5.5 Nicotine
What is Tobacco?
Tobacco is a plant grown for its leaves, which are dried and fermented before being put in tobacco products. Tobacco contains nicotine, an ingredient that can lead to addiction, which is why so many people who use tobacco find it difficult to quit. There are also many other potentially harmful chemicals found in tobacco or created by burning it.
How Do People use Tobacco?
People can smoke, chew, or sniff tobacco. Smoked tobacco products include cigarettes, cigars, bidis, and kreteks. Some people also smoke loose tobacco in a pipe or hookah (water pipe). Chewed tobacco products include chewing tobacco, snuff, dip, and snus; snuff can also be sniffed.
How Does Tobacco Affect the Brain?
The nicotine in any tobacco product readily absorbs into the blood when a person uses it. Upon entering the blood, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with drugs such as cocaine and heroin, nicotine activates the brain’s reward circuits and also increases levels of the chemical messenger dopamine, which reinforces rewarding behaviours. Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.
What are the Other Health Effects of Tobacco Use?
Although nicotine is addictive, most of the severe health effects of tobacco use come from other chemicals. Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema. It increases the risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to other cancers, leukemia, cataracts, and pneumonia. All of these risks apply to use of any smoked product, including hookah tobacco. Smokeless tobacco increases the risk of cancer, especially mouth cancers.
Electronic Cigarettes
Electronic cigarettes, also known as e-cigarettes or e-vaporizers, are battery-operated devices that deliver nicotine with flavourings and other chemicals to the lungs in vapour instead of smoke. E-cigarette companies often advertise them as safer than traditional cigarettes because they don’t burn tobacco. But researchers actually know little about the health risks of using these devices. E-cigarettes are less harmful but this doesn’t mean harmless. Read more about e-cigarettes in our Electronic Cigarettes (e-Cigarettes) DrugFacts(1).
One of the challenges that began with Vaping was the Advertising of flavours to youth, making it more appealing:
So, what’s up with vaping?
Vaping has many risks and long-term health effects that are unknown. Youth and non-smokers should not vape. Vaping is a less harmful option only for people who are already smoking if they quit smoking and switch completely. Less harmful doesn’t mean harmless. We’re here to give you the facts about vaping so you can make informed decisions.
Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birth weight. Smoking while pregnant may also be associated with learning and behavioural problems in exposed children.
People who stand or sit near others who smoke are exposed to secondhand smoke, either coming from the burning end of the tobacco product or exhaled by the person who is smoking. Secondhand smoke exposure can also lead to lung cancer and heart disease. It can cause health problems in both adults and children, such as coughing, phlegm, reduced lung function, pneumonia, and bronchitis. Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, lung infections, and death from sudden infant death syndrome.
How Does Tobacco Use Lead to Addiction?
For many who use tobacco, long-term brain changes brought on by continued nicotine exposure result in addiction. When a person tries to quit, he or she may have withdrawal symptoms, including:
- irritability
- problems paying attention
- trouble sleeping
- increased appetite
- powerful cravings for tobacco
In Canada How Can People Get Treatment for Nicotine Addiction?
Both behavioural treatments and medications can help people quit smoking, but the combination of medication with counseling is more effective than either alone.
Government of Canada – Quitting smoking: Provincial and Territorial Services(4)
Click on your province or territory to access services to quit smoking.
- Ontario
- Quebec
- British Columbia
- Alberta
- Manitoba
- Saskatchewan
- Nova Scotia
- New Brunswick
- Newfoundland and Labrador
- Prince Edward Island
- Northwest Territories
- Yukon
- Nunavut
Or call 1-866-366-3667 toll-free and talk to a quit coach.
Government Regulation of Tobacco Products
Tobacco use is the leading preventable cause of disease and premature death in Canada. The Tobacco and Vaping Products Act(5) is intended to protect the health of Canadians by:
- restricting youth access to tobacco products
- protecting people from inducements to use tobacco products
- enhancing public awareness of the health hazards of using tobacco products
The Act provides the authority for Health Canada to regulate the manufacture, sale, labelling and promotion of tobacco products.
Tobacco products are allowed on the Canadian market if they meet the requirements of the Act and its regulations. This includes:
- labelling requirements for most tobacco products, such as:
- health warnings
- toxic emissions statements
- health information messages
- minimum packaging requirements for:
- cigarettes
- most cigars
- blunt wraps
- a ban on the use of certain flavour additives in:
- cigarettes
- most cigars
- blunt wraps
- a prohibition on promoting banned flavour additives on product packaging
- meeting the fire safety requirements under the cigarette ignition propensity standard(6)
We also:
- regulate the promotion of tobacco products and accessories
- require tobacco manufacturers and importers to regularly report on their tobacco products and related activities
Behavioural Treatments
Behavioural treatments use a variety of methods to help people quit smoking, ranging from self-help materials to counselling. These treatments teach people to recognize high-risk situations and develop strategies to deal with them. For example, people who hang out with others who smoke are more likely to smoke and less likely to quit.
Nicotine Replacement Therapies (NRT)
Nicotine replacement therapies (NRTs) is an over-the-counter medications to help people quit smoking cigarettes.
