Nicotine Gum Treatment Plan
Be sure to take your time and read everything below. It is essential for you to understand the potential risks and benefits of treatment. Please do not hesitate to reach out to Ro's Care Team if you have ANY questions.
Congratulations. Entering a program to quit smoking is a great first step. It means you are facing the fact that you soon might be smoking your last cigarette. The thought of never smoking another cigarette may frighten you as much as it encourages you. That’s OK. We know that smoking cigarettes has been a source of pleasure, and maybe even comfort, over the years. Cigarettes may be killing you but they are difficult to quit for a reason.
However, you are here because something about how cigarettes are destroying your health, damaging your relationships, or putting children and others at risk, has finally kicked in. The good news is that with the doctor-recommended plan (below), you have a great shot at being smoke free.
Nicotine replacement therapy (NRT), which includes nicotine gum, increases the chance by 50% to 70% that soon you will be smoking your last cigarette, according to medical studies.
Using nicotine gum can reduce the withdrawals and other symptoms that make quitting so difficult. Read about it, learn all you can, and take control of this process. Nicotine gum should only be used as directed, and only if you are committed to the effort.
If you have any of these conditions and it has not been shared with your doctor, please do so now.
An online smoking cessation program has the advantage of convenience, but it relies on your honesty and on your involvement in the process. That includes reading everything below carefully (in addition to the packaging of your gum), and communicating with your primary care physician.
If your health should change, should you have a side effect, should the nicotine gum not work or stop working over time, should you be prescribed ANY new medication or change your medication regimen, should you visit another doctor, please contact us. Keep EVERY healthcare provider informed.
Being fully informed is the only way for you to know if this course of treatment suits your needs and if you want to accept it as presented. Understanding your plan, along with being in control of this process, will increase the chances of success. Contact us with any questions.
Let’s begin. Read everything below and, again, don’t forget to read the information on the packaging of your nicotine gum. Keep all the literature handy in case your medical status changes and you need to refer back to it.
What makes smoking so addictive?
Smoking is a Chemical Addiction (Nicotine)
Nicotine works by tricking the brain into using it just like chemicals (called neurotransmitters) normally found in the brain. Nicotine is similar to acetylcholine, which sends messages from one nerve in the brain to another. Acetylcholine can increase heart rates, breathing, and muscle movements.
Since nicotine stimulates the same nerves as acetylcholine, it too is a stimulant. When someone smokes they get an immediate energy boost. Think caffeine.
Nicotine also increases the release of dopamine, the chemical of “wellbeing and pleasure.” How many drugs can deliver a sense of wellbeing while also improving mental clarity and providing a physical jolt?
But that isn’t all nicotine does.
Nicotine is the only drug that can be a stimulant or a relaxant. It depends on your mood when you smoke. If smoked rapidly (high nicotine dose), it is a stimulant. If smoked slowly (low nicotine dose), it is a depressant. That is incredibly seductive. Within 10 to 20 seconds of lighting up, smoking gives you what you need most, at the very moment you need it—in seconds. No wonder it is so hard to quit.
Lastly, it is known that the likelihood that a drug will be abused is associated with how quickly it takes effect. Smoking delivers nicotine to the brain in seconds, which makes it highly addictive.
Researchers agree, “Nicotine-positive effects on mood and cognition are strong reinforcements for smokers that contribute to their addiction, and cigarette smoking is particularly addictive because inhaled nicotine is absorbed through the pulmonary venous rather than the systemic venous system, and thus reaches the brain in 10-20 seconds. As the likelihood that a substance will be abused depends on the time between administration and central reinforcement, tobacco smoking can easily become addictive.” (Role of nicotine pharmacokinetics in nicotine addiction and nicotine replacement therapy: a review, The International Journal of Tuberculosis and Lung Disease. 2003, 7 (9): 811–9. PMID 12971663)
Smoking is a Behavioral Addiction
There is also a behavioral component of addiction to nicotine. When people smoke in specific situations (when out with friends, with their morning coffee, after sex, on smoke-breaks at work), they come to associate those situations with the pleasure of smoking and the situations themselves can trigger strong cravings to smoke. That first sip of coffee, maybe even just the aroma, will signal a strong desire for that first cigarette of the day.
