Nicotine Gum: How To Chew Nicotine Gum

Nicotine gum is a type of chewing gum designed to provide controlled nicotine release.

Nicotine gum has been available at pharmacies for years, but its uses and effectiveness are often misunderstood. Initially designed to help cigarette smokers quit, nicotine gum now also attracts:

• Recreational users seeking alternative nicotine delivery methods.

• Smokers looking to either manage or reduce their smoking habits.

It is important to note that in the United States, only a select few brands of nicotine gum have received approval from the FDA as effective Nicotine Replacement Treatments (NRTs). These products, which also include patches, nicotine lozenges, and others, are rigorously evaluated by the FDA for their efficacy in aiding nicotine cessation.

This guide aims to provide a comprehensive overview of nicotine gum, helping you understand its potential benefits and limitations, whether your goal is to reduce nicotine consumption or quit smoking altogether.

What Is Nicotine Gum?

Nicotine gum is a type of chewing gum that delivers nicotine into the bloodstream. It's widely used as an aid to quit smoking and manage various nicotine habits. Available over the counter (OTC), nicotine gum is accessible in pharmacies across the US, Europe, and other regions.

Nicotine gum falls under the category of nicotine replacement therapy (NRT), a classification endorsed by the World Health Organization (WHO). This includes other forms of NRTs like nicotine patches, nicotine lozenges, and inhalers. While these products are designed to help individuals reduce or quit smoking, they must be purchased by individuals who are of legal age.

In the US, the legal age to purchase nicotine gum and other NRTs is 18. The FDA suggests that a minor (under the age of 18) speak to a healthcare professional about using NRT to quit smoking.

Unlike some NRTs that require a prescription, nicotine gum can be bought without one. However, it's important to note that while NRT gums are only available at pharmacies, recreational nicotine gums may be found at other retail locations, depending on local regulations and laws.

Nicotine gum is typically available in two dosage strengths. Understanding which dose is suitable for you can help effectively use nicotine gum to manage or quit smoking.

Choosing Your Nicotine Gum Dose

Nicotine gum typically comes in two dosage strengths: 2 milligrams (mg) and 4 mg. When selecting a dose, consider your current smoking habits to ensure effective nicotine management.

Use a 4 mg dose if:

• You smoke more than 25 cigarettes a day (or an equivalent amount of nicotine).

• You have your first cigarette within 30 minutes of waking up. This higher dose is suitable for heavy smokers or those who are highly dependent on nicotine early in the day.

Opt for the 2 mg dose if you:

• Smoke fewer than 25 cigarettes a day.

• Do not smoke immediately upon waking. Starting with a lower dose is a cautious approach, allowing room to increase the dosage if needed, especially if you find the initial dose insufficient after a few days.

Read the packaging carefully when purchasing, particularly if you are exploring chain-specific or generic brands available at large pharmacies like Walgreens or CVS. These often offer cost-effective alternatives but vary in dose and ingredients.

Before adjusting your dose, ensure you are using the nicotine gum correctly. Nicotine gum should not be chewed like regular gum; it requires a specific technique to release nicotine effectively, often referred to as the “Park and Chew” method.

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Nicotine gum and a variety of Nicotine Replacement Treatments (NRTs)

How to Chew Nicotine Gum

Chewing nicotine gum correctly is essential for effective nicotine absorption and to prevent unwanted results regarding the adequacy of the dose.

For optimal use, follow the “Park and Chew” method:

1. Start by biting down slowly on the gum until you feel a tingling sensation in your mouth. This tingling indicates that nicotine is being released.

2. “Park” the gum by placing it between your cheek and gums. Hold it there for about a minute. This allows the nicotine to be absorbed into the bloodstream through the lining of your mouth.

3. Continue to chew and then park the gum repeatedly for about 30 minutes or until the tingling sensation ceases. During this time, occasionally shift the position of the gum to different areas in your mouth to ensure even nicotine absorption and minimize irritation.

