Monday, September 21, 2009

Direct from Wisconsin

Some highlights from the Smokeless and Spit Tobacco Conference that I attended today:

I had been aware that the nicotine absorbed from smokeless or spit tobacco was not uniform. Just as there are different amounts of cancer causing agents in products, the nicotine level can vary. The nicotine absorption is also affected by the user. In other words, nicotine absorption can be affected by how long the product is kept in the mouth and if the dip or quid moves around in the mouth. But much more than that, nicotine content can vary by as much as 14mg per 2 gm pinch. Knowing this, I now understand why trials of nicotine replacement therapy have failed to increase cessation rates in smokeless tobacco users. You have to substitute the same amount of nicotine that you were receiving in your tobacco product when you quit and use NRT. If some people were getting 30 to 40 mg a day of nicotine but using a 21 mg patch, well there you go, failure. It would be and is hard then for tobacco cessation specialists and physicians to know what dose of NRT to recommend unless we have the data on nicotine level at our disposal.

When discussing whether or not smokeless tobacco (SLT) use would be better than smoking we have to look at context. If someone uses NO tobacco and then starts using SLT because it was marketed as “safe” it certainly is NOT harm reducing. No tobacco use is far safer than any SLT use. If a person is smoking and also using SLT it is not harm reduction. However, if a person switches completely from smoking to SLT only, it does reduce harm for that smoker.

I was surprised by a statistic today. We were looking at several variables and in those variables the number of smokeless users, concurrent users , smokers and non tobacco users and in all categories but one there were more non tobacco users YEAH! The only category that had more smokers than non smokers was in the unemployed. Now we can play with that statistic. For example, is it that smokers are not hired, or that smokers are fired? Or is it that people lose their jobs and become smokers? Whatever it is, the persons that can least afford the financial and probably health effect cost (no insurance or Medicaid) are the ones using the most!

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