TOBACCO

NICOTIANA TABACUM and NICOTIANA RUSTICA, SOLANACEAE, originate from the « new world », ie tropical and subtropical zones of North and South America.

The use of tobacco leaves by the Amerindians was very quickly noticed by Christopher Columbus and his crew.
The Tainos Indians then populated the Greater and Lesser Antilles; this Arawak people (in the process of being supplanted by the Caribs) cultivated tobacco; it is assumed that this name comes from elsewhere in their language but other philologists consider it to be of Arabic origin.
Nicotiana was named in honor of Jean Nicot, French Ambassador to Portugal, who introduced tobacco to the French court at the end of the 16th century.

Nicotiana tabacum, the most cultivated tobacco now in the whole world, is an annual plant, which allows its acclimatization in regions with varied climates: from the equatorial forest to temperate countries.

There are many cultivars (crop varieties).

Tobacco in general a fairly tall plant (1 to 2m), with alternate leaves, sometimes large in the cultivation varieties (50 to 70 cm long by 20 to 40 cm wide), the flowers are in panicles with corolla tubular tinged with pink or red.

The maturity of tobacco leaves is from bottom to top, the lowest leaves turn yellow first.

There are many species in the genus Tabacum: some are still used locally, as smoking tobacco and sometimes in shamanistic rituals.

Nicotiana rustica, was probably the first tobacco grown in South America then it was dispersed by Native Americans up to the Atlantic Canadian provinces.
It is a small plant, whose leaves contain 3 times more nicotine than common tobacco.

Nicotiana obtusifolia was used by Native Americans in the western United States, but its taste is not pleasant.

Nicotiana alata is a plant reaching 1.5 m, very decorative with its numerous white flowers, native to South America and still cultivated today in Iran.

Nicotiana glauca, a small shrub with decorative yellow flowers, contains enough toxic aicaloids (nicotine and anabasin) to make an insecticidal decoction infusion, it is too toxic for smoking tobacco.

CHEMICAL COMPOSITION AND PROPERTIES

Green tobacco leaves (Nicotiana tabacum) contain (in percentage of dry weight):

  • 40% carbohydrates (starch, cellulose, simple sugars)
  • 15-20% protein and organic acids
  • between 1 and 10% alkaloids (exceptionally 15%): nicotine is predominant (up to 90-95%); the other tobacco alkaloids are chemically close to nicotine, the most important are anabasine and nornicotine

NICOTINE

Nicotine is synthesized in the roots of the tobacco plant and then migrates to the leaves.
Nicotine is a base, volatile, colorless but browning by oxidation, and which gives its smell to tobacco.

The physical characteristics of nicotine: flash point 95°C, decomposition 247°C, suggest that the majority of nicotine is destroyed in the combustion cone of the cigarette or cigar which reaches up to 800°C.

The nicotine from inhaled smoke is suspended in drops of tar (0.3-0.5 µm) and is thus part of what is called the particulate phase of tobacco smoke, it then becomes free again (gasifies). The amount of nicotine inhaled depends on the way of smoking, depth of inhalation, cigarette held in the mouth, rate of puffs etc.

Nicotine is rapidly absorbed through the mucous membranes and enters the bloodstream.
The inhalation of tobacco smoke allows a very rapid absorption of nicotine into the blood; in 7 to 9 seconds nicotine reaches the brain. Absorption through the buccal (or rectal) mucosa is also very effective.

On the other hand, tobacco juice and saliva containing tar particles and nicotine are absorbed in the small intestine, but two-thirds of the nicotine is destroyed by the liver, which thus detoxifies the blood .

The excretion of nicotine is done a little by breathing and is also found in the urine but most of it is transformed (metabolized=destroyed) in the liver into a metabolite: cotinine.
The rate of elimination of nicotine is quite fast: in 2 hours half of the nicotine has disappeared from the blood, the cotinine remains, which persists for several days in the tissues (its half-life is 16 hours).
Nicotine binds electively to receptors of the nervous system that have been named for this reason « nicotinic receptors », it stimulates or blocks them and thus causes several direct or indirect physiological effects:

  • stimulation of the central nervous system: pleasant sensation of intellectual stimulation, but also in those who are not accustomed to nicotine: tremors, desire to vomit and if the dose is high convulsions
  • increased bowel movements (at a minimum this promotes defecation, but it can cause diarrhea)
  • increased heart rate (tachycardia) and blood pressure, constriction of blood vessels (risk of thrombosis which can cause, for example, myocardial infarction or stroke)
  • There are other known if not explained actions: increase in the level of dopamine in a part of the brain, which induces a feeling of well-being.

