Quitting Nicotine

Host: Dr. Jennifer Hunter, Assistant Director for Family and Consumer Sciences Extension, University of Kentucky 

Guest: Dr. Audrey Darville, University of Kentucky College of Nursing

Episode 39, Season 2

0:00 Welcome to Talking FACS; what you need to know about family, food, finance and fitness. Hosted by the University of Kentucky Family and Consumer Sciences Extension Program, our educators share research knowledge with individuals, families and communities to improve quality of life.

0:21 Dr. Jennifer Hunter: Hello and welcome to Talking FACS. This is your host, Dr. Jennifer Hunter, Assistant Director for Family Consumer Sciences Extension at the University of Kentucky.

Today, I'm pleased to have you with me, Dr. Audrey Darville of the University of Kentucky College of Nursing. Welcome, Audrey. How are you doing today?

0:37 Dr. Audrey Darville: Thank you for having me. I'm looking forward to talking with you today.

0:40 Dr. Hunter: So, today we're really going to focus on the topic quitting nicotine. I think we all know that nicotine is an addictive substance and it can be something that once someone starts, it can be pretty hard to quit.

But we're going to start and kick off with probably a most basic question of when we think about nicotine, we think about tobacco products. So, can you define tobacco product for us?

1:06 Dr. Darville: Sure. So, we know that virtually all nicotine is derived from tobacco plants. And so, any substance, and this includes e-cigarettes, which is where some of the line has become blurred now, are derivatives of tobacco plants.

And so, even nicotine replacement, the nicotine in those products comes from tobacco. However, they are not considered necessarily a tobacco product. They're a therapeutic agent.

So, the lines have gotten very blurred here recently between e-cigarettes, which people are trying to use to quit smoking, nicotine replacement and tobacco. And I think there's been a lot of confusion as to know which is better, which is worse. They're all tobacco products, in terms of cigarettes, cigars, e-cigarettes, hookah, some of those items as well. The nicotine replacement are therapeutic products and not considered tobacco products.

2:04 Dr. Hunter: So, when we talk about some of those, and I guess at one time they we're been considered a less mainstream tobacco products, but maybe becoming more and more popular now like e-cigarettes and vapes. You mentioned just a minute ago that sometimes people use those as a replacement for traditional tobacco products in trying to quit.

Are those more safe than traditional tobacco products or is it all about the same or how does that even work?

2:29 Dr. Darville: So, relatively speaking, I think it's hard to find anything that's more harmful to our health than a cigarette. We know that five out of 10 people who use the traditional tobacco products, such as smoke a cigarette, eventually die of an illness that can be prevented by quitting. So, that's a pretty deadly product for the long haul.

So, we look at e-cigarettes, they're not as deadly as we know tobacco cigarettes to be (combustible cigarettes), but we do know that they're not without risk.

And the problem with e-cigarettes and the lack of FDA testing, regulation and labeling requirements, all those things that go along with making sure that we know what we're getting when we buy a certain product, don't apply it to e-cigarettes. So, there's a lot we don't know about e-cigarettes.

We do know that there are some harmful chemicals and we do know based on, I'm sure everyone's aware of the news about, the tragic deaths with the e-cigarette and vaping associated lung injury or {indistinct 3:30 – 31} is the term that the CDC has used for that.

So, we do know there is a risk associated with it. But the numbers of deaths associated with e-cigarette use {indistinct 3:43} in comparison to the number of deaths associated with cigarette use. So, it's a continuum. It's not that one is harmless.

3:52 Dr. Hunter: Right. That they both come with risks.

3:54 Dr. Darville: They come with certain risk. And the risks are actually different. And I think that's another important distinction to make, is that the risks from cigarette use are somewhat different than the risks associated with electronic cigarette use or vaping.

The biggest risk actually comes from people who are using both products. And a lot of concern about people using electronic cigarettes or vaping to replace cigarettes is that if they don't replace them completely, then they're almost getting a boosted risk, an elevated risk, because they're getting the risk associated with the conventional tobacco product use and the e-cigarette is on top of that.

4:36 Dr. Hunter: That's interesting. That's not something that I heard before, because I can think of individuals that I know that they do kind of go back and forth in an effort to try and quit or to try and reduce the amount of, I guess, traditional cigarettes that they may smoke. So, I think that that's a really interesting point to share with our listeners today.

Are e-cigarettes and vapes just as addictive as traditional tobacco products?

5:02 Dr. Darville: Some research is indicating that they may be more addictive. What's happened with the latest form of e-cigarettes, most people know them by product name Jewel. We call them pod based devices.

And the game changer for these devices is that the nicotine delivery, without getting too much into the chemistry, has been changed to a nicotine salt. And that salt can become highly concentrated in that liquid.

So, we know that e-cigarette juice, the juice that's in there, is a concentration that is the equivalent amount of nicotine as you would find in a pack of cigarettes. So, one whole nicotine in one pod is the equivalent of the nicotine in a pack of cigarettes.

5:50 Dr. Hunter: Wow. I know. And we've recorded podcasts recently about e-cigarettes and vaping, especially targeted towards youths. Our listeners know, at least those that listen often, that I have a high schooler at home. And so, I know that that is one thing that he's mentioned quite a bit is just the prevalence of use within high schools-age students or even on the bus or the bathroom at school, really and truly a significant concern and one that we talked quite a bit about at home; the dangers and the risks associated with any type of tobacco product use.

