Electronic cigarettes, smokeless tobacco, inhalers – do they really help you quit? And are they safe? In recognition of Lung Cancer Awareness Month, we examine the top aids to help you kick the habit…
As any smoker knows, nicotine is a powerful drug. But some alternatives are also dangerous – leaving you breathing in chemicals found in antifreeze or smoking more rather than less.
“The U.S. Surgeon General’s report has consistently referred to it as [equally addictive as] heroin and cocaine,” says Thomas Glynn, Ph.D., director of Cancer Science and Trends for the American Cancer Society in Washington, D.C.
It’s not only the nicotine you crave. Each pack is 400 puffs, and “that repetitive behavior, unique to smoking, creates new pathways in the brain, making the activity itself habit-forming,” says Maher A. Karam-Hage, M.D., associate medical director of the Tobacco Treatment Program at MD Anderson Cancer Center in Houston.
Most people take 4-6 attempts to quit, and some give it as many as 10 or more tries before they’re successful.
To help, there are prescription and over-the-counter aids available. But some come with their own health risks.
Here, we break down the top cigarette alternatives and replacement products so you can kick the habit quickly and safely.
The Latest Smoking Alternatives
Smokeless or chemical-free cigarettes regularly make the news as quick fixes for cigarettes’ main drawbacks, but they haven’t been tested, regulated or FDA-approved.
Here’s what you need to know about the three main options:
Electronic cigarettes (e-cigarettes): Made to look like a cigarette or pen, an e-cigarette delivers nicotine through a battery-powered heating element that converts liquid from a replaceable cartridge into an inhalable vapor.
Although the device replicates the ritual, actions and flavor of lighting up, there’s no actual smoke. Perfect solution, right?
Wrong. The experts we spoke to said that most people use devices with smokeless tobacco to supplement smoking – not stop it – so they actually increase their nicotine intake.
This may be partly because e-cigarettes deliver an unreliable (or irregular) amount of nicotine, so smokers feel unsatisfied. Smokers also use them in places where smoking is banned, such as in a restaurant or office.
Initial testing of e-cigarettes has also raised concerns. Evidence indicates that “quality control processes used to manufacture these products are substandard or nonexistent,” according to an FDA statement.
As a result, e-cigarettes don’t deliver a consistent amount of nicotine, so smokers don’t know what they’re getting from one brand – or even one cartridge – to the next.
Nicotine isn’t the only harmful ingredient. According to the American Journal of Public Health, preliminary testing of two products shows that the vapor in electronic cigarettes contained at least one chemical, diethylene glycol (an antifreeze ingredient), which has a “history of mass poisonings and death when inadvertently substituted for propylene glycol in consumer products.”
In other words, because of the lack of regulation, you have no idea what else you’re inhaling.
Smokeless tobacco: Because you don't inhale, you may think these tea-bag-like pouches held under the tongue are a "safe" habit. In fact, you're transferring the cancer risk from your lungs to other body parts, such as the mouth, tongue, throat and esophagus.
This is particularly dangerous, because “oral cancers are very aggressive,” says Jamie Ostroff, Ph.D., director of the Tobacco Cessation Program at Memorial Sloan-Kettering Cancer Center in New York City.
Plus, researchers aren’t sure why, but “epidemiological data shows a clear increase in pancreatic cancer with smokeless tobacco use,” Glynn says.
Smokers also don’t find smokeless tobacco as satisfying as lighting up. Inhaling is the quickest way to absorb a drug into the lungs, so these pouches don’t deliver the same buzz, says Doug Jorenby, Ph.D., a professor at the University of Wisconsin School of Medicine and Public Health.
As a result, most people who use smokeless tobacco either continue, or start, to smoke cigarettes. In fact, 87% of people use it to supplement cigarette smoking, according to a 2010 study of 114 smokers, published in the American Journal of Public Health.
Herbal cigarettes: Don’t let the name fool you. Many cigarettes marketed as “herbal” contain tobacco.
Clove cigarettes, called Kreteks, are made from clove-scented tobacco. Others, called Bidis, are made from rolling tobacco in a dried leaf from the tendu tree, native to India.
Their dangers are serious: Clove cigarettes have been associated with an increased risk of lung cancer and other lung diseases, according to a report by the National Cancer Institute. Bidis have been linked to heart attacks, as well as cancers of the mouth, throat, larynx, esophagus and lung.