The regular absorption of nicotine can modify the activity of certain psychotropic drugs and is partly responsible for the undesirable effects of the contraceptive pill.

Nicotine, like the other alkaloids present in tobacco, anabasine and nornicotine, are quite formidable POISONS: the DEADLY DOSE for humans by mouth is approximately 1mg per kilo, i.e. between 30 and 60mg for an adult ( a pack of cigarettes can contain 20 mg of nicotine), for the record: rodents (rabbits or rats) are 50 times less sensitive than us.

The nicotine extracted from tobacco or the « juice » of tobacco are insecticides (fight against aphids for example).

USES

Originally, in Native American societies (and even now in certain South American Indian tribes), tobacco was mainly used for magical, religious purposes, by witch doctors or perhaps during reconciliation rites.
Tobacco was fairly quickly known in Europe but, because of its rarity, it was reserved for the ruling elite.
The rapid development of plantations on the East Coast of the United States in the 17th century and in the West Indies, the improvement of cultivation techniques and the use of slaves of African origin as labor increased tobacco production tenfold and « democratized « use.

Since the 17th century tobacco has been introduced all over the world; the invention of the cigarette, and the industrialization of its production and distribution by the USA in the 20th century, enormously increased the consumption of tobacco.

The cultivation and marketing of tobacco is a very profitable activity, controlled by huge multinational corporations, and a significant source of revenue for governments that tax tobacco heavily.

TOBACCO PRODUCTION IN 2000 THOUSAND OF TONNES

China 2,298.8
India 595.4
Brazil 520.7
USA408.2
Europe 314.5
Zimbabwe 204.9
Turkey 193.9
Indonesia 166.6
Russia and former Soviet republics 116.8
Malawi 108.0

TOBACCO PRODUCTION IN 2017 THOUSAND OF TONNES

China 2391
Brasil 880
India 799
USA 322
Zimbabwe 181
Indonesia 152
Zambia 131
Paistan 117
Argentina 117
Tanzania 104

TOBACCO CURING

Ripe (yellowed) tobacco leaves can be:

  • air-dried out of direct sunlight,
  • or in rooms heated by wood fires which at the same time smoke tobacco,
  • in rooms heated by smokeless hot air.
    They are then put to age, to mature; later the tobacco leaves will be prepared specifically for making cigarette, pipe, cigar, snuff, chewing tobacco. The tobaccos are mixed together (blended) and with texturizing chemicals, flavorings and preservatives.

Since the middle of the 20th century, the health services have observed a marked increase in bronchial cancers, numerous studies have shown that this increase was partly due to the use of tobacco cigarettes, the other factor being the increase air pollution by industrial fumes and exhaust gases.

Nicotine itself does not appear to be mutagenic, it is the combustion products of tobacco that are carcinogenic, they act primarily at the level of the epithelium of the bronchi by irritating it (at least recurrent bronchitis, chronic cough, emphysema ) but also pass into the bloodstream and are found in the urine.

Tobacco leaves very often contain polonium 210, an extremely toxic isotope, the tobacco plant concentrates the polonium contained in the soil.
POLONIUM 210 is mutagenic (carcinogenic) and is perhaps the main cause of bronchial cancers linked to the consumption of cigarettes.

TOBACCO IS A DRUG.

Tobacco addiction is strong: quitting smoking tobacco is more difficult than quitting drinking alcohol.
There isn’t just one way to quit smoking; the CURRENT TREND is to help the person who wishes to quit smoking by substitution treatment. There are of course other techniques: psychological, homeopathic, acupuncture, sport etc.

It is quite possible to quit smoking, without psychological help or without nicotine substitutes, by your own will. But when you have failed, when the task seems difficult and you are really motivated, you can resort to a weaning technique.

To begin with

The reduction is done by using oral nicotine substitutes (gums or lozenges) or by the respiratory route (electronic cigarette= e-ciggarette); a nicotine gum or lozenge replaces one or two cigarettes.
The reduction in the number of cigarettes is done very gradually, we try at the same time to eliminate « unnecessary » cigarettes.

Second stage

Experience shows that when consumption has been reduced to seven or eight cigarettes, smokers often wish to quit completely.

Cigarettes and gums or lozenges are then replaced by patches for which it is easy to define the right dosage or by an e- cigarette with a liquid highly dosed in nicotine (at least 12 mg per ml).