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Source: Quit.org.au

According to CDC guidance, you should use nicotine gum every 1-2 hours during the first six weeks, with no more than 24 pieces per day. Additionally, do not eat or drink for 15 minutes before or during use. Food and drinks that are acidic, such as soda and coffee, can stop the gum from working as well.

Chewing nicotine gum properly minimizes saliva production, which can dilute the nicotine content if not managed correctly. Initially, you might find yourself chewing too vigorously, leading to an excess buildup of saliva. With practice, however, you will learn to maintain a steady, manageable release of nicotine.

How Nicotine Gum Works

Nicotine gum functions through two primary processes:

1. Nicotine Delivery: the mechanism by which nicotine is absorbed into your bloodstream.

2. Addiction Management: how nicotine gum aids in alleviating the symptoms of nicotine withdrawal.

The first process focuses on the pharmacokinetics of nicotine absorption, while the second addresses the therapeutic benefits of reducing dependency.

How Nicotine Gum Gets Nicotine Into Your Bloodstream

Nicotine from the gum is absorbed through the buccal mucosa, the lining inside the mouth. This method of delivery, shared with other oral tobacco products like chewing tobacco, bypasses the digestive system and allows nicotine to enter the bloodstream directly.

1. Chewing Releases Nicotine: When you chew nicotine gum, the physical action breaks down the gum matrix, gradually releasing nicotine.

2. Absorption Through Buccal Mucosa: As the gum is chewed, nicotine is released and held in the mouth where it is absorbed through the buccal mucosa. This part of the mouth's lining is rich in blood vessels, making it an ideal site for rapid absorption directly into the bloodstream.

3. Bypassing the Digestive System: Unlike other methods of nicotine intake such as smoking or ingestion, the direct absorption through the buccal mucosa means that nicotine bypasses the digestive system. This direct route prevents the breakdown of nicotine in the liver before it enters the bloodstream, allowing for more efficient and predictable dosing.

4. Controlled Release: The 'park and chew' method recommended for nicotine gum use helps maintain a steady and controlled release of nicotine over approximately 30 minutes. This controlled release helps to avoid spikes in nicotine levels, which can be associated with more intense cravings and withdrawal symptoms.

It is important to note that, as of a 2017 review, nicotine gum does not carry the carcinogenic risks associated with tobacco use, such as mouth cancers or other tobacco-related diseases.

How Nicotine Gum Helps Curb Addiction

Nicotine gum can help manage nicotine addiction by serving as a safer substitute for the nicotine usually derived from smoking or other recreational sources. This substitution mitigates the physical withdrawal symptoms that often act as barriers to quitting smoking.

By providing a controlled release of nicotine, the gum helps stabilize the body’s cravings in a less harmful way than smoking. This controlled delivery not only reduces withdrawal symptoms but also aids smokers in gradually managing their nicotine intake, which can assist in lowering dependency. Although nicotine gum does not deliver the full amount of nicotine compared to smoking—studies indicate that users absorb about 54% to 73% of the nicotine—this reduction is beneficial as it progressively decreases overall nicotine dependency.

Nicotine gum also supports smokers during the cessation process, even if relapses occur. The CDC suggests continuing the use of nicotine gum during such setbacks to help maintain focus on the ultimate goal of quitting. It provides the nicotine the body craves without the harmful effects of tobacco combustion, serving as a psychological support.

A 1994 meta-analysis showed that higher doses of nicotine gum (4mg) are more effective for heavy smokers than lower doses (2mg). This indicates that the appropriate strength of the gum can significantly impact the success rate of quitting.

Additionally, the study revealed that other forms of nicotine replacement therapies (NRTs), such as patches, are similarly effective. Nicotine patches, for example, are particularly appreciated for their convenience and minimal upkeep, providing a steady dose of nicotine over a longer period, which may be more suitable for some users.