Currently approved NRT products include chewing gum, transdermal patch, nasal sprays, inhalers, and lozenges. NRTs deliver a controlled dose of nicotine to relieve withdrawal symptoms while the person tries to quit. NRT acts as a temporary substitute for the nicotine from tobacco products, and you can gradually taper down the dose of NRT to reduce the amount of nicotine entering your body until you stop using NRT.
Other Medications
Bupropion (Zyban®) and varenicline (Chantix®) are two approved non-nicotine medications that have helped people quit smoking. They target nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people start smoking again.
Can a person overdose on nicotine?
Nicotine is poisonous and, though uncommon, an overdose is possible. An overdose occurs when the person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death. Nicotine poisoning usually occurs in young children who accidentally chew on nicotine gum or patches used to quit smoking or swallow e-cigarette liquid. Symptoms include difficulty breathing, vomiting, fainting, headache, weakness, and increased or decreased heart rate. Anyone concerned that a child or adult might be experiencing a nicotine overdose should seek immediate medical help.
Key Takeaways
- Tobacco is a plant grown for its leaves, which are dried and fermented before being put in tobacco products. Tobacco contains nicotine, the ingredient that can lead to addiction.
- People can smoke, chew, or sniff tobacco.
- Nicotine acts in the brain by stimulating the adrenal glands to release the hormone epinephrine (adrenaline) and by increasing levels of the chemical messenger dopamine.
- Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema. It increases the risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to other cancers, leukemia, cataracts, and pneumonia. Smokeless tobacco increases the risk of cancer, especially mouth cancers.
- Secondhand smoke can lead to lung cancer and heart disease as well as other health effects in adults and children.
- For many who use tobacco, long-term brain changes brought on by continued nicotine exposure result in addiction.
- Both behavioural treatments and medication can help people quit smoking, but the combination of medication with counselling is more effective than either alone.
- Nicotine overdose is possible, though it usually occurs in young children who accidentally chew on nicotine gum or patches or swallow e-cigarette liquid.
- Anyone concerned that a child or adult might be experiencing a nicotine overdose should seek immediate medical help.
- E-cigarettes or e-vaping are less harmful but this doesn’t mean harmless, research is showing many health risks when using these products
- Youth and non-smokers should not vape
- Although vaping is a less harmful option only for people who are already smoking if they quit smoking and switch completely
For more Information:
- Quitting smoking: How to quit – Government of Canada
- CAMH: Smoking Cessation: Overview of Nicotine Replacement Therapy
- CAMH – stop (nicotine dependence clinic)
- Help Them Quit
- Gum Nicotine Replacement Therapy – CADTH
- cmaj – Canadian Medical Association Journal
- Smoking Cessation – Canadian Pharmacists Association
Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.
Films for Course Assignment
NIDA TV Spotlight on Electronic Cigarettes. By National Institute on Drug Abuse (NIDA/NIH). Interview with Virginia Commonwealth University Professor of Psychology, Dr. Thomas Eissenberg, following his discussion on electronic cigarette research(7)
Transcript
E-Cigarettes : Welcome Back, Big Tobacco – the fifth estate. Big Tobacco is trying clean up its image, moving into the booming e-cigarette business which continuing to peddle the deadly tobacco products. (8)
Transcript
ATTRIBUTION
Drugs, Health & Behavior by Jacqueline Schwab and Denise Salters is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted with minor revisions for clarity, ease of use and Canadian Content
References
- Vaping Devices (Electronic Cigarettes) DrugFacts | National Institute on Drug Abuse. (2023, January 12). National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/vaping-devices-electronic-cigarettes
- Health Canada. (2022a, March 10). Health Canada proposes to ban advertising of vaping products wherever they can be seen or heard by youth. Canada.ca. https://www.canada.ca/en/health-canada/news/2019/12/health-canada-proposes-to-ban-advertising-of-vaping-products-wherever-they-can-be-seen-or-heard-by-youth.html
- Health Canada. (2023a, January 13). Health Canada confirms ban of advertising for vaping products wherever they can be seen or heard by youth. Canada.ca. https://www.canada.ca/en/health-canada/news/2020/07/health-canada-confirms-ban-of-advertising-for-vaping-products-wherever-they-can-be-seen-or-heard-by-youth.html
- Health Canada. (2022a, November 10). Quitting smoking: Provincial and territorial services. Canada.ca. https://www.canada.ca/en/health-canada/services/smoking-tobacco/quit-smoking/provincial-territorial-services.html
- Legislative Services Branch. (2023j, January 14). Consolidated federal laws of Canada, Tobacco and Vaping Products Act. https://laws-lois.justice.gc.ca/eng/acts/T-11.5/
- Health Canada. (2008, January 15). Cigarette Ignition Propensity Regulations – Information Sheet. Canada.ca. https://www.canada.ca/en/health-canada/services/publications/healthy-living/cigarette-ignition-propensity-regulations-information-sheet.html#ignition
- National Institute on Drug Abuse (NIDA/NIH). (2013, October 25). NIDA TV Spotlight on Electronic Cigarettes [Video]. YouTube. https://www.youtube.com/watch?v=Iz67IqkLwYs
- The Fifth Estate. (2016, October 21). E-Cigarettes: Welcome Back, Big Tobacco – the fifth estate. [Video]. https://youtu.be/B2myg-4zkE8
