Monday, August 21, 2006

Drug Delivery

Nicotine patches are currently marketed as a cure for smoking. What they actually are, so far as I can tell, is an alternative delivery system for the same drug. Insofar as what smokers really want is the effect of nicotine the patches may well succeed in getting smokers to quit, but they cure an addiction to cigarettes only in the sense that whiskey cures for an addiction to wine.

Considered as a substitute, they have two big advantages over cigarettes. Since they get nicotine to the blood stream without going through the lungs, they should have fewer adverse health effects; there is no obvious reason why the use of nicotine patches would cause lung cancer. And they eliminate both the (somewhat controversial) medical effect of second hand smoke and the unpleasantness that nonsmokers experience from the smell of tobacco. The user of a nicotine patch may perhaps harm his own health, but he should have very little effect on those around him.

This may be an early and interesting example of an alternative approach to the problems associated with both legal and illegal drugs. The conventional solution is to stop people from using drugs. The alternative is to find ways of providing the effects drug users want while minimizing undesirable side effects, on themselves and others.

22 Comments:

At 1:17 AM, August 22, 2006, Anonymous Anonymous said...

A factual note: nicotine is not the part of a cigarette that harms you. It's the part that is addictive (allegedly).
Alcibiades

 
At 12:26 PM, August 22, 2006, Anonymous Douglas Knight said...

early and interesting example of an alternative approach to the problems associated with both legal and illegal drugs.

The main problem with drugs--and by "problem" I mean "externality" and by "main" probably mean some public choice measure--is that other people dislike them. Nicotine patches are an "interesting example of an alternative approach" to this problem, by classifying it as cure. The fact that it's healthier pales by comparison.

 
At 12:51 PM, August 22, 2006, Anonymous Anonymous said...

Vaporisation, ie heating the substance to be injested to the point that the active incredient is vapourised and still can be absorbed by the lungs, is a excelent alternative to smoking and works particularly well with other natural herbs.

 
At 1:47 PM, August 22, 2006, Anonymous Douglas Knight said...

I think vaporization illustrates my point. It is legal to do individually, but is it legal in public places that ban smoking? Moreover, the FDA won't let tobacco companies sell cigarette replacements that do well controlled vaporization to regulate dosage.

 
At 6:47 PM, August 22, 2006, Anonymous Ben Cooper said...

The conventional solution is to stop people from using drugs. The alternative is to find ways of providing the effects drug users want while minimizing undesirable side effects, on themselves and others.

This strategy is at least as old as methadone treatment.

 
At 10:19 PM, August 22, 2006, Blogger David Friedman said...

"This strategy is at least as old as methadone treatment."
I thought eliminated the pleasure that the heroin addict gets from heroin while preventing withdrawal symptoms. Is that wrong? In what sense does methadone produce fewer undesirable effects than heroin--itself, in medical quality, a relatively safe drug.

 
At 10:59 PM, August 22, 2006, Anonymous Anonymous said...

Insofar as what smokers really want is the effect of nicotine the patches may well succeed in getting smokers to quit, but they cure an addiction to cigarettes only in the sense that whiskey cures for an addiction to wine.

I think this is incorrect.

One aspect of "going on the patch" is to break a non-addiction related habit that most smokers have. The use of a smoke-break to insert a pause in stress, tension, etc.; to punctuate events like meeting people, meals, or other common events in daily life, etc.

A large part of breaking the smoking habit is disassociating smoking with other aspects of daily routine. The patch provides a mechanism for doing that.

This is entirely different from substituting one alcohol for another, unless you're also changing the social mechanisms under which it is delivered.

 
At 11:01 PM, August 22, 2006, Anonymous Anonymous said...

I said,

One aspect of "going on the patch" is to break a non-addiction related habit that most smokers have.

Sorry. I was typing two different thoughts at once. I meant, "is to break an addiction related habit..."

Ah, blog comments.

 
At 1:46 AM, August 23, 2006, Anonymous Anonymous said...

"I thought [methadone] eliminated the pleasure that the heroin addict gets from heroin while preventing withdrawal symptoms. Is that wrong? In what sense does methadone produce fewer undesirable effects than heroin--itself, in medical quality, a relatively safe drug."

First off, methadone is an opioid-receptor-agonist like heroin and produces for our purposes identical subjective effects as does heroin. Both heroin and methadone stave off withdrawals. Tolerance to both at a given dose occurs (ie, no high is achieved). The only difference is that methadone lasts longer in the body, and that it is legally prescribed at clinics. The myth that methadone does not get a user high is one of the few government-originated myths which serves a good purpose -- letting addicts have a chance to live relatively normal lives on a steady supply of opioid agonist drugs. Nor does methadone block the pleasurable effects of heroin -- though one's tolerance to opioids goes way-the-hell up on such a long acting opioid agonist such as methadone, so I suppose this could be construed in some way as blocking the effects of heroin, I guess...

"In what sense does methadone produce fewer undesirable effects than heroin--"
It's legal. And that's pretty much it. PHarmacologically, it is no better for you, and if anything, probably worse (messes with NMDA-receptors -- implicated in memory; duration of effect is longer and thus produces even greater physical dependence than does a shorter-acting opioid agonist).
Alcibiades

 
At 2:09 PM, August 23, 2006, Blogger William Newman said...

Alcibiades, are you sure of your source for for your "factual note" comment that nicotine is not "the" part that harms you?

