By Richard Trubo
In the 2000 movie Bounce, Gwyneth Paltrow's character, Abby, explains that she really isn't a smoker at heart, but has started puffing on cigarettes to help her get off the nicotine gum to which she's become addicted. The line invariably gets a laugh. But for people who feel that they really have become hooked on nicotine gum, Abby's quirky observation may hit too close to home.
In fact, 1.5-2 million Americans try the nicotine-laced gum each year (it was originally introduced in the U.S. in 1984). And while many, thanks to the gum, have successfully kicked the tobacco habit, some seem to have weaned themselves from one nicotine habit only to pick up a new (albeit less risky) one.
Most users of nicotine gum -- now sold over-the-counter under the Nicorette brand as well as several generic names -- see it as a short-term measure. GlaxoSmithKline, marketers of Nicorette, advises people to "stop using the nicotine gum at the end of 12 weeks," and to talk to a doctor if you "still feel the need" to use it. But that guideline hasn't kept some people from chomping on it for many months and even years. In an addiction forum on the Internet, one gum user posted a familiar message describing her 10-year-long habit of chewing between 9 and 11 pieces of Nicorette per day, and asking for "any suggestions as to how to get off the gum."
In a recent report evaluating data collected by ACNielsen, researchers concluded that 5-9%of nicotine gum users relied on it for longer than the recommended three months. About half that many were chewers for six or more months.
Nevertheless, if there are serious health risks from this kind of chronic gum chomping, they haven't been identified yet. "I've encountered people using the gum for 15 years," says John Hughes, MD, professor of psychiatry at the University of Vermont in Burlington, and spokesperson for the Society for Research on Nicotine and Tobacco. "And their main complaint is the cost of the gum." The price tag for using Nicorette gum is about the same as a pack-and-a-half-a-day smoking habit.
In some published studies, people have used nicotine gum up to five years, according to Richard Hurt, MD, professor of medicine and director of the Nicotine Dependence Center at the Mayo Clinic in Rochester, Minn. "As far as we now know," he says, "there are no heart or vascular problems associated with long-term use."
Cigarette smoking itself, of course, can cause serious, life-threatening health problems. But the nicotine in the gum is delivered slowly through the mucous membranes in the mouth, and at much lower levels than the quick-hit surge of nicotine that occurs when puffing on cigarettes. At the same time, the gum does not contain any of the cancer-causing substances present in cigarettes.
In fact, if you've been a chronic nicotine-gum user, you may have experienced the most frequent health problem that it causes -- jaw pain produced by constant chewing, week after week, month after month. As for other health concerns, a caveat is usually given to pregnant and breastfeeding women, advising them to use the nicotine replacement product only on the advice of a healthcare provider.
"In the third trimester of pregnancy, there are no adverse effects to either the mother or the fetus with the use of nicotine replacement," says Hurt. But, he adds, no studies have been done on the effects of the product early in pregnancy.
Isn't the Gum Addicting?
If you've ever felt as though you were becoming hooked on nicotine gum, you might not have been imagining it. Even though the nicotine levels in the stop-smoking product is lower than in cigarettes, there could be an addictive component to its use in some individuals.
"In the Lung Health Study of about 3,100 users of nicotine gum, some of whom used it for five years, all had been daily cigarette smokers when they entered the study," says Robert Murray, PhD, professor and director of the Alcohol and Tobacco Research Unit at the University of Manitoba, Canada. "So through cigarette use, these people had established a physical addiction to nicotine, and the gum may have perpetuated that addiction."
Some people experience withdrawal symptoms when they toss out their nicotine gum, according to Murray. These withdrawal effects can include headaches, as well as irritability, depression, and difficulty concentrating.
Nevertheless, a recent study by Hughes concluded that only a small number of long-term gum users truly meet the definition of addiction or dependence, which includes an inability to control their use of the gum. Many more could stop, he says, but are choosing to use the gum for months or years because of their fear of slipping back into cigarette use.
"Most people say that quitting smoking is the hardest thing they've ever done," says Hughes. "With the help of the gum, they've finally been able to quit, and they're scared to stop using it. Some say to me, 'If there's even a 10% chance that I'm going to return to smoking without the gum, I'm going to keep using it.'
"If the gum were something we knew to be harmful, I'd get upset about its chronic use, and insist that they get off it," adds Hughes. "But it doesn't seem to be harmful."
If the choice were between smoking and using a pure nicotine product like the gum, "it's really a no-brainer," says Hurt. "We still want to get people off the gum. But it may take some of them a lot longer than others."
Reviewed by Gary D. Vogin, MD, June 3, 2002.
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