quit smoking with NRT or e-cigarettes


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In the United States, around a fifth of all deaths are smoking related. It is clear that smoking presents serious health risks, and despite this being common knowledge, people still choose to smoke. Understanding why this is the case is essential to changing the huge number of smoking related deaths.


Nicotine is a naturally occurring insecticide in plants, and behaves as both a stimulant and depressant in humans. There are quite a few effects of nicotine on the human body - it activates parts of the brain that regulate things like our mood and cognition, and continued use results in an increase of the number of receptors that nicotine acts on. Depriving the body when it has developed this dependence leaves the brain craving nicotine to get these areas stimulated. Smoking also stimulates the release of dopamine - the body’s reward chemical - and this can give smokers the feeling of being relaxed and content.

nicotine is a highly addictive chemical found in NRT, e-cigarettes and traditional tobacco


Nicotine Replacement Therapy (NRT) is a medicinal way of replacing the nicotine you would otherwise get from smoking. These nicotine containing products come in many forms such as nasal spray, chewing gum and patches, and deliver nicotine without all the additional harmful chemicals found in traditional cigarettes.


Nicotine gum is a chewing gum form of NRT that releases nicotine as it is chewed, the nicotine is then absorbed by the mouth lining and gets into the bloodstream. It also serves to keep the mouth busy, which can help the quitting process. Alongside nicotine and the chewing gum base, nicotine gum contains Polacrilin, Sorbitol, anhydrous sodium carbonate, sodium bicarbonate, glycerol, talcum and flavourings.
The gum is meant to be used in a very specific way, as it is the chewing that gives the doses of nicotine. The gum should be chewed until a tingling sensation is felt, at which point the gum should be placed between teeth and gum or lip until it subsides, and this should be repeated over the course of half an hour.

Many studies have been conducted to assess the efficacy of the various forms of nicotine replacement therapy, and nicotine gum has shown a significant positive effect for smoking cessation. One particular study shows the 2mg strength nicotine gum had a 16% efficacy in ‘high dependence’ smokers - those craving a cigarette when they wake up - meaning 16% of the subjects had stopped smoking at one year. The 4mg strength saw the percentage of those who had stopped at 1 year rise to about 33%.
There are some potential side effects from nicotine gum from hiccups and wind to some more serious symptoms; including dizziness, nausea, vomiting, diarrhoea, weakness, arrhythmia, difficulty breathing, a rash, and blisters in the mouth. If you experience any of those symptoms while using nicotine gum, stop using it immediately and call your doctor.

nicotine gum is a traditional nicotine replacement therapy that helps adult smokers to quit smoking traditional cigarettes


A nicotine patch is another form of NRT that applies nicotine transdermally (through the skin). They are available in 16 hour and 24 hour versions, and different strengths, that apply a steady supply of nicotine to the body over the stated period. Just apply in the morning and remove at the end of the stated time period. This is easy and requires no maintenance throughout the day. 
The same study mentioned earlier also looked at the effectiveness of nicotine patches in relation to the nicotine gum available on the market. The study saw a 9% efficacy for nicotine patches - this means 9% of the subjects using the patches had stopped smoking at one year.
Nicotine patches can cause mild itching, redness and/or burning and stinging where they are applied to the skin, but this should only be considered serious if this hasn’t disappeared after 4 days. Other possible side effects include nausea, dizziness, headache, heartburn and skin flushes, and the persistence or worsening of these symptoms require a consultation with a doctor or pharmacist. Serious symptoms like mood changes, numbness in the hands and/or feet and swelling of the hands, ankles or feet mean you need to stop using the medication and consult your doctor immediately.
nicotine patches are one of the nicotine replacement therapies that have helped people to quit smoking cigarettes 


E-cigarettes are an electronic version of a cigarette that vaporizes liquid containing nicotine (called ‘e-liquid’ or ‘vape juice’) which is then inhaled. The liquid contains just vegetable glycerine (VG) propylene glycol (PG) nicotine and flavourings, eliminating the thousands of chemicals found alongside nicotine in tobacco, of which 60+ are known carcinogens.


There are some frustrating myths surrounding vaping and e-cigarettes, and some of this is down to the differences in regulation between different countries (or complete lack of, in some cases).

One such myth is that e-cigarettes give you what is called ‘popcorn lung’ - it was given this name because it is caused by diacetyl, the chemical used to give microwave popcorn it’s flavour and smell, and was first observed among workers in a popcorn factory. This appears to be a problem found mainly in the US - in the UK diacetyl is banned as an ingredient for e-liquids, whereas the United States have yet to implement comprehensive regulation for e-liquids.
Another myth stems from the lack of regulation in the US and other countries, and this is the misconception that e-cigarettes are not regulated and we don’t know what’s in them - in the UK we have strict regulations regarding standards of quality and safety when it comes to e-cigarette and vape products - even the packaging has requirements for labelling to ensure customers have all the relevant information and can make the right choice. Products must be tested and detailed information provided to the UK Medicines and Healthcare products Regulatory Agency (the MHRA).

There is also an assumption that because e-cigarettes contain nicotine, this means they are harmful. According to Public Health Matters, four in ten smokers (and ex-smokers) think nicotine causes tobacco related cancer. While nicotine is the chemical that keeps people addicted to smoking, there are over 60 known carcinogens in cigarettes, and thousands of other compounds that can affect things like nicotine uptake, and it is these chemicals that cause serious damage. Not to mention the carbon monoxide - a very reactive, unstable compound that damages the body’s ability to transport oxygen around.

