Time for major roadworks on the tobacco road

Nicotine replacement Inhaling tobacco smoke is a remarkable and exquisitely refined mechanism for delivering nicotine to the central nervous system. Remarkable for its acute safety and chronic catastrophe, and unique because it is tobacco (not nicotine) that causes the damage. The failure to make this crucial distinction is a tragedy. Alternative methods of delivering nicotine via tobacco have been available for centuries in the form of chewing tobacco, snuff, drinks, enemas, and percutaneous administration—all developed by the aboriginal peoples of North and South America.1,2 In 1942, Johnston administered nicotine intravenously to himself and 34 volunteers thus altering smoking behaviour in recipients.3 Further development of alternative nicotine delivery took another 30 years with the development of nicotine chewing gum. This was followed by transdermal, nasal, and oral nicotine vapour inhalers. These Alternative Nicotine Delivery Systems (ANDS) were developed to decrease the craving of tobacco withdrawal and improve abstinence