Trading One Nicotine Fix for Another

Even before she gets out of bed in the morning, she's ready for her first fix.

Eyes closed, sleepy fingers fumbling at the bedside table, she seizes the silver packet, expertly extracts a single white tablet and places it in her mouth.

Ah, nicotine gum.

Dana Yudovin quit smoking 12 years ago, after a quarter-century of puffing a pack a day. But now she's hooked on the gum, gobbling up a dozen or more pieces a day. Sometimes she sleeps with the gum in her mouth, tucking it into a gap between her teeth where a removable dental bridge usually goes.

Yudovin, 57, of Cambria, Calif., is among a growing number of Americans who have kicked one nicotine habit for another, albeit safer, one.

Nicotine gum was intended as a temporary regimen for smokers as they attempted to wean themselves from cigarettes. But for nearly 10% of those who use the gum to quit smoking, it has become a habit of its own, according to Dr. John R. Hughes, a professor of psychiatry at the University of Vermont Medical School in Burlington who has studied nicotine addiction.

Hughes and other doctors stress that with one exception, there is no evidence that regular use of nicotine gum poses any health risk. The exception is pregnant women, who risk exposing their fetuses to brain-cell loss and other developmental disorders.

In large doses, nicotine can damage the cardiovascular and circulatory systems by raising the heart rate and blood pressure. Taken in the small, slowly delivered doses present in nicotine gum, however, the product "seems to have very few side effects," said Dr. Neal Benowitz a professor of psychiatry and medicine at the UC San Francisco medical school.

Nicotine gum (which has been available over-the-counter as the brand name Nicorette since 1996 and was recently approved for sale as a generic product also) works by releasing nicotine into the bloodstream through the mucous membranes in the mouth. The amount of nicotine is small compared with the massive rush from a cigarette and is absorbed into the bloodstream much more slowly, but it's enough to reduce nicotine cravings in smokers trying to kick the habit, said Dr. Jack Henningfield, an associate professor of psychiatry at Johns Hopkins University Medical School in Baltimore. Many doctors, including Hughes, say the benefits of nicotine gum far outweigh the risks. Giving up smoking can add years to a person's life, while the chance of getting hooked on nicotine gum is fairly small and, for most, free of adverse medical consequences.