Drugs vs. Drugs

Science, technology, and life.
Jan. 29 2009 9:16 AM

Drugs vs. Drugs

Yesterday we talked about the tobacco industry's escape from the anti-smoking movement. The escape relies on two factors: that tobacco can be engineered into new, smokeless forms, and that the core of the tobacco business is addiction, not cancer.

One way to defeat the industry is by using the same factors. You isolate tobacco's addictive ingredient, nicotine, and engineer it into new forms. But instead of engineering the dose to sustain addiction, you design it to gradually liberate the addict.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

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Case in point: Barack Obama. Last week in the Wall Street Journal , Melinda Beck advised him to break his cigarette habit by turning to alternative nicotine products .

Nicotine soothes the primitive fight-or-flight response while focusing attention, and it releases dopamine like a pleasurable reward. Nicotine withdrawal can make it harder to think, concentrate and remember, as well as causing irritability, impulsiveness and aggressiveness. ... Nicotine-replacement therapy—with gum, lozenges, a patch or an inhaler—can alleviate those withdrawal symptoms, provided you're getting enough. You've been chewing nicotine gum for months now, but researchers have found that some smokers need more nicotine replacement than others to stop their cravings.

Nicotine alone is better than any tobacco product with residual carcinogens. As Beck points out: "Overdosing on nicotine replacement can make you feel nauseous and light headed and raise your heart rate, but it doesn't appear to cause cancer; it's the tar and various additives in tobacco that do that."

Does nicotine replacement work? Sometimes yes, sometimes no. A study of 3,300 smokers, published in the February issue of the American Journal of Preventive Medicine , found that quitting rates were low but that nicotine gum helped significantly. The study was double blind, randomized, and placebo-controlled.

Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided.

The results :

Though most study participants failed to quit completely, those who used the nicotine gum were more successful—with 26 percent achieving total abstinence within eight weeks of treatment, compared with 18 percent in the placebo group. Among those quitters, nicotine-gum users were more than twice as likely to stay continuously abstinent for a month afterward—10 percent, versus 4 percent of those in the placebo group. ... Six percent of nicotine-gum users were continuously abstinent for six months, while the same was true of 2 percent of smokers in the placebo group.

Guess who funded the study? GlaxoSmithKline . Why? Because it engineers and sells nicotine replacement products. This is the drug war of the future: the addiction industry vs. the pharmaceutical industry. Both sides sell drugs. Both design their drugs to work with the physiology of addiction. If we're lucky and the tobacco industry continues to move away from cigarettes, the nicotine war won't be about cancer anymore. It'll be about liberation from addiction.

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