This is also true of the physical appeal of the process of smoking. Think about it. All the paraphernalia that goes with smoking can be a source of comfort. Think about how you enjoy the feel of the lighter in your hand and the warming flame that sparks that first, bright ember, the scent of the first puff of smoke, and and the feel of the cigarette as it is rolled in your fingers. Even a pack of cigarettes has been designed to evoke all the positive things you feel when you handle them. Even the surgeon general’s warning that cigarettes WILL kill you and result in deformed offspring have had no effect compared to how drawn you are to tobacco—until today.
That is why smoking is so addictive and why using a combined approach, if possible, works best: medication, nicotine replacement, behavioral modification support. For different reasons, patients and their doctors can choose to use nicotine replacement with behavior modification as their treatment plan for smoking cessation.
What are the different ways to quit smoking?
1) Cold Turkey: The sudden cessation of smoking with the intent of quitting permanently. This is the most common method smokers use. Cold turkey alone works only 4% to 7% of the time.
2) Tapering: Tapering is the gradual reduction of cigarettes smoked or smoking less of each cigarette. It is no more effective than going cold turkey with nicotine patches. (Ann Intern Med 2016;164(9):585-592)
3) Nicotine Replacement: Nicotine increases the success rate by 50%. It allows the habit of smoking to be broken before nicotine is stopped.
4) Medications: Medications added to going cold turkey increases the success rate to 25%. Three drugs are approved by the FDA for smoking cessation: nicotine replacement meds, bupropion (Zyban), and varenicline (Chantix).
5) Counseling: Counseling, whether in person, by telephone, or by text messaging, increases the likelihood of success.
6) Combination Therapy: This means going cold turkey (or tapering) and adding one or all of the following: nicotine replacement, counseling, and medication. Success rates can be increased by 4 fold when all three smoking cessation aids are combined: medication (Varenicline, Bupropion), nicotine replacement, behavior modification.)
How does nicotine replacement work on addiction?
Part of what people miss when they quit smoking is the pleasure that they get from nicotine. Nicotine replacement doesn’t reproduce the precise effect that smoking does for two reasons. When ingested via smoking a cigarette, nicotine is absorbed within seconds; however, that “hit” just isn’t reproduced with patches, gum, or even nasal sprays. Nicotine isn’t absorbed as quickly by those methods as by smoking. Not only is the nicotine not absorbed as quickly with medical replacement products, but the level of nicotine in the system also doesn’t reach the same level as when it’s ingested via smoking a cigarette i. So what does the nicotine replacement do? Practically, it dulls the effect of nicotine withdrawals. It takes the edge off.
Nicotine replacements reduce the cravings that come with quitting cold turkey. Smokers can break the habits or “ritual” of smoking without feeling the symptoms that come with nicotine withdrawal (irritability, distraction, etc.). It also maintains the positive effects on mood and concentration that normally come from smoking nicotine.
Basically, it lets you approach dealing with all the social and behavioral “triggers” that make quitting so hard without complicating it with nicotine withdrawal.
NRTs increase the chance of stopping smoking by 50% to 70% (or more) when compared to placebo or to no treatment. ("Nicotine replacement therapy for smoking cessation". The Cochrane Database of Systematic Reviews. 11: CD000146. doi:10.1002/14651858.CD000146.pub4. ISSN 1469-493X. PMID 23152200.)
Is nicotine gum addictive?
It is a known fact that the likelihood of a drug being abused is associated with how quickly it works. Smoking delivers nicotine to the brain in seconds, which makes it highly addictive. Nicotine gum, on the other hand, reaches its peak blood levels in about 20 minutes. Moreover, the peak blood level with nicotine gum is lower than the peak level reached with smoking.
In essence, it gives many of the benefits of nicotine without the short bursts that make it so addictive when consumed by inhaling tobacco. In an article dealing with nicotine replacement, the authors note that nicotine can double the rate of smoking cessation by relieving withdrawal symptoms. However, they also state, “Most NRT forms deliver nicotine more slowly than smoking, and the increase in nicotine blood levels is more gradual. Compared to tobacco smoking or even tobacco chewing, few positive (reinforcing) effects are obtained from NRT use.” (Role of nicotine pharmacokinetics in nicotine addiction and nicotine replacement therapy: a review, The International Journal of Tuberculosis and Lung Disease. 2003, 7 (9): 811–9. PMID 12971663)
“Few reinforcing effects” means that it is far less likely to support a chemical addiction to nicotine.