6:24 Dr. Darville: Sure. And the risk is really, for youth, is the addiction to the nicotine. And one of the things that the studies are showing is that because e-cigarettes and vaping devices are getting better, but they're not really greatly efficient devices for delivering nicotine, is that there seems to be a progression from vaping to conventional cigarette use. And we just haven't been at this long enough to know what that means, but we have had decades of youth tobacco use go down and now we're concerned that it's going to start to inch up again.

And just to kind of segue into our topic today; we're talking about quitting nicotine. And one of the challenges is that there are these multiple products that people are using with the electronic cigarettes and the vaping devices, we don't really know exactly how much nicotine people are getting.

And you're asking about the concentration or how much nicotine that they're getting. And there is some evidence that youth are getting very significant exposure to high levels of nicotine at young ages, which in fact, may make it a lot harder for them to quit in the long run.

7:40 Dr. Hunter: Yeah. I think all the unknowns as a parent just make it so much more scary.

7:45 Dr. Darville: Sure.

7:46 Dr. Hunter: So, as you kind of alluded to a little bit about the amounts of nicotine and addiction, how can an individual tell if they have become addicted to nicotine?

7:56 Dr. Darville: So, there's a of couple ways. Probably the main way is to determine, are you having withdrawal symptoms when you don't have access to either whatever nicotine product that you're using; whether it be cigarettes, cigars, even vaping devices.

Withdrawal symptoms include feeling kind of edgy, irritable, nervous. A lot of times, people will smoke or use a tobacco product because they feel like it calms their nerves. And basically, what they're doing is they're trading their withdrawal symptoms to the nicotine.

So, poor concentration is another symptom of nicotine withdrawal. So, for example, we see in our truck drivers that a lot of times they'll smoke because the withdrawal causes them not to be able to stay focused or as alert {indistinct 8:43}and they’ll smoke, not because the cigarette is actually doing something to help them, because it's staving off the withdrawal.

8:51 Dr. Hunter: And that makes total sense. When someone is trying to quit the use of tobacco products, what works? What can help people quit tobacco?

9:00 Dr. Darville: Yeah. So, there are some great evidence-based treatments for quitting tobacco products. And these include nicotine replacement products. As I said earlier on, they're considered therapeutic agents.

What they are, is they a controlled amount of nicotine that's given at a steady dose over a set amount of time. And the amounts are actually significantly lower than people tend to get in using any other type of tobacco products.

The reason to do that is it gets the brain used to not having those big spikes of nicotine. And it gives you just sort of a steady amount that prevents people from having those withdrawal symptoms that that makes them crave or feel like they have to have a cigarette.

So, nicotine replacement products are very effective. We now know that combination nicotine replacement using a patch, a steady dose and then a lozenge or nicotine inhaler or some nicotine gum in addition to that can be very helpful.

Using these products with adequate support or counseling, seeing a healthcare provider to provide some guidance and using these products can be very helpful. We know that almost doubles the quit rates; when people use a combination of medication and some type of counseling.

And then there are two other medications besides the forms of nicotine replacement. Most people are familiar with {indistinct 10:20}, most commonly known as Chantix. They have the biggest advertising budgets. So, we know a lot about that.

But actually, studies have shown that Chantix is a relatively safe medication and it also is very effective, probably the most effective medication for treating nicotine withdrawal.

And then the other medication is {indistinct 10:42 – 43}. And it was initially marketed as {indistinct 10:45}; people may know it as Wellbutrin. And that medication works well; also works best in combination with nicotine replacement.

10:54 Dr. Hunter: So, as I'm listening to you talk, it certainly sounds like that if someone is interested in quitting tobacco products that it is good to seek some help in this process. That just waking up one day and saying, “I'm not going to smoke any more” doesn't necessarily lend itself to success.

11:12 Dr. Darville: And we know that 5 out of 100 people who try to quit cold turkey, (we call that cold turkey) they're not successful. So, 95 out of 100 people benefit from having some help. People do quit cold turkey, but it’s by far the minority of people that do.

So, the help, though, I think it's important to note, doesn't have to necessarily be a medical clinician. I would recommend it, but if you don't have easy access to see a healthcare provider, there's a website called smokefree.gov, which has a lot of great information about quitting smoking; goes over a lot of these concepts that I'm talking about here and explain some of the treatments.

You can buy the nicotine replacement products, at least the patches, the pump and the lozenges over the counter. So, you can get some guidance and some assistance from some of these websites. Make sure that they are an evidence-based website. So, that's why I talked about smokefree.gov.

12:12 Dr. Hunter: Right.

12:13 Dr. Darville: becomeanex.org is another that is overseen by the Mayo Clinic; another great source of information. And also, some links on those websites for apps or text-to-quit programs that are, again, evidence-based.

One thing I do want to caution people about that a lot of people don't know is that the tobacco industry themselves have actually put together apps and text programs and websites to sort -- they say to help people quit. Of course, their motivation is a little bit suspect.

12:44 Dr. Hunter: Different than the others. And so, our listeners, we will make certain that we link the websites that you have mentioned in our show notes so that you go back and reference that.

And you've also provided us with additional links and websites, if someone's interested in seeking out additional information; that will also be linked with our show notes.

13:04 Dr. Darville: Right.

13:05 Dr. Hunter: Audrey, thank you so much for being with us today and for sharing with us. I found this topic to be quite informative and certainly, I learned some new information. I hope our listeners have as well.

13:16 Dr. Darville: Thank you. Can I add one other thing?

13:18 Dr. Hunter: Certainly.

13:19 Dr. Darville: I just want everyone to know that the single best thing a person who smokes can do for their health in their lifetime is to quit. And there's help; we can help.

13:28 Dr. Hunter: Excellent. That's a great wrap up. Thank you so much.

13:31 Dr. Hunter: Thanks.

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