Govt Considers Restrictions On Non-Smoking Nicotine: Is It Really Needed?

Providing more pharmacologic options to smokers can increase the number of treatment-assisted quitting attempts.

Nicotine gum is perhaps one of the easiest replacement therapies available for those who want to quit or reduce cigarette smoking.

(Photo: Canva/Altered by FIT)

Nicotine gum is perhaps one of the easiest replacement therapies available for those who want to quit or reduce cigarette smoking.

A report in the Economic Times indicated that the Drugs Technical Advisory Board (DTAB) has deliberated on regulating how it is sold. No science has yet been offered as to why the ban may be enforced, even on the low-dose 2 mg variant.

According to Schedule K of Drugs Rules, 1945, nicotine gum and lozenges containing up to 2mg of nicotine are exempted from sale licence and no prescription from a registered medical practitioner is needed.

During the meeting, the DTAB had suggested bringing the Indian Council of Medical Research for assistance to reach the decision.

Nicotine Gums: Science Vs Laws

Nicotine gums have been made available in drug stores for those who wanted to quit smoking or chewing gutka from the first time that the government decided to enforce a tobacco-control regime in India.

Most tobacco users, who want to quit, use it in decreasing doses to wean their bodies away from tobacco use. This is so that heavy-duty nicotine withdrawal symptoms do not hamper their daily lives while quitting.

Many smokers also successfully use it to decrease the quantity of cigarettes they consumed in a day.

Users pop the gum in their mouth, chew it a few times, and then let it rest between their gum and cheeks to absorb the nicotine released from the gum.

In India, the available doses were reduced to 2-4 mg and now the law only allows two mg nicotine gums for over-the-counter (OTC) sales.

But, according to some media reports, the health ministry wants to control the sale of this OTC drug as well. The apprehension is that the vaping industry might use these rules to import and sell its products.

That, however, is a legal issue and not a scientific one.

Nicotine gums and lozenges help tobacco users to quit or reduce smoking. It has also helped people to stop using gutka in India, where there is a substantial number of people who chew that and betel leaves stuffed with chewing tobacco. 

Healthcare is not cheap in India. People with ‘viral fevers’ do not consult a doctor before they buy paracetamol, vitamins, and electrolytes to treat their symptoms.

The efficacy of nicotine gums and lozenges has travelled by word of mouth and been used as a tobacco cessation therapy.

Nicotine Sold Over-The-Counter in UK

The UK government, in 2022, released a document showing that it had tested a dose of nicotine gum and allowed licensing it as General Sales Medicine, which is the same as over-the-counter drugs in India.

The UK government also approved OTC sales of the 6 mg gum, which is three times the dosage that is allowed in India. 

The health ministry’s Tobacco Control Division has reportedly said that tobacco users may use the nicotine gum as a substitute rather than to cease smoking.

Media reports, so far, do not offer an insight into the scientific nature of these observations.

The study by the UK government shows that nicotine gum is far less harmful than smoking tobacco.

They even say so categorically in the case of pregnant mothers that the use of nicotine gum is less harmful to their babies than smoking is. 

Those familiar with substance addiction will be aware that quitting a substance (including nicotine) is not a one-time stint.

It has a physical, mental, and a psycho-social component to it. There are physical withdrawals and mental cravings for the substance. Even those trying to quit drugs cannot quit in one go.

While the two are not comparable, it is as tough to quit or even reduce consumption of cigarettes.

Nicotine gum puts a tobacco user on the path to quitting cigarettes or gutka and while some may come back to it, once the cycle of quitting has begun, it is highly likely that a user will quit in the future. 

Multiple Addiction Interventions in Japan

The Japan government has studied the issue of addiction and suggested behavioural counselling, cessation medication, proactive quit line counselling, and internet-based interventions to help with quitting.

Along with this, in Japan, tobacco-cessation products are available such as nicotine gums.

While India has court-initiated awareness programs, such interventions are missing from the Indian government’s to-do list for tobacco control. 

The easy availability of nicotine cessation products in the markets makes it possible for them to consider quitting tobacco use. A 15-year study of sales data in the US showed that:

Providing more pharmacologic options to smokers can increase the number of treatment-assisted quit attempts. The two largest increases in medication use occurred when prescription patches were introduced in 1992 and when nicotine gum and patches became available without a prescription.

In the US, the control regime wants to crack down on those marketing such products to minors, but not to those that want to cease tobacco use. 

The irony is that controlling nicotine gums and lozenges for prescription sale will make it difficult to access tobacco cessation products, while tobacco products—cigarettes and gutka—will continue to be available for purchase at every street corner without requiring even a licence to sell it.

(Shantanu Guha Ray is a Wharton-trained, award-winning journalist who has specialised - for over two and a half decades - in reporting on investigative news features, business features and human interest reports.  This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)