Why Nicotine’s Bad Reputation is Detrimental to Public Health

While nicotine tends to be wrongly associated with the harms of smoking, there is extensive research indicating that actually the substance has some unique medicinal properties.

Many people associate nicotine with the dangers of smoking, even though the real harm in cigarettes comes from tar and other toxic substances found in tobacco smoke. In some instances, authorities actually fuel this misinformation by promoting the use of low nicotine products with the aim of preventing or reducing the addictive effects of nicotine.

In fact, as the Biden administration neared its conclusion last month, a last-minute measure to cap nicotine levels in cigarettes was introduced. Meanwhile tobacco harm reduction experts keep highlighting that the focus should not be on nicotine, as it is not the cause of major smoking-related diseases.

Moreover, goverments and health organizations, including the WHO, recognize safe nicotine use as a tool for quitting smoking via NRT use, which includes products like nicotine patches, gums, and lozenges. These products reduce withdrawal symptoms in smokers. Then again, so do vaping products, nicotine pouches, and heat-not-burn products, yet these are often demonized.

The Therapeutic Potential of Nicotine
A recent interview on GFNTV with Dr. Michael Kariuki, a consultant pediatrician and epidemiologist from Kenya, provided a medical perspective on nicotine use and harm reduction. Discussing the therapeutic applications of nicotine and the vital role of safer nicotine products in aiding smoking cessation, Kariuki outlined the public health benefits of safer nicotine alternatives, policies in Kenya and Africa, and how harm reduction strategies could save lives.

Dr. Kariuki referred to research indicating that nicotine may have therapeutic effects in Parkinson’s & Alzheimer’s Disease. Studies have in fact shown that it may delay onset and slow progression of these conditions. Moreover, nicotine has a positive effect on memory & cognitive function, and has been shown to increase attention, concentration, and memory.

The relationship between nicotine and ADHD
Nicotine has also been studied for potential benefits in managing ADHD & Tourette’s Syndrome. On this note, there is growing interest in nicotine as a potential treatment alternative for ADHD.  Over the last few decades, ADHD diagnoses have significantly increased, with the rate of diagnosis for UK boys aged 10-16 years rising from 1.4% in 2000 to 3.5% in 2018.

Despite the increasing demand for treatment, patients often face long wait times for diagnosis and access to medication, which can carry side effects like sleep issues, appetite suppression, mood changes, headaches, increased heart rate, and jitteriness. Meanwhile, nicotine’s potential benefits for managing ADHD have been studied since the mid-1990s, with many early studies calling for further research due to promising preliminary findings.

Individuals with ADHD are known to be 40-80% more likely to smoke, often as a form of self-medication. Although smoking has well-known health risks, alternative nicotine products, such as patches, pouches, and vapes, could offer a safer option.

A 2009 study showed that nicotine patches reduced ADHD symptoms by 8% and lowered negative moods by 9%. Other research highlights cognitive improvements, with a 2018 study noting nicotine’s positive effects on attention, working memory, fine motor skills, and episodic memory. Additionally, a 2008 study found that nicotine administration improved cognitive performance in non-smoking young adults with ADHD.

Observational studies have also shown that nicotine may be used as a potential treatment for Ulcerative Colitis & Arthritis, as well as for treating obesity. In light of all the above, highlighted Dr. Michael Kariuki, while smoking is harmful, the use of safer nicotine use or administration, should not be overlooked.

The Changing Perception of Nicotine: Insights from Experts
A similar discussion on the topic was held during the 2023 Global Forum on Nicotine (GFN23). The panel discussion, “The Changing Face of Nicotine,” explored misconceptions surrounding nicotine and its potential benefits. Dr. Paul Newhouse, a psychiatrist and physician-scientist, explained that nicotine functions as a stimulant, activating brain receptors that regulate mood.

Dr. Carolyn Beaumont, a general practitioner and educator, addressed the common perception of nicotine as highly addictive. She pointed out that the term “addiction” carries negative connotations, largely because nicotine is considered the addictive element in cigarettes. However, she stressed that while smoking is undeniably harmful, nicotine by itself is not inherently dangerous.

Dr. Garrett McGovern, a GP specializing in addiction medicine, echoed this sentiment. He stated that, in his clinical experience, nicotine has not caused harm and, in some cases, has shown benefits. He criticized claims that nicotine negatively impacts adolescent brain development, noting that these arguments are largely based on animal studies rather than solid human evidence.

While Dr. Alex Wodak, a retired physician and former president of the Australian Drug Law Reform Foundation, referenced Michael Russell’s famous statement, “People smoke for nicotine but die from the tar.” Wodak adapted this idea, suggesting that smokers are not dying from nicotine but rather from resistance to harm-reduction strategies.

Research Barriers and Stigma
Despite all the promising findings in nicotine, Dr. Konstantinos Farsalinos, a cardiovascular physician and senior researcher at the University of Patras, highlighted the challenges scientists face in studying nicotine. He noted that stigma surrounding nicotine often discourages further research, particularly in medical applications. When asked whether this perception is likely to change, he acknowledged that researchers outside of tobacco studies may be more open to exploring nicotine’s therapeutic potential. However, he remains skeptical about nicotine being widely accepted as a medical treatment in the near future.

These discussions underscore the need for a more nuanced understanding of nicotine—one that separates it from the harms of smoking and recognizes its potential medical applications. More importantly, the most well-established use of nicotine therapy: helping smokers quit combustible cigarettes, needs to be emphasized.