Combining Nicotine Gum With Other NRTs

As of April 2024, there are seven medicines approved by the Food and Drug Administration (FDA) to help quit smoking. These include nicotine replacement medicines (NRTs) (the nicotine patch, lozenge, gum, oral inhaler, and nasal spray) and pill medicines (varenicline and bupropion SR).

The CDC suggests combining quit-smoking medicines for better results. Specifically, the CDC suggests combining a “long-acting” NRT (e. g. nicotine patch) with a “short-acting” (e. g. nicotine gum, lozenge, spray, and inhaler) one.

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Source: CDC

The nicotine patch is described as "long-acting" because it releases nicotine slowly, providing a consistent level throughout the day. This gradual delivery helps manage withdrawal symptoms by maintaining a steady state of nicotine. Conversely, "short-acting" nicotine replacement therapies such as nicotine gum deliver nicotine more rapidly. These products are useful for quickly addressing acute cravings and can be used when a craving is expected, offering immediate relief.

By combining the patch, which delivers a steady supply of nicotine throughout the day to ease withdrawal symptoms, with a faster-acting form like nicotine gum, you can effectively manage both persistent cravings and sudden, intense urges to smoke. The gum allows for flexible usage, letting you control the frequency of doses to ensure you do not consume more nicotine than desired. This flexibility also extends to reducing your nicotine intake when you feel ready to wean off NRTs altogether.

Additionally, you might find that you can use a lower dose of the gum than if you were using it without the patch, due to the continuous support from the patch. Both types of NRTs are available over the counter, making them easily accessible.

Nicotine Gum Benefits

Nicotine gum offers several benefits, categorized broadly into (1) its immediate effects on the brain and (2) the health advantages of reducing reliance on harmful nicotine products.

Immediate Effects of Nicotine

Nicotine gum provides a nicotine high. The effects of a nicotine high include improved attention, memory, and cognition. These are due to nicotine's stimulating effects on the brain, which enhance mental clarity and focus. Additionally, nicotine has anxiolytic properties that can reduce anxiety, potentially contributing to a feeling of calmness.

Unlike smoking or vaping, where nicotine delivery is rapid and often accompanied by a 'head high,' nicotine gum provides a steadier release of nicotine without the associated lack of oxygen that smoking causes. This results in a more controlled and less intense experience of nicotine’s effects.

Health Benefits of Cutting Back on Dangerous Nicotine Products

Originally developed as a smoking cessation aid, nicotine gum is now also used as an alternative to various nicotine delivery methods. Traditional and alternative tobacco products (ATPs), from e-cigarettes and vapes to smokeless tobacco like snus, carry significant health risks. These products are linked to severe health issues, including lung disease from the ultrafine particles and heavy metals in vapes and mouth cancers from chewing tobacco.

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Source: CDC

Nicotine gum, by providing a safer delivery method for nicotine, can help mitigate these risks. Quitting smoking, in particular, has well-documented health benefits. Within hours to months of quitting, improvements can be seen in heart rate, blood pressure, and oxygen levels. Over the years, the risks of severe diseases like lung cancer and heart disease significantly decreases. The comprehensive list of health benefits of quitting smoking, as detailed by sources such as the CDC, shows improvements ranging from enhanced immune function to reduced risks of heart disease and cancer.

Moreover, quitting smoking or vaping can also improve fertility, enhance the senses of taste and smell, make physical activity easier, and protect those around you from the effects of secondhand smoke.

While nicotine gum can be an effective tool for reducing nicotine dependence and avoiding the severe health risks associated with other forms of tobacco, it is not without potential side effects.

Nicotine Gum Side Effects

Nicotine gum, while effective in aiding smoking cessation, may present certain side effects worth considering. Common side effects specific to nicotine gum include:

• Mouth and/or jaw soreness: Caused by chewing habits resembling regular gum consumption. Adjusting chewing techniques can alleviate this discomfort.

• Stomach discomfort, hiccups, or excess saliva: Avoiding excessive chewing, sucking, or swallowing, and modifying dosage can help manage these symptoms.

