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Nicotine as Miracle Drug
Dr. Anna Fels recently saw a patient who had an interesting method of self-medication. The psychiatrist wrote up the experience in the New York Times:
We talked for a long time about why she had come to see me. Then, as is my practice with a new patient, I asked what, if any, psychiatric medications and nonprescription, psychoactive substances — legal or illegal — she had used. Her answer was a new one for me. She stated that she chewed approximately 40 pieces of nicotine gum per day and had done so for well over a decade.
Responses to this question are often illuminating and can be rather humbling. Although doctors are trained to focus on prescription medications, there are and have always been nonprescription “remedies” for psychiatric conditions. And people’s preferences for one type of substance over another can give a glimpse into their symptoms and even their brain chemistry.
If a patient tells me he falls asleep on cocaine, I wonder if he might have attention deficit disorder. A patient who smokes marijuana to calm down before important business meetings leads me in the direction of social phobia or other anxiety disorders. I often wonder if people who take ketamine recreationally might be depressed, since this anesthetic has been shown to have antidepressant effects and is, in fact, being investigated for potential therapeutic use.
But tobacco is terrible, right? We’re all aware of the lung cancer risks of smoking and the various mouth cancers that strike people dipping Copenhagen. These dangers are real, but what causes cancer is not the nicotine but the tar and various chemicals found in the tobacco.
Nicotine is tobacco’s addictive component, which is why so many smokers wean themselves off those smelly old coffin nails with a nicotine patch, gum, or e-cigarettes. This gives them their fix without the serious cancer risks that come from tar.
Sorting through patients’ uses of psychoactive substances, from cocaine to alcohol to coffee, leaves me with an appreciation of the wildly different neurochemistry of people’s brains. One person will drink alcohol and feel euphoric, witty and extroverted, and the next will be logy and nauseated. In one patient, marijuana sharpened his focus and made it possible to pay attention in class, hugely improving his grades. Another felt paranoid and a third used it as a sleep aid. And presumably these substances all hit the same brain receptors in each of them.
My new patient explained that in her sophomore year at college she had started smoking. The effect, she said, was like “a key that fit perfectly into a lock.” Her brain felt clearer, her thoughts were more coherent, her mood and energy improved. Not wanting to damage her lungs, she soon switched over to nicotine gum and had been taking the same amount of it for well over a decade — a pattern of stable “dosing” that I discovered is typical in long-term nicotine users.
…But as I thought about our conversation later, I found her image of a key in a lock particularly striking; it was the very same one that psychiatrists and neurophysiologists use to describe the interactions in the brain between neurotransmitters and their receptors. And in fact, neurons do have receptors into which nicotine neatly fits, mimicking the actions of the brain’s own molecules.
Dr. Fels looked up some research and found that isolated nicotine does create positive effects in some people. It can improve brain functions, memory, and mood, and perhaps even decreases the potential for Parkinson’s disease. Eager to test these findings, she tried nicotine gum herself, but it only made her shaky and nervous. For her, the key didn’t fit the lock.
As you can see from my profile picture, my drug of choice is caffeine. If I don’t have a jolt of coffee first thing in the AM, I’m dragging through meetings, I think at half speed, and I’m distracted by nearly everything. By mid-afternoon, I get an all-over headache which is my brain’s way of reminding me to stop what I’m doing and guzzle a cup or three of joe. On the other hand, a Coke or cup of tea seems to tire me out, even though both have caffeine.
I’ve met people who use marijuana to enhance their creativity or just take the edge off (lots of comedians and musicians fit this profile), others who need a stiff drink at the end of the day to calm themselves, and others who can’t function without a constant supply of black tar heroin (your secret is safe with me, Peter Robinson).
I’m curious: Do you have a minor (hopefully legal) drug of choice that helps you function better?
Published in General
Didn’t we all.
I’ve never tried the nicotine thing. Caffeine has been the stimulant of choice. I got way too far into that one Seattle winter when I was working a long hour, high stress gig. After that I switched to decaf, and now the occasional shot of the good stuff does its thing.
Individual variance in drug response is definitely real. My wife and I have very different reaction to opiates. I’m fairly insensitive, need twice the normal dose of morphine to get a result (found that out the hard way) and it puts me to sleep before getting any other effects. My wife, OTOH, gets hallucinations and nausea from any of the straight opiates – can only tolerate a couple of the codeine analogs (found that out the hard way too). I don’t think either of us are in danger of addiction.
I need 2 things every single day. Coffee and a shot of that brunette I married 23 years ago. But I gotta get that first. Mrs. EJH can’t stand the smell or taste of the java.
Done!
I spent my elementary school years slightly wired on theophylline, a drug similar to caffeine, to keep my airways open. Before inhaled steroids came along, it was the go-to treatment for asthma severe enough to need daily treatment, but not severe enough to require systemic steroids. It’s possible I was never quite the same once inhaled steroids came along and the theophylline stopped.
