Non-Cigarette

Tobacco Products
(NCTP)
Karina DiLuzio, BS, CTTS, CWC and
Julee Moorlag, RCP, CTTS
2017
 Agenda

• Cigars/Pipes
• Smokeless tobacco
• Dissolvable Tobacco Products
• Hookahs (Waterpipes)
• Treatment methods

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Cigars

Definitions according to US Department of Treasury

– Cigar: Any roll of tobacco wrapped in leaf
tobacco or any substance containing tobacco.
– Cigarette: Any roll of tobacco wrapped in paper
or any other substance not containing tobacco.
Cigars

• Use of cigars significantly increased in the

late 1990s.
• Only tobacco product that prevalence
increases with increased incomes.
Pipes

• Tool consists of a long hollow tube with a bowl

at the end, traditionally made of clay or slate.
• Pipes come with many tools for cleaning. Many
pipes are considered collectors items, valued for
the craftsmanship.
• Lowest level of tobacco use
Smokeless Tobacco (ST)

• Chew – coarser cut tobacco leaves, also called

plugs, twists, or loose leaf. (comes in a bag)
• Snuff – Moist ground tobacco. (comes in a can)
The finer the cut, the more nicotine absorbed.
3/4 of all ST users use Snuff (NSDUH)
Chew

Rick Bender lost half his jaw, part of his tongue, bottom teeth,
and ability to raise his right arm more than halfway. He speaks
out against chewing tobacco.
Snus

Snus is small pouches of moist snuff. The by-product is

swallowed, not spit, which makes it easier to use.
Snus

• Originated in Sweden, where it is sterilized so less

carcinogenic. Considered “safer” than cigarettes, but
not “safe”.
• Tobacco companies have put more chemicals in the US
forms of Snus.
• Not as popular as cigarettes, but considered a gateway
to them.
Snus
 What’s new in NCTP?

• Dissolvable Tobacco Products include Orbs, Sticks and Strips. No

spitting is required. The amount of nicotine in these products
varies from 0.6 milligram to 3.1 milligrams per serving. The
average smoker takes in 1 milligram of nicotine per cigarette.

• A nicotine gel is a tobacco product that contains nicotine and can

be absorbed through the skin
Tobacco Companies version of NRT

• Tobacco companies market their own version of

“quitting” tobacco products! Difference is they are
NOT regulated by the FDA and are NOT purified like
NRT! But they can lead people into believing that
tobacco companies have their best interest at heart
and want them to quit!!
Hookah (Waterpipe)

• Hookahs are Waterpipes that are used to smoke

specially made tobacco (several flavors)
• Vary in size, shape and style
Hookahs (Waterpipes)

• Hookahs were invented in India during the 16th century

by an Indian physician.
• Hookah smoking is typically done in groups, part of
certain cultures and is often used with the same
mouthpiece being passed from person to person
(increased risk of infectious disease).
 Question from NAP school presentation:
On average a 45 minute Hookah session (very typical) is equal to
smoking about how many cigarettes?

1. 2 cigarettes
2. 5 cigarettes
3. 1 pack (20 cigarettes)
4. >3 packs (60 cigarettes)
5. >5+ packs (100 cigarettes)
One Hookah session vs. smoking one cigarette gives out:
– 72 X more tar
– 4 X more nicotine
– 11 X more carbon monoxide
Treatments for ST

• It can be very difficult

to estimate amount of
nicotine from ST.
• Levels change per brand
and can even change
from city to city in the
same brand!
• Need to dose NRT by #
cans per week rather
than amount of
nicotine in brands.
www.Trinketsandtrash.org
Treatments for ST

Approximate bioavailability of nicotine in:

Cigarette = ~1mg
Pipe = ~5.2 mg
ST-
-Chewing tobacco = ~4.5 mg
-Snuff = ~3.6 mg
Cigars-
-little cigars, swishers = ~3.8 mg
-Premium = ~13.3 mg
4mg nicotine gum = ~1.9 mg
 Treatments for ST

• NRT use – patches, gum, and lozenges seem to be

the most effective.
– Use in combination when appropriate
• Chantix and Wellbutrin are also used
• Nasal spray and nicotine inhaler are generally not
used as designed to replace cigarettes, not ST
• Non-tobacco products –
– finely milled mint leaves
– Coffee pouches
– Tea blends

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 Treatments for ST

Suggested nicotine dosing for ST:

• Low addiction: (< 2 cans or pouches per week) 14 mg patch
• Moderate addiction: (2-3 cans or pouches per week) 21 mg patch
• High addiction: (>3 cans or pouches per week) 42 mg patch (2- 21 mg)

• Starting level should be used for 4-6 weeks, tapering by 7-14 mg steps every
2-4 weeks based on patients reports of w/d symptoms, urges and comfort.
• A short acting NRT can be added to this as needed.
• Zyban and Chantix can also be used.

• Signs of too much NRT are nausea and dizziness, which usually occur within
1-2 hours of patch application. This occurs infrequently, even at higher
doses.

Mayo Clinic Nicotine Dependence Center

Questions?

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