Dissolving Tobacco: ‘Candy’ to feed nicotine addiction

Who ever thought that tobacco companies would come up with a way to market a tobacco product that does not light up or need to be spit out? Camel Orbs and other forms (sticks or strips) are being marketed now. It is interesting, a dissolving product that delivers from 0.6 to 3.1mg of nicotine (depending on form vs. 1mg per usual smoked cigarette). It is made from ground tobacco, and flavored. You would think given the dose of nicotine delivered that it is considered at least an over the counter agent?

I learned of this from a recent newsletter for clinicians (Here is the link where the article is posted: http://www.smartbrief.com/servlet/wireless?issueid=41F0A8DB-0D52-4644-A460-C671DA25785E&sid=4424389f-4968-420d-b19a-428ead999285 ). I think they missed the boat on the focus to report: that babies or children might accidentally put the small tic-tac size ‘candies’ in their mouth and ingest toxic doses of nicotine. This report follows a study from Connelly et al.( 2010) in Pediatrics (http://pediatrics.aappublications.org/papbyrecent.dtl). This is a concern to be sure. Adults might shake out a few from their childproof container and leave them where a child could find them. In addition, the ‘candies’ are flavored, so they taste good and encourage eating more than one? An important point and users should beware.

A bigger concern, is that tweens and teens might be interested in trying this substance for the effects of nicotine without smoking! It even tastes good. Let’s see if we can hook a whole new generation on tobacco and call it candy this time. Not a good idea. There are enough other substances in the world to get hooked on. Do we really need a new one? I can see the rationalizing already, it isn’t smoked so won’t cause lung cancer, secondary smoke, etc…

When a product delivers a pharmacologically active agent like nicotine, shouldn’t it require strong regulation? More than that of a tic tac? Particularly when we have reams of data about how addictive the substance is? I don’t think this is much different than other nicotine products, which pharma created and I’m sure went through many hoops to get approved. Shouldn’t this product be treated the same way?

The New York Times coverage of this story yesterday, (here is the link: http://www.nytimes.com/2010/04/19/business/19smoke.html) identifies that in fact the FDA does regulate tobacco now… R.J. Reynolds did submit documents showing research and other material about this new ‘candy’, but the FDA still has 2 years to determine the safety of the product. I guess they can begin marketing it before we know its safety?

From what I can find, they are also available as ‘sticks’ (like a toothpick that dissolves) and ‘strips’ (like a breath mint strip). Here is a picture of the product, in case you are interested:

My thoughts on 'Anti-Energy' Drinks

Let me be perfectly clear: I am not an expert on nutrition, nor do I research these agents or drinks. I do have an opinion though, which I shared on my blogs Wednesday and I will share today.

I was asked by someone if I knew anything about the effects of anti-energy drinks such as Drank, which just recently started being sold in Connecticut. The product contains three main ingredients: valerian root, rose hips and melatonin. Part of the question was if there was evidence of an effect of these ingredients on stress relief and/or relaxation. In addition I was asked if I know anything about the three main ingredients. I do not have special knowledge to answer these questions with, they are not my areas of study. They are excellent questions!

I do think this is an interesting twist on the use of nutrients and other agents in beverages. In fact I have not researched energy drinks to any great degree, except to look up some of the ingredients. I just have a long standing concern: people think just because something is a ‘natural’ substance (herb or vitamin or mineral) it is ok to take it however they wish. I also don’t think people understand the lack of protections we have, given the lack of required evidence of safety to put products like these on the market. People may also think because it is on the store shelf it must be safe.

Unfortunately the websites available about drinks of these kinds do not have specifics about the amounts of each ingredient. They do not identify specifically the labelling with nutritional information (at least that I could find on the website for Drank). I'll have to go to the store and see what the label says. Despite the ingredients mystery, they are very direct in suggesting this is a fun new way to relax though.

I do not know off-hand of the safety of the ‘anti-energy’ drinks. My concerns about safety would be similar to those of all energy or 'nutritional' drinks. Whenever we begin to use agents in food or beverage that are commonly consumed at meals or other times, we have to wonder about the effects of exposure (i.e. how many of these drinks might you drink in a day? What is the dose of the substance you get over the day?). Is it like water and you can drink as much as you want?. Over long periods of time and with penetration of these products in the marketplace there is increased population exposure. Because they are foods/drinks they are differently regulated. How many people do you know that would take 3 pills a day (valerian, rose hips and melatonin) without considering the safety? Drinking them seems to make them appear safe to people. That is my concern. What if they are on other medication? Could they interact and cause negative effects? Do they check with their health practitioner to be sure it won’t cause a problem?

The other concern is we may have studies of a substance like melatonin for example and consider it safe for some use in some dose, but are there potential interactions between the three substances in this particular drink? Also where is the long term evidence of safety of these substances (individually and combined) in such a common food/drink source? An absence of evidence does not equal an absence of negative effect. It just means we haven’t studied it in this way.

