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Addicted to Nicotine

Thursday May 29, 2003 - The Borneo Bulletin

Dr Hj Rozaimee delivers his lecture entitled "Nicotine Addiction" at Central Lecture Theatre, Universiti Brunei Darussalam.

Listening attentively to the lecture.

Where is Borneo?

The President and Executive Board of Brunei Darussalam Institute of Chemistry organised a Professional Lecture entitled "Nicotine Addiction", by Dr Hj Rozaimee bin Hj Tengah, who is a Medical Officer, Ministry of Health, Brunei Darussalam. The talked was held on Sunday May 25, 2003 at 9.45am at Central Lecture Theatre, Universiti Brunei Darussalam.

Smokers usually start the habit as early as in their teens, and are addicted to nicotine by the time they are adults; thereafter the choice to quit becomes an illusion. Although two-thirds of smokers want to quit, and about a third try each year, but only 2% have managed to succeed! So, do you think nicotine is as addictive as "hard" drugs such as heroin?

Of all the possible ways of obtaining nicotine, smoking cigarettes remain by far the most addictive. The reason is that smoking cigarette maximises the rapidity, frequency, reliability, and ease of attainment of the reward from nicotine. Nicotine via cigarettes reaches the brain in 10 seconds, which is faster than via intravenous use.

It is much easier and cheaper to purchase a pack of cigarettes (for example, from petrol stations or local supermarkets) than it is to purchase a packet of nicotine gum. Unfortunately, cigarettes are the deadliest form of nicotine delivery available on the market. It is not the nicotine per se but the combustion and release of over 40 carcinogens as well as other toxic chemicals that are responsible for the bulk of premature illnesses and deaths that result when cigarettes are used as intended.

Lastly, but certainly not the least, let us ponder why the most toxic form of nicotine delivery happens to be the least regulated?

Structure of nicotine

Nicotine is an alkaloid (a substance with a basic charge), contained in the leaves of several species of plants. The primary commercial source of nicotine is by extraction from the dried leaves of tobacco plant: Nicotina tabaum & Nicotina rustica.

The chemical formula for nicotine is C10 H14 N2 with a molecular mass of 162.23. 3 - (1 - Methyl - 2 - pryrrolidinyl) pyridine has been given as the proper nomenclature for nicotine.

Nicotine pharmacology

Nicotine has a complex toxicology that includes both adrenergic and cholinergic effects, as well as central nervous system effects. Typically, nicotine produces an initial stimulation of the peripheral nervous system, followed by depression and blockade of sympathetic and parasympathetic ganglia and neuromuscular junctions.

Nicotine toxicity

- Gastrointestinal distress - digestive problems, stomach upset, bowel cramping, constipation etc

- Hypothermia - lowers body temperature to below-normal levels

- Vomiting

- Hypertension - blood vessels constrict to create high BP in some people, increasing potential for aneurysms

- Seizures - uncontrolled electrical activity in the brain, resulting in tremors and other abnormal responses

- Respiratory distress - nodules in the lungs which increases the potential for the development of small cell lung carcinomas by several hundred percent

Other abused drugs

Nicotine is as addictive as "hard" drugs such as heroin. Heroin induces euphoria, relieves pain and often induces sleep. Heroin overdose can result in death. Serum hepatitis is common. Also skin abscesses, inflammation of the veins, constipation and respiratory depression.

Nicotine has certain effects and mechanisms in common with cocaine, including the involvement of dopaminergic transmitters. Cocaine increases blood pressure, heart rate, breathing and body temperature, feelings of euphoria. Regular use can cause anxiety, insomnia, weight loss, increased paranoia and psychosis.

Nicotine affects the same areas of the brain as amphetamines. Amphetamines promotes feelings of alertness, increase in speech and physical activity. Amphetamines can produce toxic effects, mood swings, circulatory and cardiac disturbances, feelings of paranoia, hallucinations and convulsions.

Cigarette the best method of obtaining nicotine

Of all the possible ways of obtaining nicotine, smoking cigarette remains by far the most addictive. The reason is that smoking cigarette maximises the rapidity, frequency, reliability and ease of attainment of the reward from nicotine. Nicotine via cigarette reaches the brain in 10 seconds, even faster than via intravenous use. This is the chemical largely responsible for "hooking" people on cigarettes (popularly known as smoking addiction).

Flavouring chemicals e.g. alkenylbenzenes are found in tobacco additives which are used to enhance the taste of cigarette smoke. Research carried out, has associated the inhaling of alkenylbenzenes with cancer as well as lung damage in laboratory animals.

Tobacco addiction

The modern cigarette, developed and find tuned by the tobacco industry over decades, is a wonderfully efficient nicotine delivery device, delivering the optimum dose of nicotine, so ever rapidly to the dependent brain, with the help of many additives (sugars, mint, licorice or cherry), so that the smoke of the cigarette is made more pleasant.

Quitting is not simply a matter of choice for the majority of tobacco users. It involves a struggle to overcome an addiction. Tobacco use typically is woven into everyday life and can be physiologically, psychologically and socially reinforcing. Many factors combine with tobacco's addictive capacity (including media depictions, cultural and societal acceptance of tobacco use) in order to make quitting difficult.

Other ingredients in cigarettes

Many people are unaware of the number of toxins in tobacco smoke. Tobacco smoke contains over 4000 chemical compounds, including at least 40 cancer-causing carcinogenic agents. 3 main ingredients. Apart from nicotine: Tar and carbon monoxide.

