Pilot study on lower nitrosamine smokeless tobacco products compared with medicinal nicotine

Abstract

Smokeless tobacco (ST) products have the potential to be used as a harm reduction method for cigarette smokers. These products can deliver significantly less toxicants than cigarettes, although they are not toxicant free nor harmless. It is important to examine potential health risks and benefits of these products. These two small pilot studies examined the effects of two different ST products (Exalt and Ariva) compared with medicinal nicotine, another potential harm reduction product. Dependent, healthy adult cigarette smokers, who were motivated to quit smoking, underwent 1 week of baseline smoking measurement. They were then asked to quit smoking and were randomly assigned to use either an ST product or a medicinal nicotine lozenge (MNL, Commit) for 2 weeks, then crossed over to use the other product for 2 weeks. In the last week, following the sampling phase, subjects could choose the product they wished to use. Assessments were made repeatedly during baseline cigarette use and throughout the 5 weeks of treatment. Outcome measures included biomarkers for tobacco exposure and subjective, physiological, and behavioral responses. Tobacco-specific carcinogen uptake was greater from Exalt than from the MNL, and was comparable between the MNL and Ariva. Physiological effects and subjective effects on withdrawal and craving were comparable among Exalt, Ariva, and the MNL. Ariva was preferred over the MNL, which was preferred over Exalt. With the exception of medicinal nicotine products, low-nitrosamine ST products have the greatest potential to result in reduced toxicant exposure compared with other combustible reduced exposure products and have promise for reducing individual risk for disease. However, the population effect of marketing of such products as reduced exposure/reduced risk is unknown. The need for further research in this area and regulation of tobacco products is evident.

A pilot randomized study of smokeless tobacco use among smokers not interested in quitting: Changes in smoking behavior and readiness to quit

“…This suggests that Ariva and Stonewall are effective products to curb withdrawal and craving. In support of this interpretation, we found no changes in overall craving or withdrawal as smokers substituted Ariva/ Stonewall for cigarettes, which is generally consistent with reports from others (Blank, Sams, Weaver, & Eissenberg, 2008;Kotlyar et al, 2007;Mendoza-Baumgart et al, 2007). However, although cigarettes per day significantly decreased among smokers who used Ariva/Stonewall, reduction in CO was less striking (6%), suggesting partial compensation (e.g., inhaling deeper, more frequent puffs) and/or problems with the use of CO as a biomarker of tobacco exposure in this population (see following).…”

“…We further asked PREP participants about the manner in which they used Ariva/Stonewall (e.g., to avoid smoking restrictions, cut down on cigarette smoking). As prior studies have examined toxicant exposure Mendoza-Baumgart et al, 2007), these outcomes were not included here; however, participants provided a breath sample for carbon monoxide (CO) testing at each visit.…”

Transdisciplinary Tobacco Use Research Centers: Research achievements and future implications

“…These studies showed (a) no difference in levels of total NNAL, 1-HOP, and cotinine in smokers of regular, light, and ultra-light cigarettes, respectively, which is consistent with epidemiological studies showing that these cigarettes do not lead to reduced risk for cancer ; (b) significant but only modest reductions in carcinogen exposure when smokers switched from conventional to modified reduced carcinogen cigarettes ( Hatsukami et al, 2004 ); (c) a significant reduction in carcinogens when ST users switched from a conventional U.S. product to Swedish snus (Hatsukami et al) and when smokers switched to Swedish snus or tobacco lozenge ( Mendoza-Baumgart et al, 2007 ); and (d) the greatest reductions occurring with medicinal nicotine products. These studies support the concept of a continuum of risk associated with different types of nicotine-containing products .…”

Are smokers receptive to using smokeless tobacco as a substitute?

“…One group reported that smokers consistently preferred use of nicotine replacement therapy (NRT) over smokeless tobacco, citing such advantages as greater efficacy (17%) and health benefits (13%) (Shiffman et al, 2007). An additional study, which utilized a crossover design (Mendoza-Baumgart et al, 2007), indicated that smokers preferred a nicotine lozenge over the product Exalt, a smokeless product marketed in the United States.…”