Another key problem with all these smoking alternatives is that they make it harder to break your habit, Ostroff says.
“They make smoking even more a part of your life and won’t help you address the psychological dependence.”
To decrease your need for nicotine, you’ll need a replacement product.
Nicotine-Replacement Products
Nicotine withdrawal sends many people back to cigarettes. It can cause difficulty concentrating, as well as anxiety, irritability and insomnia.
Replacement products ease those symptoms, and five types – nicotine patches, gum, lozenges, inhalers and nasal sprays – are FDA-approved.
All deliver controlled amounts of nicotine safely and come with instructions for tapering off use. These products double the success rate for people trying to quit, Glynn says. When combined with counseling, it triples.
Patches: These deliver a steady, continuous dose of nicotine over 24 hours so you “don’t wake up with a horrible craving,” Glynn says.
Patches can be irritating to skin, however, so they aren’t a good choice for people with sensitive skin or an allergy to adhesive tape.
Gum and lozenges: Unwrapping and chewing these replacements, or letting them dissolve slowly in the mouth, “helps meet oral and tactile needs,” Glynn says.
But the gum can stick to dental work and isn’t recommended for people with temperomandibular joint disease (TMJ).
Inhalers: Available only by prescription, these small plastic mouthpieces look like cigarette holders and mimic the action of smoking with no smoke (unlike a cigarette) or vapor (unlike an e-cigarette).
Some people keep the mouthpiece even after they’ve stopped smoking, Ostroff says, because just puffing on the empty mouthpiece removes their urge to smoke.
Inhalers can irritate the mouth and throat, however, and aren’t recommended for people with asthma.
Nasal sprays: Also available only by prescription, sprays offer the fastest nicotine absorption – in other words, the most satisfying buzz.
“They come closest of all treatments to mimicking what happens when someone inhales on a cigarette,” Ostroff says. But they can also cause nasal irritation and aren’t recommended for people with asthma or nasal or sinus problems.
There are some health risks to the replacement products. Because the nicotine delivery is more constant than with smoking cigarettes, some side effects – such as stomach upset – can worsen when you first start using them.
You can also have especially vivid dreams if you use some products, such as the patch, overnight. But the side effects taper off as your body adjusts.
If you’re pregnant, don’t use any of these stop-smoking aids. And check with your doctor if you have diabetes, heart disease, asthma, stomach ulcers, irregular heartbeat or have been prescribed a medication to help you quit smoking.
Prescription Medications
If you consult with your doctor about quitting smoking, he’s likely to prescribe one of the following:
Buproprion (Zyban): FDA-approved in 1997, this antidepressant reduces nicotine withdrawal symptoms by acting on the same neurochemical in the brain – dopamine – as nicotine does.
Buproprion can be used alongside nicotine-replacement products, increasing success in quitting, Jorenby says. But it’s not recommended for people with seizure disorders or heavy drinkers (because drinking lowers your seizure threshold).
Varenicline (Chantix): Generally, smokers take this for a week before their quit date, Jorenby says. Approved by the FDA in 2006, it can triple your chances of success by blocking nicotine cravings.
It’s the single most effective treatment we have, according to Jorenby. “With this medication, smoking just doesn’t do anything for the smoker,” he says. “Smokers told me it felt as if they were just sucking on air.”
Varenicline is metabolized by the kidneys. If you have had kidney disease, your doctor may want to adjust your dose.
Neither buproprion nor varenicline is recommended for pregnant women. If you’ve had symptoms of depression or bipolar disorder, you should be monitored closely by your doctor while taking these medications, because both have a rare risk of increasing negative thoughts.
More Ways to Quit
Regardless of the methods you use to stop smoking, you’ll have greater success if you don’t do it alone.
“Clinical data shows that people who use counseling combined with medical support, are more likely to quit,” Jorenby says.
This can be as simple as enlisting friends or family to talk to you when you have an urge to smoke, Glynn says.
You can also talk to one of the National Cancer Institute’s trained counselors. For help within your state, call 1-800-QUITNOW. Or, call this number from anywhere: 1-877-44U-QUIT.
Find more resources on the smokefree.gov website.
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