Time to quit “Ordinary Smoking”

For thousands of years, the tobacco plant has been used for various purposes, ranging from general enjoyment to medicinal uses. Apart from the sniffing and chewing of tobacco, the more common means of tobacco use today is smoking. Nicotine, the drug in question, can have positive psychiatric effects, but is also very addictive thus leading to dependence and other severe health effects. Although the harmful effects of tobacco have been known for decades, nicotine addiction continues to be one of the major causes of noncommunicable diseases and mortality worldwide.

Despite the availability of therapeutic alternatives, nicotine’s inherently addictive nature makes smoking cessation a real challenge for users.Traditionally, combustible products have ruled the tobacco market where smoke from the burning of tobacco delivers nicotine to the users, along with thousands of toxic and carcinogenic compounds. These products mainly include cigarettes, little cigars, cigarillos, cigars and hookah. In addition, flavors are added to mask the harsh taste of tobacco and facilitate new user recruitment. There was also an attempt to manufacture safer cigarettes, known as light cigarettes which ultimately failed to deliver the promise of reduced harm. Products with lower nicotine content have also been adopted to reduce the extent of addiction. Overall, the central effort has continued to develop products that deliver nicotine efficiently without the toxic compound load.

Tobacco products have evolved significantly over the decades

Tobacco products have evolved significantly over the decades

In this quest, e-cigarettes were introduced in the mid-2000s which have gained rapid popularity among existing and naive users. Simply speaking, these products are composed of nicotine in an organic solvent that creates a nice visible cloud of vapor. Enticing flavors and attractive packaging were used to attract users. Originally conceptualized as an aid for smoking cessation, e-cigarettes quickly became a topic of debate dividing health professionals and regulatory authorities. On one hand, vaping does result in reduced harmful compound exposure, but it is suspected to act as a “gateway” to nicotine addiction in youths due to tempting flavors. Additionally, there is grave concern about the long-term hazardous health effects unique to inhaling the e-liquid and flavor compounds. Currently, thousands of different flavored e-liquids are available in the market and the severity of use was even acknowledged by Oxford dictionary by making “vape” the word of the year in 2014. The Internet is also full of vaping videos also called “cloud chasing”. However, e-cigarettes do not to provide a satisfactory nicotine “kick” to the users and also pose danger to the users.

So, what’s next? The next big thing for the US tobacco market is the heat-not-burn products; strategically named “iQOS”, or I Quit Ordinary Smoking. The principle is based on heating instead of burning the tobacco to provide the nicotine with reduced toxic chemical compound generation. Already launched in different parts of the world, iQOS, also known as “heat sticks”, promise nicotine delivery with reduced harmful compound exposure. Research from the tobacco industry supports these ideas. Currently, iQOS is under review in the US by FDA, and if approved, have the potential to completely replace combustible tobacco, as we know it. However, with addition of flavors and selective marketing strategy, these may well be the next biggest concern for health professionals.

Acknowledgements: Drs. Robert Tarran and Boris Reidel for their support.

Edited by Nicole Smiddy

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