For example, for five cigarettes and fifteen gums, knowing that each cigarette provides an average of 1 mg of nicotine and that the yield (about 50%) of a 2 mg gum provides 1 mg, we must provide 5 mg + 15 mg , i.e. 21 mg, which corresponds to a 21 mg patch, supplemented on demand with a few gummies or lozenges.
We will then gradually reduce the consumption of substitute nicotine with, in the case of the e-cigarette, liquid at 6mg per ml then without nicotine.

The « tobacologists » have devised a test to measure the importance of tobacco addiction and better dose nicotine replacement therapy

FAGERSTRÖM TEST

How long after waking up do you smoke your first cigarette?
less than 5 minutes: 3 points
6 to 30 minutes: 2 points
31 to 60 minutes: 1 point
after 60 minutes: 0 point

Do you find it difficult not to smoke in forbidden places (ex: cinemas, libraries…)?
Yes: 1 point
No: 0 point

Which cigarette do you find most essential?
the first morning: 1 point
any other: 0 point

How many cigarettes do you smoke per day on average?
10 or less: 0 points
11 to 20: 1 point
21 to 30: 2 points
31 or more: 3 points

Do you smoke more closely in the first hour after waking than during
the rest of the day?
yes: 1 point
no: 0 point

Do you smoke even if an illness forces you to stay in bed?
yes: 1 point
no: 0 point

The level of nicotine dependence is obtained by adding the points:
0-2 points: very low; 3-4 dots: low; 5 points: average; 6-7 points high; 8-10 points: very high.

For a dependency score below 5, one in two people quit smoking without special help, but for a score above 7, the success rate drops to 10% without smoking cessation aid
Conducting nicotine replacement therapy

The principle of the treatment is, as we have seen above, to compensate for the decrease in nicotine absorbed by smoking.
Presented in the form of stamps (patches), gums, lozenges, cartridges to inhale, the substitution treatment has no contraindications (according to the specialists), except for the rare allergy to the glue of the patches.

Since 2009 and the spread of the e-cigarette, there is an alternative to the use of patches (patches), gum or nicotine lozenges (see below) .
We give (by simplifying a little) an example of classic treatment recommended by Pr. Lagrue (tobacco specialist, tobacco center, Albert-Chenevier hospital, Créteil).

The dosage of drugs containing replacement nicotine depends on the results of the Fagerström test:

8 to 10: two patches (2 to 21 mg / 24 h or 1 to 21 mg / 24 h + 1 to 14 mg / 24 h, depending on the body size of the subject – one of the two patches is removed in the evening to avoid sleeping troubles) ; and one supplements possibly on request, by oral substitutes.
6 to 7: a 21 mg/24 hour patch + oral substitutes; in case of sleep disturbances, remove the patch at night or use the 15 mg/16h patch.
4 to 5: a 14 mg/24 hour patch or oral substitutes; or 10mg/4pm.
below 4 to 5: oral substitutes alone.

We can judge the result the following days and possibly modify the treatment:

If the dosage is adapted, we hardly feel any withdrawal syndrome.
In case of sudden desire (coffee, meeting, etc.) just take a gum or a tablet.

If the dosage is insufficient, nervousness (irritability, anger) is obvious, there is a persistent desire to smoke, it may be difficult to concentrate, the mood may be depressed; the dose of oral substitutes is then increased.

In case of excessive dosage, which is quite rare when the Fagerström test has been done, there is no desire to smoke and one can feel the effects of excessive smoking (nausea, sweating, tachycardia, arrhythmia, faintness , etc.); you can remove your patch before going to bed or reduce the dose of nicotine swallowed

It will of course be necessary to gradually reduce the quantity of nicotine replacement.
In 3 to 6 months the need to smoke will have disappeared but you must remain vigilant, a sudden urge may occur in certain circumstances.

Negative effects of smoking cessation:

  • A bit of anxiety (but don’t go from smoking addiction to anxiolytics addiction).
  • Transit disorders: in case of nicotine overdose diarrhea, and finally weaning tendency to constipation.
  • Some cravings.
  • Coughing and expectoration are paradoxically frequent when quitting smoking, which can be discouraging; it can last a few weeks; it is linked to the resumption of activity of the cilia of the cells of the bronchial mucosa, which until then had been more or less paralyzed by nicotine, a great spring cleaning in a way.

The association of tobacco and alcohol is frequent, 80% of alcohol addicts are also dependent on tobacco.

Quitting alcohol is much less difficult than quitting tobacco, the alcohol withdrawal syndrome lasts on average only a fortnight, and we generally start with alcohol withdrawal because the withdrawal from tobacco is likely to increase. alcohol consumption with the possible occurrence of acute accidents.

