Your friend needs a pick-me-up during her morning commute—or that midafternoon slump, or the end of her bartending shift, and coffee ain’t cutting it. She’s seen other people take a cigarette break at moments like these, but it seems unwise to start a habit that kills seven million people a year. So she’s started sneaking packs of nicotine gum. They taste like Wrigley’s Spearmint and give her a calm, focused, energized feeling. But she knows that the sensation comes from nicotine, an addictive drug she’s been warned about since that assembly in sixth grade. That has to be bad, right? But before she can really consider it, she’s become a pack-a-day chewer.
The intended use of nicotine gum is simple: The consumer chews it for a period of time, usually 12 weeks, to combat cravings and withdrawal symptoms as they quit tobacco. It’s a product you’re only supposed to use at a certain point in your life and then walk away from, like maternity clothes or bicycle training wheels or the music of The Doors.
Medical researchers have also considered the therapeutic uses. In 2017 alone, studies were published testing the effectiveness of nicotine gum in reversing low blood pressure in Parkinson's disease patients, relieving intestinal pain after colorectal surgery and improving the performance of 20-something male athletes. (It was a little help to the athletes and Parkinson’s patients, but none to those recovering from colorectal surgery.)
Nicotine is a stimulant. It locks into the receptor sites of the natural neurotransmitter acetylcholine, raising heart rates, respiration and blood sugar. Most importantly, it causes the release of the pleasure chemical dopamine. This is why smokers feel a rush of alertness, composure, and ease when they light up. It’s understandable why your friend wants that kind of boost in a form that doesn’t include the cancer and heart disease risks of burning and inhaling the 4,000 chemicals in cigarette smoke. After all, nicotine by itself is not known to be carcinogenic.
Nicotine gum is also, by design, less addictive than tobacco, which delivers the drug right into the bloodstream via the lungs. The quick delivery system of smoking combined with a quick diminishment of good feelings (the effect of a cigarette is halfway gone in 40 minutes) makes for an especially addictive drug. But the release of nicotine through chewing gum is much more gradual.
That does not mean nicotine gum is not addictive at all. In 2007, Jean-François Etter, a professor of public health at the University of Geneva in Switzerland, published one of the few studies on nicotine gum-chewers who had never smoked. He didn’t find many—just five—but three of them were as dependent on the gum as the average smokers were on cigarettes. They were also more prone to getting hooked on the gum than one-time smokers who used it to wean themselves off tobacco, perhaps because they never built up a tolerance to nicotine.
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“I’ve never smoked,” one 39-year-old woman told Etter. “My sister had some nicotine gum when she was trying to quit smoking, and I happened to try a piece. It seemed to wake me up and give me an energy boost, which I liked. I don't drink coffee, so I use the gum to wake me up when I'm feeling drowsy.” At the time of the interview, she chewed 15 servings of gum a day and had been consuming it for 10 years.
So is chomping on a Nicorette a good way to get the feeling of puffing up without the immense health risks that come with a pack of Camels? It’s a lot better than smoking, but not really, according to according to Nancy Rigotti, director of the Tobacco Research and Treatment Unit at Massachusetts General Hospital.
Rigotti says there isn’t much research on the long-term effects of using nicotine gum, but it’s certainly addictive and there are much more suitable, clinically tested drugs for the purposes for which creative-minded users are utilizing the product. “Bottom line,” Rigotti says. “I can’t think of any good reason for someone who’s never smoked to chew nicotine gum.”
The Worst That Will Happen
If your friend gets hooked, like some of Jean-François Etter’s subjects, she could be shelling out $40 every few weeks at CVS to feed her fix.
Also, while it’s hardly decided science, one review of available medical literature found that nicotine—as a single element—may be related to an increased risk of cardiovascular, respiratory, and gastrointestinal disorders, and have a negative impact on several bodily systems. “No drug is completely harmless,” Rigotti says, “not even coffee.”
What Will Probably Happen
Even if it can’t be categorized as harmless, nicotine gum “has to be pretty safe to be sold over the counter in the United States,” Rigotti says. She has encouraged patients to continue using it as long as they need if the alternative is relapsing back to smoking. She isn’t aware of any documented adverse effects from long-term usage.
But nicotine gum runs the same risk of any addictive stimulant: Dependence and tolerance leading to even more use.
What to Tell Your Friend
Your reliance on nicotine gum isn’t a huge health hazard. It’s just kinda weird, seeing as you never smoked. Although scientists haven’t studied the risks of chewing nicotine gum long-term, there might be some and you could probably find a healthier, more proven, less addictive fix for your fatigue problem. Still, you are taking considerably fewer health risks than anyone who inhales their dose of nicotine.
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