I suspect ‘anti-energy’ drinks will be popular in the marketplace… It makes you wonder whether people will be pumping up on energy drinks all day and then trying to settle down with the anti-energy drinks in the evening. I am sure the beverage industry is very excited about all this… It is like they are the new but unregulated pharma – without having to shoulder the costs of safety research and clinical trials.

I am sure I told you more than you are really interested in. I am not the ‘expert’ on these ingredients. There are many people I am sure who have much more knowledge than I do about these ingredients. (actually you might look at the medline plus search info for supplements from the national library of medicine, if you haven’t already found it). Here is the link to info about melatonin:
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-melatonin.html I would consider medline plus a trustworthy source of data on ingredients like this.

‘Healthy Drinks’ Mask High Caffeine Content

I decided to cross-post this piece here as well... I find this topic quite disturbing.

I was glad to see the Journal for Nurse Practitioners take up an important issue to our health and well-being: Energy Drinks. Pohler, H. (2010). Caffeine intoxication and addiction. Journal for Nurse Practitioners. 2010;6(1):49-52. http://www.medscape.com/viewarticle/714855

These drinks are marketed as a healthy alternative to other choices like soda and coffee, but in my view they potentially have many negative implications. For the past two years, I have observed a 7th grade boy purchase two cans of Red Bull each morning when I purchase my cup of coffee. 2 cans of highly potent, caffeinated Red Bull, which is advertised to “revitalize body and mind”. Some days he buys Full Throttle (which CNN tells me ( http://www.cnn.com/HEALTH/library/AN/01211.html) nearly doubles the dose of caffeine per can (cans are bigger)).

How commonly do children buy these drinks? I wonder a bit about the groups that are the highest consumers of energy drinks like Red Bull or Red Star or Liquid Cocaine? Are we (and our children) unwittingly getting hooked on high doses of stimulants in ‘healthy’ energy drinks? Let’s not forget the little ‘shots’ available for purchase too, so you can quickly get your stimulant without a lot of drinking… Also, check the label of your vitamins, as often vitamin supplements have caffeine in them as well. I had that experience a while back. It isn’t pretty to see me after a cup of coffee and a vitamin with caffeine. We need to look at the labels of the products we buy!!!

Caffeine is one issue, each 8.3oz can of Red Bull contains 75mg of caffeine. The other ingredients have potential effects as well. Here are the ingredients of Red Bull: Carbonated water, sucrose, glucose, sodium citrate, taurine, glucuronolactone, caffeine, inositol, niacinamide, calcium-pantothenate, pyridoxine HCl, vitamin B12, artificial flavors, colors.

I appreciate Pohler telling us that ingredients like guarana and cola nut are synonyms for caffeine in an ingredients list. She also details the physiologic metabolism of caffeine into byproducts theobromine and theophylline (which can be found on labels of nutraceuticals).

Consumers need to be aware of what they are ingesting. I found in the store some vitamin labels might list the name of a stimulant (like guarana or caffeine) and on the external package not print the amount (mg) in each tablet (which made me think at the time of purchase there was no caffeine in there). I didn’t recheck the bottle label inside the packaging until a few days later when I realized I was jittery and overstimulated and knew I hadn’t increased my coffee consumption. My One-A-Day multi-vit actually gave me as much caffeine as my morning coffee. Time to change vitamins, and be careful about reading those labels!

While I readily admit a ‘habit’ (do I really have to call it an addiction?) of a 16oz hazelnut coffee each day, I haven’t moved to even try a product like Red Bull. I am also reticent to drink Vitamin Water and other ‘nutritious’ drinks because the additives that make them ‘healthy’ are not familiar to me. What is taurine? (ok, I looked it up, it is an amino acid) And Glucuronolactone? (an artificially produced stimulant – so adds to the load of stimulant in Red Bull). I recognize some of the nutritional ingredients like niacinamide, pyridoxine and vitamin B-12, which worry me a little less. However it goes back to my argument about using nutraceuticals in general: where is the evidence to tell us the use of ingredients in this way is really healthy? In addition the labels don’t tell us how much of each ingredient we are ingesting, and we all know that many vitamins, minerals and nutritional products can have toxic effects if we ingest too much.

Health professionals are well aware that drugs interact with one another. In addition, at times substances that are seemingly ‘good’ for us have negative effects. This is the reason I don’t drink beverages like that. Nor would I allow my child to drink them! Particularly on a daily basis in high amounts. Do we have long term data on children's brain development to tell us this is not harmful? Do we have any long term data that tells us that these ingredients together won’t harm our kidney function in the future? Or other body systems? What happens 10 years out with daily high dose stimulant, taurine, glucuronolactone and other ingestion? (actually caffeine seems better to me given our lack of knowledge of these other ingredients and the high prevalence and long term use of caffeine in our culture… unless of course some of the common chronic illnesses are fed by caffeine – which of course hypertension is one).

Am I the only one who is worried about the marketing and unwitting consumption of ‘healthy’ beverages like this? I am pleased to see Nurse Practitioners considering the implications of stimulant beverage consumption by their clients. As mental health clinicians we can be no less vigilant...