Coffee and tobacco are strongly linked: both give pleasure and reinforce each other; drinking coffee increases the urge to smoke. During weaning from tobacco, we advise against stopping coffee (do not exaggerate!) and we try to dissociate the « gestures » of coffee and cigarettes.

Smoking cannabis can also reinforce or accelerate tobacco dependence and make it more difficult to quit.

The association of tobacco and alcohol is frequent, 80% of alcohol addicts are also dependent on tobacco.

Quitting alcohol is much less difficult than quitting tobacco, the alcohol withdrawal syndrome lasts on average only a fortnight, and we generally start with alcohol withdrawal because the withdrawal from tobacco is likely to increase. alcohol consumption with the possible occurrence of acute accidents.

Coffee and tobacco are strongly linked: both give pleasure and reinforce each other; drinking coffee increases the urge to smoke. During weaning from tobacco, we advise against stopping coffee (do not exaggerate!) and we try to dissociate the « gestures » of coffee and cigarettes.

Smoking cannabis can also reinforce or accelerate tobacco dependence and make it more difficult to quit.

ELECTRONIC CIGARETTE , E-CIARETTE VAPE TOBACCO WEANING

Since 2009-2010 a small « revolution » in the consumption of tobacco derivatives accompanies the globalization and the trivialization of the use of e-cigarettes.
Can we get rid of cigarette and smoking addiction with the help of this electronic cigarette?
In practice, we see that people who have given up smoking cessation for reasons of cost or inefficiency or too much brutality of weaning manage to considerably or even completely reduce their consumption of cigarettes thanks to this e-cigarette.

It remains to be seen, in the years to come and by analyzing epidemiological data, whether addiction to cigarettes is replaced by vaping or whether weaning becomes total and successful on a mental and physical level.

What are the health consequences of vaping?

The « consumable » ingredients of the electronic cigarette are: the liquid which vaporizes (propylene glycol or glycerol or both in various proportions), nicotine and additives giving aroma.
Glycerol (= vegetable glycerin) and propylene glycol are not considered toxic or harmful to health, but heating them to vaporize them can release in a badly adjusted or badly manufactured e-cigarette toxic compounds, irritants even carcinogenic like acrolein (temperature above 250°).
Nicotine whose concentrations vary between 0 mg and 24 mg (or even more) per ml can present a risk of poisoning for someone (a child) who swallows the syrupy and slightly sweet liquid of the vaper.
Flavor additives are chemical substances whose formula and fate after heating remain mysterious.
The majority of « vapers » do not complain of side effects, apart from dry mouth or tongue irritation.

Bronchitis, cough and vaping

In some cases, usually after 2 to 4 weeks, one can observe the appearance of a dry irritative cough, which can turn into a wet cough, especially in people with bronchi already weakened by smoking .

E-cigarette traders minimize the problem and try to convince their customers, including through dedicated blogs, that it is just a rehabilitation of the respiratory system, that the hair cells of the bronchial mucosa are reactivated and produce more mucus and you have to persevere, it’s classic when you stop smoking.

In some cases this may be true, however I have observed vaping « bronchitis » which does not resolve spontaneously even after stopping vaping and may require antibiotic treatment to dry them out.

For me it is a real intolerance to certain compounds of the liquid of the electronic cigarette or the liquid after heating.

Sometimes the problem decreases when you change vaping liquid supplier, or when you make this liquid yourself from vegetable glycerin (VG) or propylene glygol (PG) (of European origin) by varying the percentages of these products, and completely eliminating aromas that could be allergenic.

Conducting smoking cessation with the electronic cigarette

We start with the use of a vaping liquid concentrated in nicotine (12 mg per ml for example) and when the need to smoke traditional cigarettes fades, we switch to a liquid less concentrated in nicotine (6 mg) see without nicotine.

Weaning is much more flexible and adaptable to each particular case, and you can continue to vape without nicotine, the smoker’s gesture is still there and is generally sufficient, the next less painful step will be quitting the e-cigarette.

ABSTRACT

TOBACCO, NICOTINE AND ITS WITHDRAWAL
Humans love to smoke, it gives them a feeling of well-being,
it helps them to bear life’s difficulties, stress.
Tobacco is a drug. Smoking is dangerous for your health, it’s written on all cigarette packets.
It is the combustion products of the cigarette that are in question, much more than the nicotine in tobacco.
Current treatment to help quit smoking is based on the rational use of nicotine
as a substitute for cigarettes using patches, lozenges or electronic cigarettes.

Copyright 2023 : Dr Jean-Michel Hurtel

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