Tobacco lozenges and pouches
Lozenges that contain tobacco, and small, pouches of tobacco (Revel®, Exalt®) are being sold as other ways for smokers to get nicotine in places where smoking is not allowed. The FDA has ruled that these are types of oral tobacco products much like snuff and chew, and are not smoking cessation aids. This means that the FDA does not have authority over them. There is no evidence that these products can help a person quit smoking. Unlike scientifically proven treatments with known effects, such as nicotine replacement products, anti-depressants, nicotine receptor blockers, or behavioral therapy, these oral tobacco products have never been rigorously tested to see if they can help people quit tobacco.
We know that oral tobacco products such as snuff and chewing tobacco contain human carcinogens. These products cause mouth cancer and gum disease. They also destroy the bone sockets around teeth and can cause teeth to fall out. There are studies showing potential harmful effects on the heart and circulation, as well as increased risks of other cancer. They also cause bad breath and stain the teeth.
In 2004, a Chinese company started making a refillable “cigarette” that had a battery and an electronic chip in it. It is designed to look like a cigarette, right down to the glowing tip. When the smoker puffs on it, the system delivers a mist of liquid, flavorings, and nicotine that looks something like smoke. The smoker inhales it like cigarette smoke, and the nicotine is absorbed into the lungs.
The electronic cigarette, or e-cigarette, is sold with cartridges of nicotine and flavorings. Several brands and varieties of the e-cigarette are now sold in the US. Here, the e-cigarette is usually sold as a way to get nicotine in places where smoking is not allowed, although some may sell it as a way to quit smoking. The cartridges are sold in different doses of nicotine, from high doses to no nicotine at all.
The e-cigarette has no published clinical trials that suggest it might work as a way to help smokers quit. No clinical trials have been submitted to the FDA. As of early 2009, the FDA has not ruled as to whether e-cigarettes are medical devices but it is investigating. There may also be questions about how safe it is to inhale some of the flavorings and other substances in the nicotine mists into the lungs. Even substances that are safe to eat can harm delicate tissues inside the lungs.
Like other forms of nicotine, the e-cigarettes and nicotine cartridges can be toxic to children or pets. They can also pose a choking hazard.
Nicotine lollipops and lip balms
In the past, some pharmacies made a product called a nicotine lollipop. These lollipops often contained a product called nicotine salicylate with a sugar sweetener. Nicotine salicylate is not approved by the FDA for pharmacy use. The FDA has warned pharmacies to stop selling nicotine lollipops and lip balm on the Internet, calling the products “illegal.” The FDA also said “the candy-like products present a risk of accidental use by children.”
Other smoking cessation products like these may not use nicotine salicylate and, therefore, may be legal. But they still pose a risk for children if they are not well-labeled and stored safely.
Nicotine water and nicotine wafers
These products are advertised as ways to get nicotine in places where smoking is not allowed. They are not marketed as aids to quitting smoking, but questions about their safety have been raised. Some of these formulas can be quite dangerous if accidentally taken by children or pets, so they must be stored carefully.
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