What's a safe level of nicotine?
"Is there such a thing as a safe level of nicotine?" asks RALPH PRICE, MD, of Blackstock, ON. "In practice, how many cigarettes does it take for a new user to become addicted? And at the other end, how easy is it to get off the nicotine patch once started? Does the patch have any toxic or nefarious effects?"
There's no safe level of nicotine absorbed through cigarette smoking, though smoking a cigarette every few days is unlikely to be problematic. Common sense should guide you in counselling patients. Most studies demonstrate that it's much safer and healthier to absorb nicotine through replacement therapy than by smoking. Nonetheless, it remains a risk for those with coronary artery disease, angina, arrhythmias and vasculopathies. The number of cigarettes it takes for a new user to become addicted is hugely variable. Some never seem to develop an addiction at all, others very quickly. Nicotine can reach the brain quite speedily, in 11 seconds. As a general rule, the faster a substance is absorbed, the stronger its addictive potential. There are few studies on the development of dependence to the transdermal nicotine patch, but it seems to have a lower abuse potential than other forms of nicotine replacement. One trial showed 0.9% use of the patch after six months and less than 0.4% after 24 months. Exposure to excessive amounts of nicotine can prove toxic in adults and fatal in children. AKS