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This week, the FDA met to evaluate the safety and risks of dissolvable smokeless tobacco products. These smokeless tobacco products are not stop-smoking aids that many Americans turn to fulfill their New Years resolutions. These dissolvables are instead intended to satisfy nicotine cravings in situations where smoking is not allowed (like at your local public school). They usually come in the form of flavored mints, strips, and sticks of smokeless tobacco. Cigarettes that make your breath smell good? What seems to be the problem?

Apparently, parents are not crazy about how easy it will be for their children to get away with sampling these "mints" and, in doing so, acquiring a nicotine addiction. The mints (marketed under the cute names of "Orbs," "Strips," and Sticks" by Camel) are packaged in very colorful looking containers and the mints are the size of a tic-tac.

But, tic-tac it is not. In fact, the form of the dissolvables has now captured the attention of the FDA. The dissolvables raise concerns about accidental ingestion by young children. A study published in the April 2010 issues of Pediatrics found that smokeless tobacco products are the second most common cause of nicotine poisoning in children. Only cigarettes caused more nicotine poisoning.

The FDA may take action to cap the amount of nicotine in each piece to eliminate or significantly reduce the possibility of a fatal nicotine overdose if a child consumed an entire package. Some experts, and this mother, would rather have this type of smokeless tobacco eliminated. Dr. Lee Beers, a pediatrician at Children’s National Medical Center in Washington D.C. says, “There doesn’t really seem to be any reason to have tobacco in a format that is much more easily ingestible and with quite a few downsides, particularly when you think about children and adolescents.”

Its hard enough worrying about all the future trouble coming my way using my own frame of reference as a background. But, turning nicotine into some sort of acceptable breath mint scares me more than a cheap six-pack and my kids home alone for an evening.

17 Comments

  1. Gravatar for Electricman
    Electricman

    'Safety" might not be the first word you think of when describing a tobacco product that threatens to turn people into nicotine fiends.

    these"harm reduction" sites falsely claim: "It is a medically proven fact that is much less harmful than smoking," casaa boast. "Safety, from the harm of smoking ." Claims such as these are purely deceptive. They also profit from addicting your family and children to this dangerous addiction.

    Just because there is no smoke, doesn't mean that smokeless tobacco is safe. Smokeless tobacco can cause cancer and a whole bunch of other bad health effects.

    Recent research shows that smokeless tobacco use might also cause problems beyond the mouth. Some studies have shown that using smokeless tobacco may cause pancreatic cancer. And scientists are also looking at the possibility that its use might play a role in the development of cardiovascular disease--heart disease and stroke.

    http://www.nidcr.nih.gov/OralHealth/Topics/SmokelessTobacco/SmokelessTobaccoAGuideforQuitting.htm

  2. Gravatar for kristinnm
    kristinnm

    Nicotine already IS in the form of "an acceptable breath mint" and it's called a "Nicorette mini lozenge" - approved and endorsed by the FDA and available to youth without a prescription.

    Have you really thought through the impact of banning innovative, lower-risk, smokeless tobacco products when cigarettes are still widely available? 47 million smokers, many of whom cannot or will not quit, could be using a much less harmful product instead. Youth smoking is on the rise again in many areas. Banning smokeless will not protect children - it will only leave the most harmful product on the market unchallenged. So long as cigarettes are available, it's simply irresponsible to ban or discourage less harmful options. And yes, it IS a scientific fact, acknowledged by the entire medical community, that smokeless tobacco does not carry nearly the same health risks as smoking. No, it's not "100% safe" and we don't make that claim, but neither is sugar, caffeine, fat, driving, sports, prescription medicine and a whole bunch of other things we consume and do. But it's better than the alternative these people have - smoking.

    To believe that banning smokeless tobacco will stop kids from smoking or cause smokers to quit is simply wishful thinking while cigarettes are still for sale. These products fall under the same laws as other tobacco products and should not be sold to youth (and people who are not already using tobacco should NOT start.) But if kids would buy these illegally, then they would also buy cigarettes illegally, if the smokeless was not available. To believe otherwise is simply naive.

    The best protection from youth nicotine addiction is educating and monitoring your children. But banning less harmful versions of tobacco simply leaves those youth who DO choose to use tobacco and adults who are already addicted with only the most deadly option. It's like removing seat belts from cars in hopes that youth will then start driving responsibly - no one would see that as a reasonable solution. We don't ban fatty foods from the market - we offer low fat and non-fat versions so people have options to lower the health risks in their diet. An appealing smokeless tobacco product that can convert smokers or keep youth from choosing to smoke in the first place offers the same kind of choice.

