Nicotine most harmful cigarette ingredient, GPs think
A survey of GPs has revealed some falsely believe one of the greatest health risks from smoking is nicotine.
This belief could influence health advice to smokers when considering whether to recommend the use of alternative nicotine products.
Nicotine is the addictive component of tobacco smoke, but unlike some other constituents of tobacco smoke, it is not carcinogenic (cancer-causing) and according to the Royal College of Physicians (RCP) 'medicinal nicotine is a very safe drug.'
Switching to alternative nicotine products such as nicotine gums and electronic cigarettes can, therefore, help many smokers quit smoking or cut down, thereby reducing exposure to tobacco smoke and the associated harm.
However the views held by some GPs in both the UK and Sweden may influence their willingness to recommend the use of alternative nicotine products to help smokers quit outright or to cut down to quit.
This could have some impact on the successful implementation of the National Institute for Health and Care Excellence's (NICE) guidance on harm reduction approaches to smoking.
NICE guidance advocates broader use of nicotine replacement therapies and clearly differentiates between the risks associated with cigarette smoking and those of using nicotine products.
The guidance also proposes that the education and training of practitioners should 'include the principles and practice of tobacco harm reduction.'
The study participants (100 UK, 120 Sweden) were asked about the risks associated with tobacco and nicotine products, smoking cessation and tobacco harm reduction approaches, and influential sources of information.
The majority of survey respondents (96% UK, 98% Sweden) said that they regularly discussed smoking cessation with their patients, but less than half believe that long-term nicotine replacement therapy (NRT) is preferable to smoking (31% UK, 48% Sweden).
The survey findings show that a substantial proportion of GPs (40%) believe nicotine to be the first or second riskiest component of cigarettes, incorrectly identifying it as more harmful than smoke.
Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.
“Although GPs clearly understand that smoking is more dangerous than NRT use, it is worrying that so many associate nicotine with cancer.
“It is also unclear whether the perceived risk of nicotine in tobacco and NRT is because of this association with cancer or because of its ability to cause addiction”, said lead researcher Dr Sudhanshu Patwardhan, Medical Affairs Manager at British American Tobacco, who sponsored the study, published in Drugs & Alcohol Today.