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NEWS: Zosia Kmietowicz Doctors told to treat nicotine addiction as a disease BMJ 2000; 320: 397 [Full text]

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Call a spade a spade.

Tom Oommen   (16 February 2000)

Call a spade a spade. 16 February 2000
Tom Oommen, Associate Professor in Pharmacology Fr. Muller's Medical College, Mangalore, India Send response to journal: Re: Call a spade a spade.	In our culture where there is a pill for every ill psychotomimetic drugs have become a symbol of prestige, success, happiness and relaxation. According to the WHO, drug addiction is a psychic or physical state resulting from the interaction between a living organism and a drug, and characterized by behavioral and other responses that always include a compulsive desire to need to use the drug on a continuous basis in order to experience its effects and avoid discomfort of its absence. Dependence is also defined as a state of periodic or toxic intoxication detrimental to the individual and to society, produced by the repeated use or consumption of substances. Today, forty years after the first report on cigarette smoking, it still remains the single largest cause of premature disability and death in the UK. It appears that it has taken 40 years, several deaths and a high morbidity rate to get the medical fraternity to finally recommend that nicotine addiction should be treated as a disease (1). Strangely enough, the WHO had several times thought of deleting the term 'addiction' from its parlance and substituting it with 'habit'. Replacement of terminology does not guarantee a change in attitudes or a paradigm shift in the approach to the problem. Even rats show a behavioral manifestation of the nicotine abstinence syndrome, the abstinence signs including gasps, ptosis, shakes, chattering of teeth, yawns and changes in locomotor activity. these symptoms suggest that the nicotinic withdrawal may be due to the sudden availability in (or even increase of) the nicotinic receptors (2). Further, chronic administration of nicotine has been reported to produce tolerance to the locomotor depressant effects and aversive stimulus properties of nicotine (3). In a comparative study on the effect of subcutaneous nicotine injection with saline on the subjective and psychological measures in smokers and never-smokers cognitive tests caused reduction in calmness and increased alertness, though there was no evidence of nicotine improving mood in either group under either condition. Compared with smokers, the never-smokers experienced stronger symptoms of nicotine toxicity and a greater reduction in alertness in response to 0.6mg nicotine, suggesting chronic tolerance to some effects in smokers. It was concluded that if nicotine had a mood-enhancing effect it occurred only after tolerance had been acquired to its primary effects (4). Nicotine replacement therapy has now found a place in the rehabilitation of nicotine addicts. Much as the tobacco industry would like to brush under the carpet the statistics of tobacco-related morbidity and mortality, governments are equally eager to increase their revenue from the manufacture and sale of tobacco. Sure, it's duty free. But so are the hazards. And where will the nicotine addict spend eternity? In the smoking or the non-smoking zone? References 1. Kmietwicz Z. Doctors told to treat nicotine addiction as a disease. BMJ 2000; 320: 397 2. Hilderbrand BE et al. Behavioral manifestation of nicotine abstinence syndrome in the rat: peripheral versus central mechanism. Psychopharmacology 1997; 129 (4): 348-356 3. Shoaib M et al. Discrimination stimulus effects of nicotine and chronic tolerance. Pharmacol. Biochem. Behav. 1997; 56(2): 167-173 4. Foulds J et al. Mood and psychological effects of subcutaneous nicotine in smokers and never-smokers. Drug Alcohol Depend. 1997; 44(2): 105-115