    For the record, CASAA (the Consumer Advocates for Smoke-free Alternatives Association) is a non-profit organization, formed by former smokers to educate the public about tobacco harm reduction - safer alternatives for those who cannot or will not quit. None of the board of directors or officers get a salary for our organizational work - we are all volunteers. So we do not "profit from addicting your family and children" as CASAA members. Ideally, we'd want no one to use any product that is a health risk, but that isn't realistic. We simply acknowledge that people will do things that aren't necessarily good for them and they need to know that there are less risky options available and we want to keep those options available for them. We truly believe that removing or blocking lower risk products and leaving only the most dangerous product on the market is simply a bad idea for public health. We volunteer hundreds of hours of our own time (along with real jobs and our families to take care of) to this mission and our only motivation is saving lives. Anyone who accuses us of anything else either doesn't know us or has some reason to attempt to falsely discredit us for their own benefit.

  3. Gravatar for Jonathan O'Nan
    Jonathan O'Nan

    That was very well written but you left out all the natural products that are available and legal for minors to purchase so while your on your rant about how dangerous smoking alternatives are why dont you do your research and start attacking the eggplant farmers and such other people who grow anything that contains nicotine naturally. Leave Smokeless tobacco alone, It has only helped thousands upon thousands of people to quit a death sentence and in no study has nicotine been found to cause any form of cancer. Is it 100 percent safe, no but is there anything in this world that is 100 percent safe? When you go to bed at night is there the chance that you wont wake up in the morning.

  4. Gravatar for MattZuke
    MattZuke

    "Its hard enough worrying about all the future trouble coming my way using my own frame of reference as a background. But, turning nicotine into some sort of acceptable breath mint scares me more than a cheap six-pack and my kids home alone for an evening"

    You do understand that we have both the nicotine gum and lozenge don't you? You do understand that it's actually given to kids freely, and a good portion of kids actually experiment with it?

    Okay, think about it another way, it's estimated that over 400,000 people die from smoking, close to the figure of non-tobacco related heart disease. All an alternative product needs to be is 75% less harmful for your worst fear to be a net neutral, every kid growing up to reject cigarettes and opt for this hypothetical product. The estimates on ANY smokeless tobacco product represent a harm reduction of 98%. As in if everyone uses it, a 4x increase, that's an estimated 368,000 lives saved. It's a net win, making your biggest worry fast food.

    Remember, about 1:4 kids try cigarettes, about 3:4 of those become habitual users, and 1:7 people continue smoking until death. If you fail to promote tobacco abstinence, and normal cessation methods fail as they often do, this is a plan B. Plan B increases the odds you'll outlive your child who was foolish enough to experiment with cigarettes.

  5. Gravatar for Sam
    Sam

    Electricman, Is you're real name Zorba? or Dalli?

  6. Gravatar for mattzuke
    mattzuke

    "Some studies have shown that using smokeless tobacco may cause pancreatic cancer."

    Perhaps you can cite these studies.

    The truth is NRPs have not been directly studied for long term use, the FDA had to defer to long term studies on Snus use in Sweden.

    Dr. Neal L Benowitz, FDA's leading expert on tobacco products is 100% clear on this subject. "The lack of increase in common cancers in lifelong {Smokeless Tobacco} users indicates that nicotine is not a general cancer promoter"

    http://www.fda.gov/downloads/Drugs/NewsEvents/UCM232147.pdf

    I admire any parent for being concerned. However, the objective reality is a child is more likely to be exposed to "nicotine candy" in the form of NRPs . After all, there is no real age restriction on these products, and they do actually look like candy and they are sold without even the most rudimentary child proof containers. But we shouldn't take NRPs off the market.

    It's sad that RJR specifically has better child proof containers than NRPs.

  7. Gravatar for Linc Williams
    Linc Williams

    "A study published in the April 2010 issues of Pediatrics found that smokeless tobacco products are the second most common cause of nicotine poisoning in children. Only cigarettes caused more nicotine poisoning."

    of these events how many lead to a fatality? Zero

    Of these events how many lead to long term damage? Zero

    lets put this in perspective instead of trying to drive it off of primal fears- According to poison control center across all substances -

    1.2 million unintentional poisonings among children ages 5 and under were reported to US Poison Control Centers.

    smokeless tobacco incidents numbered 1768 with Zero significant outcomes

    Since nicotine replacement products are not tracked specifically they are in the group labeled Other which totaled 1197

    The number of Cigarette/cigar is 10706

    Just wanted people to know the numbers not the shock value quotes being used

  8. Gravatar for Jessica Hoerman
    Jessica Hoerman

    First of all let me just state, that I am glad to read the well thought out arguments with regards to this issue. I appreciate the time taken to consider my blog and to continue the discussion.

    That being said, I think a lot of responders missed the point of my argument. I am not suggesting that this product be made illegal, nor do I pass judgment on any adult that choses to use this product. However, this product is not being marketed as a smoking cessation drug, if it were it would look more like a drug than a piece of candy or mint. Instead, these dissolvable tobacco products have as much, or more nicotine than a cigarette and the intended market is adult consumers for use in venues where smoking is banned.