Second hand smoke is problematic when it comes to smoking, and it is assumed that similar problems are present with vapour from e-cigarettes. Public Health England’s 2018 review of evidence found there have been no identified health risks of passive vaping to the health of bystanders.

Two myths that can be addressed together are the idea that e-cigarettes encourage young people to smoke because of things like ‘fruity flavours’ - and that the tobacco industry is using e-cigarettes as a method to keep people smoking. Whilst young people are experimenting with e-cigarettes, this does not turn into regular use in most cases - data collected by Action on Smoking and Health (ASH) showed a rise in the percentage of people who have tried e-cigarettes, but occurrence of regular use remained at 1%. This, coupled with the fact that 2016 saw the lowest prevalence of smokers in the UK since 2010 - just 15.8% - strongly suggests that tobacco use is in decline, not being exacerbated by e-cigarettes.

Lastly, sceptics have suggested that e-cigarettes don’t actually help you quit smoking - all the evidence shows this to be incorrect. Some studies have shown that using an e-cigarette can be almost twice as effective as other forms of nicotine replacement therapy - one study showed a 9.9% abstinence rate at one year using NRT, whereas the e-cigarette group saw 18% abstinence rate at the one year mark, when both products were accompanied with behavioural support. 


Making the switch from smoking to vaping cuts out all the harmful chemicals found in tobacco, and allows you to get your nicotine in a way that feels similar to smoking. Public Health England maintains that e-cigarettes are 95% less harmful than smoking, so using e-cigarettes to stop smoking is an effective way of delivering the nicotine to your body and keeping your hands busy while you do! 


In all seriousness, the action of smoking is a big part of the addiction, if only psychologically. Vaping is brilliant because it delivers nicotine in an action that smokers are used to, without the negative effects from smoking cigarettes. Forms of nicotine replacement therapy are normally prescribed for a course, and while the general consensus is that using these products long term is safer than long term tobacco use, there is some indication in animal studies that long term use can increase cancer risk.

Other factors that demonstrate the validity of vaping against forms of NRT include the nicotine delivery itself. Whilst vaping still doesn’t deliver the same nicotine hit as a cigarette, new generation devices have improved the level of nicotine absorption.


Nicotine patches are easy and convenient, only need to be applied in the morning and taken off after the indicated time period. It slowly builds the blood nicotine level and maintains it, which means there is a delay between the initial application and satisfaction, between 30 minutes to an hour. Vaping gets to a significant blood nicotine level much faster than the patch, so the faster action should result in less time craving or suffering withdrawal symptoms. With an e-cigarette you can adjust your dose accordingly by taking more (or less) puffs; patches deliver a consistent amount over time, so the dosing can’t be adjusted.


Using gum has a similar problem to patches - the nicotine takes approximately half an hour to reach significant levels, meaning it does little to address a craving swiftly. It also has very specific instructions for use so the user must keep these in mind when chewing away, and eating or drinking shortly before (or during) use reduces nicotine absorption, so these instructions should be followed to extract maximum value from nicotine gum.

Vaping gets more nicotine into the blood quicker than nicotine gum, so addresses cravings faster. Also, vaping can be done at your leisure, with some variation between devices and liquid strengths, where the gum should be used once every 2 hours (at least when you first start use), reducing the flexibility and ease of use. Here in the UK there are only 2 different nicotine strengths available in the gum, which again means less flexibility - vaping gives the option of different strength e-liquid, and the option to make your liquid, which can be tailored to your own needs.

The gum is also designed to be used as a quitting aid over a given period of time. While this pressure may be beneficial for some, vaping does not have the same limitations, and can be adjusted in different ways if necessary. Lower the nicotine content in your liquid, use the device less, take bigger but fewer drags, or even change device - the options for vaping are more numerous than those for gum, and as a ‘one-size-fits-all’ approach rarely works due to individual differences and preferences, this gives vaping the edge.


As we have established, there is evidence to support the supposition that new generation e-cigarettes are more effective as a long term tool for quitting than the forms of nicotine replacement therapy available, when accompanied by behavioural support. The same study also demonstrated reduced coughing and phlegm production for the e-cigarette group versus the NRT group.
Another study looked at the short term efficacy of e-cigarettes, e-cigarettes with NRT, and NRT alone - all alongside behavioural support. The two groups that used an e-cigarette saw similar short term success: the e-cig only group had a 62.2% success rate at 4-6 weeks, the e-cig with NRT saw a 61.5% success rate, as opposed to the NRT only group, which saw a success rate of 34.8%.

Every new study appears to be providing more evidence to support the validity of e-cigarettes and vaping as a smoking cessation method. The efficacy is also consistently outperforming that of current nicotine replacement therapy products, in both short term and long term studies. If you are a smoker looking to quit nicotine, e-cigarettes may provide you with the best chances of success.


So why is vaping better than patches or gum? Patches and gum are slower to act, give the user less freedom, don’t replace the action of smoking, and the current evidence shows them to be less effective at helping people quit smoking.

While there are individual cases where nicotine replacement therapy in the form of patches gum, or other products may be preferred due to medical reasons, vaping is proving to be more successful than these other products for getting people away from smoking. Now that really is worth sharing!
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