Changing smokeless tobacco products new tobacco-delivery systems.

Smokeless or noncombusted oral tobacco use as a substitute for cigarette smoking has been gaining greater interest and attention by the public health community and the tobacco industry. In order for the product to appeal to smokers, tobacco companies have been manufacturing new noncombusted oral tobacco (i.e., moist snuff) that is lower in moisture content and nitrosamine levels, packaged in small sachets and "spitless." While the primary motives of the major tobacco companies are to maintain or increase tobacco use, some members of the public health community perceive the use of noncombusted oral tobacco products as a harm reduction tool. Because cigarette smoking is associated with greater toxicant exposure compared to noncombusted oral tobacco, reduced mortality and morbidity are hypothesized to ensue, if cigarette smokers switched completely to these products. However, variability exists in levels of nicotine and toxicants and potential health consequences from use within and across countries. Therefore, promulgating noncombusted oral tobacco products as a safer alternative to smoking or as a substitute for smoking may engender more rather than less harm. To date, limited research is available on the effects of marketing noncombusted oral tobacco products to smokers, to support the use of these products as a harm reduction tool, and to determine the effects of varying levels of tobacco toxicants including nicotine on health. The need exists for manufacturing standards to lower toxicant levels of all noncombusted oral tobacco products, for the formulation of appropriate tobacco-product regulations and for the development of a strategic plan by the public health community to address this controversial topic.

Nicotine pharmacokinetics and subjective effects of three potential reduced exposure products, moist snuff and nicotine lozenge.

OBJECTIVE: To compare nicotine pharmacokinetics and subjective effects of three new smokeless tobacco potential reduced exposure products (PREPs; Ariva, Revel and Stonewall) with moist snuff (Copenhagen) and medicinal nicotine (Commit lozenge). METHODS: 10 subjects completed a randomised, within-subject, crossover study. Subjects used one product for 30 min at each of the five laboratory sessions. Maximal nicotine concentration (Cmax) was determined and area under the concentration time curve (AUC) was calculated for a 90-min period (during use and 60 min after use). Nicotine craving, withdrawal symptoms and ratings of product effects and liking were measured during product use. RESULTS: Nicotine AUC and Cmax were higher for Copenhagen than for any other product (p<0.002) and higher for Commit than for either Ariva or Revel (p<0.001). Cmax for Commit was also higher than for Stonewall (p = 0.03). Craving was lowest during use of Copenhagen (p<0.03). Craving during use of Stonewall, Ariva and Commit was lower than during use of Revel (p<0.05). Withdrawal symptom score during use of Copenhagen was lower than during use of Revel (p = 0.009). Copenhagen scores were higher (p<0.005) than all other products in several measures of drug effects and liking (feel good effects, satisfaction, liking and desire for product, and strength of product). CONCLUSION: The new smokeless tobacco PREPs result in lower nicotine concentrations and equivalent or lower reductions in subjective measures compared with medicinal nicotine. Since health effects of PREPs are largely unknown, medicinal nicotine should be preferentially encouraged for smokers or smokeless tobacco users wishing to switch to lower-risk products.