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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A Stimulating Treatment for Drug Addiction

Drug addiction is notoriously difficult to treat. Limited treatment options are available for those suffering from addiction, including behavioral therapy, rehabilitation programs, and medication. However, current drug addiction medications are only approved to treat opioid, tobacco, or alcohol abuse, leaving out many other drugs of abuse,such as cocaine or methamphetamine.

Yet even when patients successfully complete rehab or stick to a medication plan, there is still a risk of relapse. This can often be due to the emergence of drug cravings. For instance, a former alcoholic may see a sign for a bar they used to frequent. That sign can induce feelings of craving for alcohol, even long after the user quits or abstains from drinking. Strong cravings could lead to a relapse and a resumption of the cycle of addiction.  

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No pharmaceutical treatments are currently available for cocaine addiction.

However, a recent discovery may change the way we approach drug addiction treatment. Italian researchers, working alongside the National Institute on Drug Abuse (NIDA), were able to reduce drug cravings and usage in cocaine addicts for the first time using a technique called transcranial magnetic stimulation (TMS).

Long-term use of drugs change how brain cells communicate to each other. Think of a drug addict’s brain cells as speaking in gibberish, or unable to speak at all. Important messages aren’t being sent correctly, which contributes to the negative effects of addiction.

In a TMS procedure, researchers place a figure-8-shaped magnetic coil on the patient’s head. When turned on, the coil can send electrical signals into the brain. Importantly, brain cells communicate using electricity, and the “messages” between cells depend on the strength and frequency of these signals. Researchers found that the electrical signals from TMS help change the way brain cells “speak” to each other, getting rid of the gibberish and making cells communicate normally.

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TMS uses a magnetic coil to send electric signals into the brain.

In the case of drug addicts, the electrical signals from the magnetic coil are focused at a brain region called the dorsolateral prefrontal cortex (dlPFC). This is a part of the brain that handles decision making and cognitive ability, and is affected by drugs of abuse. For instance, drug addicts demonstrate lower dlPFC activity compared to non-addicted individuals during cognitive tasks.

Knowing how important this brain region is, researchers performed a study where they stimulated the dlPFC of drug addicts using TMS. They had cocaine addicts undergo either the TMS procedure or take medication (as a control group). They found that the cocaine users who experienced TMS had less cocaine cravings than their control counterparts. Further, the TMS group had more cocaine-free urine samples compared to the control group.

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The dorsolateral prefrontal cortex is affected by drug addiction.

Other studies support these results, focusing specifically on the prefrontal cortex, which appears to be a “sweet spot” for treating drug addiction. For instance, an earlier study found that daily TMS sessions, focused more broadly at the left prefrontal cortex, reduced cocaine craving. A later study honing in on the left dlPFC found similar reduction of craving in cocaine users.

Interestingly, the Italian TMS study was based on a rodent experiment with a very similar design. In this study, researchers allowed rats to develop a cocaine addiction and then stimulated a brain region analogous to the human dlPFC. Amazingly, the rats decreased cocaine seeking behaviors, much like their human counterparts in the TMS study. When this brain region was inhibited, or “turned off”, the rats increased their cocaine seeking.

Despite their promise, these TMS studies are just the beginning. Researchers are still a long way from developing a cure or reliable treatment for drug addiction. Like any new drug or treatment, it will be many years before TMS could be accepted as standard care for drug addicts. However, TMS has been successfully used to help patients in other ways. For instance, it has been used to help treat depression and is often used to help doctors identify damage from strokes, brain injuries, and neurodegenerative diseases. TMS holds a lot of promise and is on the cusp of being a successful drug addiction treatment. It’s only a matter of time before this stimulating idea becomes reality.

Peer edited by Robert Lee and Julia DiFiore.

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