There are all sorts of nifty carcinogenic chemicals in the tar you get from burning organic matter, so technically nicotine couldn't be the harmful part no matter what, but isn't it a harmful part? My foggy memory was that nicotine is believed to be a harmful part if only by its connection to heart disease. A moment with Google "nicotine heart disease" gave this as an early hit, so evidently I am not the only person who thinks so.

Alas, that's about as far as I trust the sources I found in that search. That source also states as simple uncontroversial fact that secondhand smoke uncontroversially a major cause of death, with a death toll comparable to that of auto accidents, which to me is approximately as goofy as stating as uncontroversial fact that nicotine does not harm you. Looking further I find stuff like this, which looks like a lightly edited marketing handout release from a nicotine patch supplier.

Still and all, I think your claim is surprising enough that you should cite a source, so I will try to be polite by citing a reason for surprise. From Google "nicotine blood pressure" it appears that that connection is absolutely uncontroversial, which makes sense since it sounds so easy to observe. I hope you'll grant me that the connection between blood pressure and heart disease is uncontroversial. And then: why would nicotine be harmless? Habituation causing long-term blood pressure effects to be negligible? The existence of counteracting good effects?

 
At 2:49 PM, August 23, 2006, Anonymous Anonymous said...

we should call your idea: "harm minimization" by arm transportation.

 
At 4:10 PM, August 23, 2006, Anonymous Douglas Knight said...

William Newman,
I believe that smoking has 50 times the reduction in life-expectancy as chewing tobacco--years vs weeks. I imagine this claim is overstated, because I imagine that chewers consume less than smokers. But I believe the biggest problem from chewing tobacco is local (gum, etc) forms of cancer, which a patch won't cause. Chewing tobacco seems like a pretty clear upper bound on the danger of nicotine alone, and I imagine it's quite a bit safer. I imagine it does some harm, but compared to smoking it's probably neglible.

 
At 2:30 AM, August 25, 2006, Anonymous Anonymous said...

Yo William Newman,
Lots of things raise your blood pressure but are not long-term harmful. Exercise comes to mind...
Caffeine too.
Your first link went to a page saying smoking contributes to heart disease. No argument here.
The second link went to a "Not Found page."
I can't comment on your google nicotine heart disease search really.
If nicotine causes cancer, it's news to me. Lol, just to double check i wasn't nuts, I myself made use of teh google, typing in nicotine AND cancer. The second result is "Half of smokers incorrectly believe nicotine causes cancer," and the third is "Many mistakenly believe nicotine causes cancer."
So I don't think my reasoned opinion is in the minority really...
Alcibiades

 
At 2:46 PM, August 25, 2006, Anonymous Anonymous said...

Wasn't there some plan on the part of cigarette manufacturers at some point to market a smokeless cigarette? Was this what douglas knight was referring to?

 
At 11:54 PM, August 26, 2006, Anonymous ben cooper said...

Methodone may not be the best known treatment for heroin addiction or better for the long-term corporeal health of the patient than the drug itself. But as long as clinicians believe that its effects diminish the cycle of highs and lows associated with regular use, giving addicts a chance to disassociate themselves from corrupting social forces and allowing them to get high without committing crimes, it is in practice a way of providing the effects drug users want while minimizing undesirable side effects, on themselves and others.

 
At 12:03 AM, August 27, 2006, Anonymous Anonymous said...

Sorry. To quibble, the last sentence should read it is in practice a strategy for providing the effects drug users want while minimizing undesirable side effects, on themselves and others.
Ben

 
At 6:02 PM, September 03, 2006, Blogger Andrew said...

A large part of the smoking "experience" is the slow, deep breathing that goes with it, and tends to relax the mind and body. Nicotine patches obviously don't offer that, so smokers should need to take up some form of deep breathing exercises as a substitute for the non-narcotic smoking effects.

 
At 4:58 PM, September 04, 2006, Anonymous Anonymous said...

There are really a number of effects that contribute to what we usually call "addiction", such as tolerance, withdrawal, and craving. Tolerance and withdrawal are pretty well understood (they are usually caused by the body's adjustment to the drug), but craving is more mysterious. It seems that it can be seen as a form of conditioning, and that it is stronger for drugs and modes of administration where the effect is felt very quickly, such as snorting (insufflation), smoking, and shooting up (injection). This is not at all surprising given that for conditioning to work, the stimulus and the reward need to be closely associated. Nicotine patches are a slow delivery mechanism that does not provide the immediate reward of a cigarette, but that does counteract withdrawal effects. The idea would be that a nicotine addict could get over the cravings first before having to deal with the withdrawal. I have no idea how well they actually work, but I think it's oversimplification to claim that they are "just" another way of delivering the drug. Similarly, opium is more addictive when smoked than eaten, amphetamine is more addictive when snorted than eaten, and so on.

 
At 4:32 PM, September 07, 2006, Blogger Anthony said...

People's objections to nicotine as a drug are primarily based on the properties of the delivery system, not the behavior of people acting under the influence of nicotine. Very few people act significantly more irresponsibly under the influence of nicotine. Thus the patch is an effective subsititute.

 
At 1:12 PM, April 09, 2007, Anonymous Celia said...

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At 9:43 PM, March 13, 2008, Blogger southcoast said...

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At 10:07 PM, March 23, 2008, Blogger southcoast said...

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