I’m looking forward to vaping becoming more popular, because even trace amounts of ordinary cigarette smoke can precipitate an asthma attack for me, a problem that has gotten worse over time. At one point, I used to carry nicotine gum with me to dress rehearsals and concerts, on offer to anyone who found it an acceptable substitute for a cig – it’s cruel to deprive the habituated of nicotine entirely when they’re asked to perform. Once out of curiosity, I tried a piece of the gum. It just left me nauseated.
Now, I’m more likely to just ask the doc for a short scrip of Prednisone for concerts.
If I could take just one drug to feel good, and damn the consequences, it would be Prednisone, a systemic anti-inflammatory steroid. It also tweaks the HPA axis. For me, it’s the difference between being used to feeling slightly sick most of the time, and finally feeling healthy. But I can’t damn the consequences, so I don’t.
Times when I’m prescribed Prednisone, my lungs are clear, allergies gone, migraines gone, body pain gone, brain unfogged… It’s wonderful. But only temporary, and the inevitable withdrawal is a… witch.
MFR
I also love the prednisone that I sometimes have to take for my asthma! The ankle with a plate, the old lady knee–all that just disappears. Unfortunately, so does my ability to sleep and I can’t stop talking. So not worth the “high” but it does feel good!
You guys are such amateurs. I’ve never smoked a day in my life and I could gain twelve pounds in a week without trying. Just start serving up Tex Mex and Blue Bell ice cream…
Reading through this thread has be revelatory. I never imagined everyone was so much affected by drugs on a regular basis. Perhaps that’s because drugs seem to have so little effect on me (alcohol, cycling, and Ricochet excepted). Caffeine make zero discernible difference on my mood, heart rate, or attention. I’ve tried Red Bull – nothing. Aspirin, acetaminophin, and ibuprofen never relieve my headaches or other pains. On the few occasions I’ve gotten prescription pain medication they didn’t seem to help much.
In answer to the question in the OP, only Ricochet makes me feel better. Alcohol gets me buzzed but I don’t like the sensation; I drink it for the taste. I seem to be addicted to cycling but it doesn’t give me a high. So it’s just Ricochet: addictive and satisfying.
Nicotine is back to being my legal drug of choice, after a hiatus of about 20 years. Like Annefy, I was once a smoker. I started vaping in mid-2015.
Unfortunately, it doesn’t yet seem to have helped with my weight, at least not in the sense of weight loss. It is possible that my nicotine has stopped a previously inexorable increase. :)
The only time I’ve tried nicotine was the summer I turned 10. My dad thought it would be funny to offer me some chewing tobacco (probably Red Man or Beechnut). It made me dizzy and nauseous. He did find it hilarious, as I recall.
If I need to take a long drive I’ll have a caffeinated soda on the theory that it should help me stay awake, but if it actually has an effect on alertness it’s so subtle that I can’t say if it’s effective or not. If I have too much caffeine it can give me a twitch in my left lower eyelid.
:-)
I don’t get that wired from it, and fortunately sleep fine. I get more stuff done on Prednisone, and feel more energetic, but not tweaky. For me, it pretty much feels like having a really good, but otherwise normal, day.
Me too. I will get really sleepy at some points in the day, but after just 15-25 minutes lying on my back in corpse pose and then falling asleep, I’m completely clear headed.
I’ve also noticed a big improvement in my mood in the years since I’ve given up sugar. Even eating something like white bread can make me feel sleepy at odd times.
Excessive caffeine gives me an eyelid-twitch. Not helpful in tense negotiations.
Is the science in on vaping? I’d be enthusiastically supportive of those who want/need their fix doing that—I can’t stand the smell of cigarettes, and the second hand smoke thing is a problem both gum and vaping solve. Annefy—or any other smokers here— does vaping work just as well? Do you still tend to long for a real cigarette for other reasons (e.g. the taste, the smell, or what David Sideris calls “the little campfire” you get to kindle?)
My father smoked, in part (I think) to control symptoms of combat-related PTSD, and died at 68 of heart disease, to which smoking no doubt contributed…though so did the PTSD.
Plenty of mental illness in my family, so most of my nearest and dearest have taken or continue to take medication of one kind or another— and these are addictive at least in the sense that, without them, the symptoms of depression/anxiety/bipolar make an unpleasant reappearance.
Nicotine and alcohol probably kept a whole lot of people with mental illnesses more or less glued together—I hadn’t really thought of cigarettes as something to be grateful for, but it probably improved life for Europeans once it appeared on the scene? That would be a fun little historical research project!
Is there any research on using nicotine clinically? Do doctors ever suggest to patients with relatively mild anxiety “hey, you know, you could take up vaping?”
This brought Chief Inspector Dreyfus to mind…
Nicotine and caffeine are stimulants. Back in the days of Mr. C’s early career in nuclear effects testing (yes, big KABOOMs were involved), he, and virtually every last one of his colleagues, sat in an office (pre-cubicles) smoking cigarettes and drinking coffee while designing experiments and analyzing data. We’re both convinced it was a more productive time for him personally, and in America generally.