    My original comment to issue with the marketing confusion of this product and the potential it has to get into the hands of children – whether that be mistakenly or deceptively. I am in complete agreement that it is the role of the parent to discuss dangerous items with our children and I am not trying to hide from this job nor place blame on others for my potential failure at this job. But, it is an unfair battle when there are products placed on the market that can be confused with safe, legal items that we have no reason to discuss with our children.

    Although the packaging of Orbs states that it is a “dissolvable tobacco” product – I have a hard time believing that it is a marketing fluke that the Orb package looks hauntingly similar to the tic-tac packaging. Is it a mistake that the orb is a tiny pellet shaped similarly to a tic-tac and that the logo includes the same shape of the leaf used on the tic-tac logo? I suggest no.

    As I noted in the original blog, the FDA heard arguments last week about the appeal of these smokeless products to kids, and for me the most compelling arguments came from Judy Hou, a youth advocate and a member of YStreet, a youth organization that fights tobacco use and promotes ways teenagers can lead healthier lives. Hou noted that her organization surveyed teens in Virginia and found that 42 percent of the teens surveyed thought Camel Orbs were candy, mints or gums based on their packaging. And, 28 percent of youth who don’t currently use tobacco said they would try Camel Orbs “fresh” based on seeing its package. But, rather than trust other studies, I conducted my own at home. I asked my kids what they thought the package was – all three said mints until they read the packages closer.

    We need more discussions like this to warn parents and children about these items. And, I suggest that we need the assistance of the FDA as well.

    Although this note can’t deal with all the comments, I would like to comment on a few of items mentioned. There are no long term studies done on this specific product since it is too new - your arguments are well taken. However, I think that most would agree that preventing nicotine addiction in children is enough to warrant the discussion of the marketing of these products.

    I do want to address the insinuation that I was discrediting the CASAA, Consumer Advocates for Smoke-Free Alternatives Association. Your arguments are rather troublesome to me, because, not only did you completely miss the point, you also went off into directions that I did not present and I am not sure why.

    To be clear, I am not suggesting a ban of any product that will help adults to stop smoking – but, of all people, you should be aware that this product is not being marketed as a cessation product. Dissolvable tobacco products deliver as much, or more, nicotine as a cigarette which would not allow your body to wean off of the nicotine addiction. Instead, the market for this product is nicotine fixes when smoking is not socially appropriate – office buildings, airplanes and schools come to my mind.

    I do not take issue with you or any of your board members, who I presume are not paid advocates. But, if your goal is to provide smokers and non-smokers alike with truthful information about alternatives to cigarettes then I suggest you should jump on board helping get word out to parents that these products exist and they could be confused as mints. Why would we want to suggest a “less risky option” to a child that doesn’t yet smoke? I am not benefiting from this blog, I am a parent that is concerned about safety and your suggestion to the contrary is insulting.

  9. Gravatar for Electricman
    Electricman

    CASAA's bylaws allow for a minority of the board of directors to be vendors of nicotine products/accessories ... Just ask Kristen what she sells (electronic cigarette accessories) the "harm reduction " site is run by ecf electronic cigarette forum. That's my problem with this "harm reduction " site if people profit from nicotine addiction how can you trust or believe anything that is said?

  10. Gravatar for MattZuke
    MattZuke

    "I suggest you should jump on board helping get word out to parents that these products exist and they could be confused as mints"

    You are making a classic error in your evaluation, which is one that is understandable. The FTC evaluation of nicotine delivery per cigarette does not equal the nicotine content of the cigarette. The FDA no longer sees fit to test cigarettes for nicotine content, nor requires this be posted on cigarettes. As a parent you can not say 1 cigarette only contains 1mg of nicotine thus if eaten by a child presents little to no risk. One cigarette can deliver 1 mg after being lit on fire. The FDA doesn't require this data, but a good estimate is at least 10mg/nicotine per cigarette in the tobacco, dry tobacco between 14-24mg/gram.

    And we already do educate children on the risks of nicotine gum, lozenge, and mini lozenge, which also look like candy. We also educate children about the risks of mistaking Good and Plenty with Prozac, Sweet Tarts for aspirin. It's not a pharmaceutical conspiracy, nor big tobacco one. Candy and medication share a common design element because they're designed to go in your mouth.

    As a point of interest, Ariva dissolvables are on par with nicotine gum, Stonewall specifically 4mg/piece. RJRs are actually lower, .6-3.1mg/piece (1mg orb, 3.1mg stick, .6mg strip) and have great child proof packaging. Altria AFAIK has no childproof packaging, but are less candy like looking more like chocolate covered toothpicks, 3.1mg/stick.

    As you might imagine, oral NRPs are more widely available, and present a risk to children because they're given to kids freely and are sold without age restrictions typically.

    http://news.bbc.co.uk/2/hi/uk_news/england/west_midlands/8160901.stm

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