Dispelling the Myths about Nicotine and Nicotine Replacement Therapy

Editor's Note: This article was originally written by patient expert Carol Southard.

Many smokers have misperceptions about nicotine, which often result in not using evidence-based treatments when quitting. Misperceptions about nicotine are often derived from how the harmful effects of tobacco are presented in cessation materials. The following are key points to keep in mind when considering the use of Nicotine Replacement Therapy (NRT):

  • NRT can double a smoker's chances of permanently quitting smoking.

  • NRT reduces the intensity of physical withdrawal symptoms for many people (i.e., irritability, frustration, anger, craving, hunger and weight gain, anxiety, difficulty concentrating, restlessness, and insomnia).

  • The likelihood of long-term cessation is increased when a smoker uses NRT in adequate amounts and for a sufficient period of time.  It is important to try to get as much nicotine from the product(s) as the smoker did from cigarettes on a daily basis.

Most NRT product labels say that the product should be used for 8 or 12 weeks. For some smokers, this is enough time to stop smoking for good. Some smokers don't need to use NRT that long to stop smoking. Other smokers may need to use NRT for several months or even years to stay off cigarettes. If it ever comes down to a choice of using NRT or returning to smoking, stay on the NRT. A good rule of thumb is that if it feels "normal" to not smoke despite having a desire to do so, you are ready to stop the NRT.

  • Nicotine and NRT do not cause cancer. Studies show that NRT is a safe alternative to cigarettes for smokers, and** DOES NOT** cause cancer or heart attacks, even for smokers who already have had heart attacks or heart disease. Nicotine is not the dangerous chemical in cigarettes. Cigarette smoke contains many harmful chemicals, and it is these, not nicotine, that are responsible for the heart attacks, cancer, and lung disease. The risks of cigarette smoking are much greater than the risks of NRT. NRT packages come with many warnings and directions that can lead a person to believe that NRT is far more risky than it actually is. It is a mistake to think that any NRT product is as dangerous as cigarettes.
  • Using NRT is not trading one nicotine addiction for another because the likelihood of long-term dependence to NRT is very low. NRT is much less addictive than cigarettes. Some smokers worry about becoming addicted to NRT or becoming 'hooked on' the gum, lozenge, or patch. While it is true that the nicotine in NRT products is addictive, smokers are already addicted to nicotine--they get a lot more of it from each cigarette they smoke than from any NRT product.

  • The amount of nicotine delivered in NRT is less than in cigarettes and is controlled and delivered more slowly. Smokers usually do not get as much nicotine from NRTs as from cigarettes, nor do they find NRT as enjoyable to use as cigarettes. This is because breathing in smoke through the lungs gives the brain a rush of nicotine within ten seconds of each inhalation while NRT gives nicotine more slowly through the skin or lining of the mouth. In fact, most smokers don't use enough NRT to get all the help they could to stop smoking.

  • NRT products can be used alone or in combination. Even though the NRT packages say you should not use more than one NRT, most experts agree that, for some smokers, using more than one type of NRT product at the same time can be helpful in stopping smoking and is safe.

  • The cost of NRT will vary by frequency and duration of product use. In 2005, the average daily cost of various pharmacotherapies were estimated at $6.07 for the nicotine inhaler, $5.81 for nicotine gum, $4.98 for nicotine lozenges, $3.91 for nicotine patches, $3.40 for nicotine nasal spray.  In comparison, as of November 2005 the average retail price of a package of 20 cigarettes (full-priced brands) ranged from a low of $3.51 in South Carolina to a high of $5.96 in Alaska.

  • NRT is customarily used only for a limited time, whereas cigarettes are consumed for as long as the smoker continues to smoke and for some that is the rest of their lives While some smokers could find it hard to stop using NRTs because of the nicotine in these products, there are two important things to remember: first, even using a NRT for a very long time is much less harmful to health than smoking for the same amount of time; second, stopping an NRT is not likely to be as hard as stopping smoking.

  • Nicotine does not cause tobacco-related diseases; rather it is the toxins found in cigarettes, and not the nicotine, that causes the negative health effects.

  • Nicotine does not cause the yellowing of teeth, fingernails, and skin; rather, it is the tar found in cigarettes that does.

  • NRT can be safely used by people with diabetes or high blood pressure and does not increase the risk of heart attacks (note: the effects of NRT on those with acute cardiovascular disease has not been studied sufficiently).

  • NRT does not cause weight gain, nicotine may actually help control weight.

You could be disappointed if you think using NRT or anything else will make quitting smoking easy. But using NRT could make quitting easier by reducing your cravings or the bad feelings you have when you stop smoking. Like other tools, NRT can help you--if you are also willing to put some work into it. NRT is one good tool to help you quit smoking. But NRT cannot do all the work for you there is no magic bullet unfortunately! If NRT helps you stop smoking, but you go back to smoking when you stop using NRT, you should seriously think about using NRT again.

Many medicines need to be used over and over again to deal with health problems that do not go away completely. For chronic diseases like asthma, diabetes, and high blood pressure, medicine often needs to be taken for a long time not just a few weeks. Just as an asthma medication that helped an asthma attack before is likely to help again, NRT is likely help a smoker stop again if it was helpful before.