• Light-headedness, nausea, throat, and mouth irritation: Occurs when nicotine is absorbed too quickly. Adjusting consumption habits can mitigate these effects.

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Source: ACTC

Severe side effects from nicotine gum are infrequent, with mild symptoms often diminishing as the body adjusts to its use. It's important to note that early symptoms might be mistaken for nicotine withdrawal, which typically subsides within four weeks as the body adapts to the new nicotine levels.

These side effects are manageable, and modifying usage patterns often reduces their impact. Despite its generally well-tolerated nature, nicotine gum may not suit everyone. Some individuals may prefer alternative methods of nicotine intake, while others with intense habits may benefit from supplementary aids like nicotine patches.

Nicotine Gums: Approved NRTs vs. Non-Approved Varieties

It's important to understand the distinction between nicotine gums approved as Nicotine Replacement Therapies (NRTs) and those, like Lucy, which haven't received official NRT approval.

Approved NRT gums, such as Nicorette or Nicotrol, have undergone testing and regulatory approval processes to confirm their efficacy and safety in aiding smoking cessation. These gums are specifically formulated to deliver controlled doses of nicotine, helping users manage cravings and withdrawal symptoms effectively.

On the other hand, products like Lucy, while containing nicotine and marketed as alternatives to smoking, have not undergone the same regulatory scrutiny or validation as NRTs (as of April 2024, Lucy Gum was “not a medicine and not approved for smoking cessation”). Consequently, their safety, efficacy, and standardized dosing may not be as assured.

Conclusion

Nicotine gum serves as a versatile tool for nicotine addiction management, catering to various user groups, including those attempting to quit smoking and individuals seeking alternative nicotine delivery methods. Nicotine gum is offered in 2 mg and 4 mg dosage strengths, with customized recommendations aligned with individual smoking habits to ensure effective utilization. Adhering to proper chewing techniques, notably the "park and chew" method, facilitates effective nicotine absorption, maximizing the gum's potential benefits.

Nicotine gum can help addiction management by alleviating withdrawal symptoms and gradually diminishing dependency. Its compatibility with other Nicotine Replacement Treatments (NRTs) enhances efficacy, offering a comprehensive approach to combating nicotine addiction. Moreover, by promoting a shift away from conventional, harmful nicotine products like cigarettes, the use of nicotine gum as directed not only aids in addiction recovery but also fosters long-term health benefits.

Resources to Quit Smoking

• Smokefree.gov - Provides tools, tips, and support that can help you quit smoking.

• Centers for Disease Control and Prevention (CDC) - Quit Smoking - Offers resources on how to quit smoking, including tips on quitting, benefits of quitting, and quit plans.

• American Cancer Society - How to Quit Using Tobacco - Provides detailed information on why to quit, how to quit, and dealing with the emotional and physical aspects of quitting.

• Mayo Clinic - Quit Smoking - Features articles, tools, and tips on quitting smoking and overcoming addiction.

• Truth Initiative - Provides innovative tools and resources for young people, including a text-to-quit program.

Glossary

• Nicotine Gum: A type of chewing gum that contains nicotine and is used as a smoking cessation aid or as an alternative nicotine delivery method for recreational users.

• Nicotine Replacement Therapy (NRT): A form of treatment for nicotine addiction that involves the use of products that deliver nicotine to the body, such as nicotine gum, patches, lozenges, inhalers, or nasal sprays, to help reduce withdrawal symptoms and cravings.

• Controlled Nicotine Release: The gradual and regulated release of nicotine from NRT products to mimic the nicotine delivery of cigarettes without the harmful effects of tobacco smoke.

• Park and Chew Method: A technique for using nicotine gum that involves chewing the gum until a tingling sensation is felt, then "parking" it between the cheek and gum to allow nicotine to be absorbed through the oral mucosa.

• Alternative Nicotine Delivery Methods: Non-combustible products or devices that deliver nicotine to the body through routes other than smoking traditional cigarettes, such as vaping devices, nicotine gum, sublingual nicotine, lozenges, or patches.