturer’s recommended dose), with the idea that you use it to wean yourself off nicotine.

But, like many people, Dad couldn’t do that. Instead, he started buying the gum in the High Street, where it is available everywhere, from Sainsbury’s to Boots. He buys a box, costing up to £26, a week and chews 15 gums a day (the maximum initial amount recommended by doctors before you should taper off and stop completely).

He says it works — ‘If I feel like a cigarette, I have a piece of gum and it stops the cravings’ — and has noticed real health benefits. ‘My breathing is already better and I can walk and run properly.’

But he is definitely addicted. ‘I take them everywhere with me. I can’t run out. One day, I’ll try to give up nicotine completely — but the gum is addictive.’ His case is far from unusual. While gum was meant to bridge the gap between addiction and freedom for smokers, many have trouble weaning themselves off it.

They now have a new addiction: to gum, with 10 per cent chewing it four times longer than they should (a year) and 5 per cent for two years. Some use it for ten years.

Under new legislation that came into effect last Friday, cigarette packaging is to be stripped of its bright colours and will, in future, be a uniform green-brown colour.

To go by the experience of other countries that have done this, it will lead to many more smokers switching to nicotine replacement therapy (NRT) products, such as gum.

And inevitably, many will end up addicted to it.

The nicotine in the gum is released on chewing and absorbed through the tissues lining the mouth.

When the taste becomes strong or hot (this signals that the nicotine has been released), users are told to ‘park’ the gum in the side of their cheek until the feeling fades, before continuing to chew.

There are two strengths, 2mg and 4mg. The latter (which Dad uses) is recommended for people on more than 20 cigarettes a day. One 2mg piece of gum has double the amount of nicotine absorbed (on average) from a cigarette, though experts say gum-chewers don’t absorb it all.

There is no doubt that gum, even a decade of use, is ‘safe’ compared with smoking.

Half of all lifelong smokers die early, losing around three months of life expectancy for every year after the age of 35 that they smoke, according to a report last month.

Some 8.7 million people in the UK still smoke.

As Professor John Britton, chairman of the Royal College of Physicians tobacco advisory group, explains, smokers are ‘like people in a nightclub when a fire breaks out’ — they just need a way out, and that’s what nicotine gum provides.

Yet while the gum doesn’t contain the toxins that put smokers at such high risk of disease and premature death, it may not be as benign as people think.

The leaflet that accompanies nicotine gum brand Nicorette, for instance, warns that ‘very common side-effects’ include stomach discomfort, nausea, headaches and tingling or numbness in hands and feet, with more than one user in ten affected. Less common are vomiting, palpitations and hives.

Some effects may be due simply to the act of chewing itself, as Dr Andy McEwen, of the National Centre for Smoking Cessation and Training, explains.

‘The effects of chewing ten to 15 pieces of gum a day are pretty onerous,’ he says. ‘That’s around one piece every hour, with recommended chewing of around 20 minutes, so people do say they have sore jaws. And nausea, dizziness, insomnia and headaches can also be side-effects of the gum, but they are for most medications.’

There is some evidence of more serious harm. In 2014, a study by scientists at the Virginia Bioinformatics Institute, in the U.S., found nicotine was such a powerful carcinogen, it caused thousands of cell mutations similar to those known to be a precursor to cancer.

But Professor Britton said while there was evidence that nicotine can promote cancer growth, it didn’t cause the disease.

‘The long-term risks have been tested as far as 12 years, and we know there were no very adverse health effects,’ he says — although he adds that the same cannot yet be said for 20-year or 30-year use. There may be a risk to unborn babies. A study by the Loma Linda University School of Medicine and California State University, in the U.S., found that, in rats, nicotine is absorbed by the foetus and can lead to high blood pressure and heart problems later in life (the NHS, however, says the gum is safe to use in pregnancy).

And patients who have recently had a stroke or heart attack, or have angina or heart rhythm problems, are advised to talk to their doctor before using the gum, because nicotine can increase heart rate and blood pressure.

People with dentures or dental work may also want to avoid gum because it can stick to them; prolonged use may irritate the mouth or affect the teeth.

But the fact remains that for the ‘small percentage’ using gum long-term, ‘nearly everything is safer than smoking’, says Dr McEwen.

There are more than 7,000 chemicals in cigarette smoke, including carbon monoxide, arsenic and cyanide, and at least 69 of them can cause cancer.

Most of the ingredients in nicotine gum, such as the gum base and flavourings, are the same as in normal chewing gum.

How addictive a nicotine product is depends on the speed of absorption, says Robert West, a professor of health psychology at University College London.

In theory, the nicotine in gum, which is absorbed relatively slowly into the bloodstream (taking around half an hour), shouldn’t be as addictive as people such as my father find it. So what’s going on?

‘Most people using the gum for years will have had failed attempts at giving up smoking,’ says Professor West. ‘They’ve made a mental calculation that they really don’t want to go back to smoking and are quite happy using the gum.

‘Most health professionals will tell you that you’d live a happier, richer, healthier life if you had no nicotine at all, but the gum is a buffer and a transition to abstinence.

Some people use it for many years — but most reduce their use eventually.’

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>