I have my doubts as to whether prescribing nicotine will ever become acceptable to the medical establishment. The anti-smoking sentiment (anti-vaping, too, although it seems utterly irrational) is such that, as Dennis Prager often points out, parents would rather their kids cheat on tests than smoke cigarettes.
Nicotine is to “health” as carbon dioxide is to “climate science.” People have settled on the matter, despite all evidence to the contrary.
I was at the newsroom of the LA Times one Saturday night with a then-employee. It was clean and neat. I told my friend it was nothing like what I imagined.
He mentioned that newspapers started their decline the day the newsroom became smoke free.
KatieB: DocJay some months back had a post about some of the horrible side effects of long term anti-depressant/anxiety meds. If I have time later I’ll look for it. Like me I am sure you find that people think any thing that is “prescribed” is problem free.
I keep hearing horrible things about vaping – everything from exploding batteries to “popcorn” lung. The second I believe is caused by some of the flavorings in the juice.
And no, I don’t miss cigarettes at all. And I am someone who, while never a heavy smoker (about a pack or two/week) loved smoking. When my doc used to hassle me about it I would tell him to save his breath. My kids were all alive and I was somehow managing to run marathons, so I wasn’t going to worry about it.
I prefer vaping to cigarettes by far, and not just because I can do it anywhere, although that’s definitely a plus. Although my entire family is tired of having to look for it. You never misplace a burning cigarette but it’s easy to put your vaper down somewhere and have to put everyone on red alert to look for it.
On a personal note, God made humans. We are not perfect. I’m all for availing yourself of anything that doesn’t effect your personality or relationships but helps you be more productive and happy. Nicotine is my drug of choice.
I know two guys that tried kicking cigarettes by using e-cigarettes but went back to the real thing. They both said the e-cigs had an insufficient “kick.” One guy I know smoked pipe for decades and tried quitting many times. His doctor prescribed nicotine gum and that did the trick.
As one of the few people whose physiology would force her to prefer living under the same roof as a cheater to living under the same roof as a smoker, the day when nicotine itself is simply accepted, and the priority becomes making non-nuisance-causing forms of delivery as cheaply and widely available as possible, cannot come soon enough!
Yeah, that’s correct. Less efficient delivery mechanism.
Hmm…
So, maybe “hypo sprays”, or needles without needles, are becoming a reality. Perhaps someday nicotine users will be able to get their “kicks” that way.
My problem with vapers are the ones who are ostentatious about it. Big colorful garish vaping devices and an exuberant exhalation of pseudo-smoke. Hey, pal, keep it to yourself. Social protocol demands that you keep your emanations (oral, anal, nasal, olfactory, mammary) to yourself as much as possible. Militant vapers annoy me just like militant public breast feeders. If you gotta do it, do it. But keep it tight. Don’t make show of it and expect me to celebrate it with you. If you had a hard session at the gym and you have a little BO, I get that. But don’t jam your hand up high in the air like Horshack and waft your pitstink at me
Negotiation? Might be beneficial. Makes you look a little crazy. Can you add a big ol’ gonna-kill-you-infidel beard?
I love me some caffeine. But I am getting too tolerant to it and it’s losing it’s kick. I get mine in pill or potion form. I mix up a 1.5x or 2x dose of pre-workout mix which is a stiff dose of caffeine and other workout enhancers. One time I spilled my potion and I freaked out like a junkie who just lost their fix. Otherwise, I pop a few fat burner pills to get my dose. I am not a coffee drinker.
Agree wholeheartedly. A guy I was talking to at a vape shop (a bunch of people I find to be universally nice) had a comment. He said it’s the people who never smoked cigarettes, and therefore knew and understood smoking etiquette, that are the most obnoxious about vaping.
BTW, I tried e-cigarettes when they first came out. Found them to be good in a pinch (like a road trip) but not a long term solution. The new vapes are much, much better.
Mine is very small and discreet, I can hide it in my hand. Which also makes it harder to find …
We made it into orbit and on, to the moon, in record time, driven by engineers who constantly smoked at their desks while working.
We have not returned since and space programs now take decades to progress.
Coincidence? I think not!
Agreed. I’m repulsed by cigarette smoke, but not as sensitive as those in my family who are sickened for weeks following one quick exposure. Smoke-free nicotine sources are better for everyone.
Koblog
We made it into orbit and on, to the moon, in record time, driven by engineers who constantly smoked at their desks while working.
We have not returned since and space programs now take decades to progress.
Coincidence? I think not!
Annefy;
One of my favorite movie scenes ever was in Apollo 13 when the clock was ticking and the engineers were trying to rig a filter of some sort.
Can you imagine now? Here’s a tube sock, some plastic and some duct tape. Figure out how to use it to save 3 lives. You’ve got an hour. And if you need to smoke, go down 3 stories and make sure you’re 80 feet from the building.