Tar

A term used to describe the 20 (or more) different carcinogens (cancer-causing substances). Tends to collect in the lungs. Clinically linked to several forms of lung cancer.

Carbon monoxide (CO)

CO is the same deadly stuff that comes out of a car's exhaust pipe. People have been known to use CO to commit suicide. CO enters the bloodstream and stays there for up to 6 hrs after each cigarette.

Every cell in our body needs oxygen to survive. CO molecules take the place of oxygen in our blood. It's much like taking a seat in a bus - once it's full there is no more spaces left. Hence, inhibiting the transportation of oxygen to the body's vital organs via the bloodstream.

Decreased oxygen supply to the heart may lead to a heart attack. Increased CO reduces the level of oxygen carried to our brain which can lead to a decrease of mental ability. Smokers also become easily short of breath because the blood is carrying less oxygen.

Other constituents

Arsenic: a poison used in insecticides

Ammonia: a chemical used in toilet cleaner

Acetone: a solvent used in nail varnish remover

Benzene: a solvent used in the manufacture of fuel

Cadmium: a poisonous metal found in batteries

Chromium: used for metal plating

Formaldehyde: a chemical used to preserve dead bodies

Hydrogen cyanide: a lethal gas and can be used in photography

Hydroquinone: used in rubber production and in motor fuel

Lead: used in storage batteries

Nickel: used in stainless steel production

Nutbae: used in camping gas and lighter fuel

Phenol: used I disinfectants and germicidal paints

Tecanoe: used in paint stripper

Ricnesa: found in ant poison

Toluene: used in explosives

Other tobacco products

Smokeless (spit) tobacco has 3 forms:

- Snuff: ground-up moist tobacco, usually placed between bottom lip and gum. Snuff users become addicted to nicotine and may be tempted to switch to cigarette to get larger and quicker doses of the drug

- Chew: shredded tobacco leaves placed between the cheek and gum. Tobacco chewers become as addicted to nicotine as smokers

- Plug: shredded tobacco leaves which are pressed into a hard block and placed between the cheek and gum

Recently, the cigar industry has tried to attract new, younger users, including women, by promoting cigars as a sophisticated, luxury product.

Typical amount of nicotine found in various tobacco products

Cigarettes: 15 - 20 mg

Cigars: 15 - 40 mg

Snuff: 12.4 - 15.6 mg / gm

Chewing tobacco: 2.5 mg / gm

Gum: 2 mg / gm

Transderm patch: 17.5 - 52.5 mg / patch

History of tobacco

Columbus' crew introduced tobacco growing and use to Spain. Jean Nicot, the French ambassador in Portugal, first introduced tobacco in French court. The different ways of using tobacco also originated from America. Cigarette, Beedi, Snuff, Cigars and Pipes remain the popular means of using tobacco.

Most of the work related to nicotine rich tobacco varieties could be attributed to tobacco companies in USA. The developmental work from 1960 to 1994 aimed ultimately at increasing the sale of tobacco products.

Before the recent revelations in 1960, that the presence of nicotine in tobacco products make them addictive and is the reason why many people continue to use them, and despite the evidence of the harmful effect of tobacco use, Nicotine generally was perceived to be merely a natural part of tobacco leaf and inevitable component of any tobacco product.

Tobacco companies started on working for developing a more addictive, a new nicotine rich, harder to kick tobacco and finally developed a genetically altered variety with the code name Y - 1. The history of development of nicotine rich tobacco varieties in the world, thus can be attributed to British American Tobacco (BAT) industries.

Tobacco as a global epidemic

One-third of the world's population aged 15 and above, smoke regularly. More than 1.25 billion smokers worldwide. 1 billion male smokers and 0.25 billion female smokers. 80% of them in developing countries.

Tobacco was estimated to account for just over 3 million annual deaths in 1990. Rising to 4 million unnecessary deaths per year (corresponding to 11,000 deaths daily) in 1998. Half of these deaths occur in productive middle ages. Responsible for one death every 10 seconds worldwide.

It is estimated that tobacco attributable deaths will rise to 8.4 million in 2020. By 2030, tobacco likely will be the world's leading cause of death and disability, killing more than 10 million people annually and claiming more lives than HIV, TB, maternal mortality, motor vehicle accidents, suicide and homicide combined.

Unless the current smoking patterns change, in 21st century, about 1 billion people will die from smoking - 10x compared throughout 20th century.

Brunei statistics

Male smokers: 31.1%

Female smokers: 5.3%

Age 20 to 29: the largest group of current smokers

Health impact of tobacco

Most health consequences of smoking are not manifested until 3 to 4 decades after the onset of persistent smoking. This reduces the seriousness with which tobacco issues are addressed. Lung cancer and CHD (coronary heart disease) are the most common fatal conditions caused by tobacco, responsible for 30% of all deaths in the UK.

A prospective study by Doll and Peto, which began in 1951 for 40 years, involving 40,000 male British doctors, found that smoking is associated with excess mortality from the following diseases: Cancers of the mouth, oesophagus, larynx, pharynx and lung, COPD (chronic obstructive pulmonary disease) and other respiratory and vascular diseases.

Another prospective study by Rimm et al, involving 40,000 men, found that smoking over 15 cigarettes per day, is associated with a doubled risk of developing type 2 diabetes.

A study published by Wannamethee et al, found that life-long smokers have a nearly 4-fold increased risk of having a stroke. The risk in ex-smokers was found to be nearly twice that in non-smokers. Benefits from stopping smoking can be seen within 5 years.

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