Taking the splutter and cough out of needing nicotine There are three well-trodden paths available to the smoker's conscience when it comes time to stop. Cold turkey is a jolt and will have you jonesing for a cigarette constantly. Substitution is filling the gap with maybe a double cheeseburger or an extra banana and chocolate Man'oucheh. The third is nicotine replacement therapy. Nicotine replacement therapy is admittedly a tricky notion. It's based on the premise that it's hard to quit the smoking habit and the addictive nicotine at the same time, so it presumes you can quit the former cold turkey while helping you ease gradually off the nicotine. Let's talk for a minute about how it works. The cigarette is still the most efficient nicotine delivery system, technically speaking, as the rate of transfer into the blood through the lungs can't be beat for maximum nicotine absorption. But there are many means other than the lungs for bringing nicotine into your body. The most effective of these are mucus membranes (like those in your nose or mouth), which, like the lungs, allow for rapid transfer into the bloodstream. Essentially, nicotine replacement therapies are marvels of modern science that let you get at the nicotine but avoid the cigarette. And though some are less appealing than others, they are all meant to make the transition to non-smoker that little bit easier . or so the theory goes. Let's take a look at what it's like in actual practice. Nicotine gum comes in two equally dreadful flavors. Thankfully the mint flavor is sugar free, but its similarity to the decidedly non-subtle taste of chewing tobacco remains the same as the original, neutral flavor. But lest you think that the taste is the only barrier to get through, the information sheet warns you that nicotine gum has been known to "irritate your throat, upset your stomach or give you hiccups. And you're supposed to chew just once or twice, then put it between your gum and cheek, and only chew again when you next crave a cigarette. Chinese water torture is nothing compared to this. Though the extent of your gum-induced nausea may vary between the 2 and 4 mg options available, you can continue chewing and vomiting in the pleasant knowledge that you'll be back to smoking cigarettes again soon. And don't think it's the cheap option: 105 pieces go for LE 295. At the suggested maximum of 15 a day, you would need to buy and consume one of these pricey packs of gum every week. Nicotine patches will cost you nearly LE 200 for seven and each one will administer 15 mg of nicotine continuously over 16 hours from morning to evening. The dose of daily nicotine has to be higher here, since the patch, generally put on your arm, uses skin as the conduit, which is not as efficient as mucus membranes. One useful aspect of the patch is that instead of having to feel and react to the craving, as with the gum, this stream of nicotine into your system minimizes the craving in the first place. The cost comes down with the strength to LE 175 for seven of the weakest 4 mg patches. The most recent addition to the quit-smoking foray is the nicotine nasal spray, and what a talented bugger it is. This has you firing each nostril with 0.5 mg of nicotine twice every hour. Over the course of a single day, that's 35 mg of nicotine, at a rate that would mean you'll be done in less than a week due to its 200-spray capacity. These are also LE 200 each. The high dose, expensive delivery systems - the gum, patches, and nasal spray - are designed to take away your need to smoke, but not your need for nicotine necessarily. In using these products you must still gradually wean yourself down. The advice for the nasal spray is to use it for eight weeks, before reducing your usage in half for another two weeks, before quitting - and before being a whopping LE 2,000 out-of-pocket. At LE 7.5, a pack of Marlboro Lights comes with 0.7 mg of nicotine for the whole pack. For a pack-a-day smoker, that's LE 55 a week, including the lighter. And that's only 5 mg of nicotine - for the whole week - thanks again to the efficiency of the lungs as a nicotine-transport system. It's such a shame cigarettes also come with the 9 mg of tar, not to mention a tantalizing blend of hydrogen cyanide, carbon monoxide and heavy metals. Types of nicotine replacement therapy to hit the market next may be the Nicorettes Inhalator or Microtab, already available in the West. One is a glorified plastic tube, a barrel that takes nicotine cartridges and directs insertion into your mouth. The latter is a sublingual tablet, to be dissolved under the tongue and taken up to 15 times a day. But if shooting nicotine into your nose 32 times a day or popping 15 sticks of gum a day isn't habit forming, then what is? Oh - smoking cigarettes. As for having your body receive that much nicotine - more than 1,960 mg over eight weeks - how big a burger is going to fill that gap? So when it comes time to finally give up your nicotine replacement of choice, you're going to have to just quit, like you could have with the cigarettes. On this weekend when there's so much talk of Thanksgiving, maybe (cold) turkey's not so bad after all.