What dose of nicotine gum should I use?
Nicotine gum is available in two strengths: 2 mg and 4 mg. If you smoke fewer than 25 cigarettes per day, use the 2 mg gum; if you smoke more, the 4 mg gum is recommended. It is also recommended that you use the 4 mg dose if you smoke your first cigarette within 30 minutes of waking up.
Some people use the gum when needed. However, people do best using one piece every 1–2 hours in the first 6 weeks—never exceeding 24 pieces/day.
It makes sense to use nicotine on a regular basis to keep some in your blood at all times. Since most cravings last only about 5 minutes, the opportunity to chew nicotine gum, and get levels high enough to mean anything, is unlikely if the craving comes on suddenly.
On the other hand, some people know what “triggers” the desire to smoke. It might be when they get in their car, or when they have a drink, or while watching sports with friends. The point is they know in advance when they will need some nicotine and can start using it well in advance.
Typically, life is a good deal more complicated, which is why continued use of gum works better—at least in the first few months.
How should I use nicotine gum?
Nicotine gum is medicine and should not be chewed the way you would chew a stick of spearmint. The gum is just a very convenient way to get nicotine into your system.
The gum should be at room temperature, but it is good to warm the gum in your mouth for a minute before you start to chew. The gum should be chewed slowly until you taste a flavor or feel a “peppery” sensation. This may take 10 to 20 chews. Then, the gum should be moved to a place between the gums and cheek.
When “parked” in that spot the nicotine will be absorbed well. That “peppery” feeling will start to disappear. It can take as little as a minute or as many as 5 minutes for that to happen. When it does, the gum should be chewed slowly to release more nicotine (maybe 3 or 4 chews) and parked in the cheek. This should be repeated for about 30 minutes or until it loses its ability to cause that peppery sensation.
The fact that it might take just two or three chews every once in awhile is good. There are many social situations where chewing gum continuously would be awkward, and some people just do not like to chew gum. Nicotine gum can be used discreetly.
Remember, you can chew another piece of gum before an hour is up if needed, but never use more than 24 pieces in a day. Also, chew only one piece at a time and try not to park it near fillings or crowns—and park the gum in different spots. Sometimes, using the gum leads to increased sores in the mouth and moving it around may make that less likely.
Over time, you can taper your nicotine gum but it is always better to use some gum than to go back to smoking—so do not feel the need to rush it.
Can anything make it less likely to work?
Yes. Chewing the gum too quickly and too much. Chewing quickly leads to a rapid release of the nicotine and creates more saliva. That dilutes the nicotine and makes it more likely you will swallow it. The nicotine is absorbed best when the gum rests on the skin of the cheek (buccal mucosa). Nicotine is absorbed poorly from the stomach compared to the cheek. Worse, when nicotine is swallowed, it can lead to hiccups, gas, and nausea.
Try not to swallow for a minute or so when you start to release the nicotine. Allow it to be absorbed where it is intended to be absorbed, the cheek and not the stomach. The first few days are key. You may notice a burning sensation, which means you are chewing it too quickly. The same is true for lightheadedness, hiccups, gas, nausea, or too much saliva. Begin gently.
Nicotine gum should not be used while you are still smoking. This can lead to nicotine poisoning. And, while this may seem obvious, nicotine gum is a medicine and should be kept away from children. Even a piece of used gum can be toxic to children or pets. Gum is tempting to children so when you are done with a piece of gum, dispose of it in a manner that makes it impossible for children or pets to reach.
Symptoms of nicotine poisoning
These are just some of the symptoms: headaches, hearing or vision problems, confusion, tremors, dizziness, weakness, abdominal pain, vomiting diarrhea, nausea, flushing, sweating, salivation, low blood pressure, irregular heart rate, shortness of breath or other breathing difficulties.
If you suspect nicotine poisoning call (800) 222-1222 — The United States National Poison Hotline—and go to the nearest emergency room.