OPINION: The truth about nicotine: We shouldn't normalize addiction

Laura Oyler’s syndicated column “The Truth About Nicotine” in the Oct. 7 Albuquerque Journal argued for loosening regulations on noncombustible nicotine (e-cigarettes and nicotine pouches) because nicotine has been unfairly vilified. Her framing missed the broader — and more troubling — truth: Nicotine is a powerfully addictive chemical with profound health and social consequences.

Oyler is correct that smoking causes cancer, emphysema, heart attacks, strokes and many other diseases that kill nearly a half million Americans each year. But Oyler only describes the relative harm reduction of noncombustible nicotine products compared to smoking. She does not describe well-documented harms of nicotine and risk to new users.

Nicotine is a psychoactive drug that permanently alters the brain’s reward circuitry, reinforcing compulsive use. Nicotine increases heart rate, elevates blood pressure, damages arteries, causes insulin resistance and harms adolescent brain development. It also is associated with miscarriage, low birth weight and infant abnormalities. Although nicotine does not directly cause cancer it speeds the growth of tumor cells, decreases the body’s ability to suppress tumor growth and reduces the effectiveness of cancer treatment.

Oyler’s column suggests that the safety of Food and Drug Administration-approved nicotine replacement therapies (NRT), such as nicotine gum or patches, be applied to myriad noncombustible nicotine products. This comparison ignores the rigorous scientific testing of NRT for cessation and safety. NRT is used temporarily, and was not designed, tested or advertised for long-term use. However, many people who smoke and initiate e-cigarette use become long-term users of both products. For current cigarette users, vape and pouches keep people addicted to the products killing them.

Among youth, noncombustible nicotine is marketed as an appealing lifestyle product, often with candy and fruit flavors. The result is an increasing number of nicotine-dependent youth who might never have touched cigarettes. Nicotine addiction, based upon widely accepted measures, is increasing among adolescent e-cigarette users. Individuals who only use e-cigarettes are exposed to over 80 harmful chemicals, including carcinogens (formaldehyde, acetaldehyde, heavy metals and volatile organic compounds) and diacetyl, which can cause irreversible lung damage. Many teens who vape subsequently turn to cigarettes to support their nicotine addiction.

Oyler is a nicotine product lobbyist; it is no surprise that she argues that Food and Drug Administration oversight is oppressive and unfair. She writes, “Regulators have given cigarettes a free pass to dominate the market, while smoke-free alternatives are pushed to the sidelines.” Her critique of the FDA’s approval process for smoke-free products is misplaced. Caution exists because public health regulation must account for individual risk reduction and for population-level harm. Easier access to nicotine helps some tobacco users switch to a lower risk product while addicting countless new individuals and normalizing nicotine use.

Oyler argues that we should not “punish the industry for past behavior” but tobacco companies’ current behavior remains a problem. They continue to use the same deadly tactics to sell noncombustible nicotine products that they honed resisting tobacco control — lobbying to circumvent regulations and to block local government control over nicotine products and aggressively marketing to children who are the primary target for fruit- and candy-flavored vape and nicotine pouches.

Honesty about nicotine means telling the whole story. Nicotine is highly addictive and stands as a risk to the health of millions of Americans. To reduce the toll of smoking-related disease, we should focus on evidence-based therapies and public policy that discourage all forms of nicotine dependence.