Evaluating the acute effects of oral, non-combustible potential reduced exposure products marketed to smokers

Abstract

Background Non-combustible potential reduced exposure products (PREPs; eg, Star Scientific’s Ariva; a variety of other smokeless tobacco products) are marketed to reduce the harm associated with smoking. This marketing occurs despite an absence of objective data concerning the toxicant exposure and effects of these PREPs. Methods used to examine combustible PREPs were adapted to assess the acute effects of non-combustible PREPs for smokers. Methods 28 overnight abstinent cigarette smokers (17 men, 14 non-white) each completed seven, Latin-squared ordered, approximately 2.5 h laboratory sessions that differed by product administered: Ariva, Marlboro Snus (Philip Morris, USA), Camel Snus (RJ Reynolds, Winston-Salem, North Carolina, USA), Commit nicotine lozenge (GlaxoSmithKline; 2 mg), own brand cigarettes, Quest cigarettes (Vector Tobacco; delivers very low levels of nicotine) and sham smoking (ie, puffing on an unlit cigarette). In each session, the product was administered twice (separated by 60 min), and plasma nicotine levels, expired air CO and subjective effects were assessed regularly. Results Non-combustible products delivered less nicotine than own brand cigarettes, did not expose smokers to CO and failed to suppress tobacco abstinence symptoms as effectively as combustible products. Conclusions While decreased toxicant exposure is a potential indicator of harm reduction potential, a failure to suppress abstinence symptoms suggests that currently marketed non-combustible PREPs may not be a viable harm reduction strategy for US smokers. This study demonstrates how clinical laboratory methods can be used to evaluate the short-term effects of non-combustible PREPs for smokers.

Evaluating oral noncombustible potential-reduced exposure products for smokers

“…and "Do the tobacco products you are using this week taste good?"). These results are consistent with previous work in which these products were administered acutely in a laboratory setting (Cobb et al, 2009), demonstrating reliability across studies and methods.…”

“…Findings support those of previous work (Cobb et al, 2009), and together, they suggest that currently available noncombustible PREPs are unlikely to substitute for smokers' own brand of cigarette. To be a successful PREP, a noncombustible tobacco product for smokers will need to reduce toxicant exposure demonstrably and also will likely need to approximate a cigarette's ability to suppress the aversive symptoms associated with cigarette abstinence.…”

“…In this study, participants' usual level of CO exposure (i.e., OWN condition) was 23.7 ppm (collapsed across days, SEM = 1.0); these levels were significantly lowered by A (collapsed across days, M = 7.2, SEM = 1.0) and CS (collapsed across days, M = 6.1, SEM = 0.8) on all days. Both oral tobacco conditions were also associated with significantly lower levels of urine cotinine on Day 3 compared with participants' usual levels as observed in the OWN condition (see also Cobb et al, 2009). Of course, even lower levels of urinary cotinine and NNAL-T were observed when participants abstained from all tobacco products (i.e., No-T condition).…”

“…For example, Star Scientific markets Ariva, a compressed tobacco tablet intended for "adult smokers in situations where they cannot or choose not to smoke." According to the manufacturer, the tobacco used in Ariva is cured such that the formation of TSNAs is limited; laboratory study reveals that this product delivers nicotine, although at a dose lower than a typical cigarette (Blank, Sams, Weaver, & Eissenberg, 2008;Cobb, Weaver, & Eissenberg, 2009;Kotlyar et al, 2007). Another noncombustible PREP is R. J. Reynolds' Camel Snus (CS), a sachet of tobacco that is marketed for "pleasure for wherever."…”

The Effect of Sensorimotor Replacement on Smoking Cessation and Craving

“…The size of this effect is unknown, and regression analyses revealed significant individual differences, in that males and more dependent smokers reported more similar ratings between the two types of cigarette. A fair number of studies have however found similar craving suppression to nicotine containing cigarettes [7,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”