Treatment Recommendations for Smokeless Tobacco

Treatment for smokeless tobacco (ST) dependence differs from the treatment of tobacco dependence for smoking. In general, there are three reasons why treatments that work for cigarette use do not always work for smokeless tobacco use:

  • First, a normal dip or chew contains from 3.6 to 4.5 mg. of nicotine. A cigarette contains 1.8 mg. of nicotine.
  • Second, when an individual takes a drag from a cigarette, it takes approximately seven seconds for the nicotine to reach the lungs and for dopamine to be released. This provides a quick satisfaction to their craving. With ST, once a dip or chew is placed into the mouth, it takes up to 30 minutes to receive the same satisfaction.
  • And third, when a cigarette is extinguished, the individual is no longer receiving nicotine. However, with ST, nicotine continues to be absorbed for up to 60 minutes after the tobacco is removed.

Behavioral treatment and nicotine replacement therapy in combination is found to be the most effective way of treating smokeless tobacco dependence.

BEHAVIORAL THERAPY:

As with cigarette smokers, it is important to encourage behavioral counseling in addition to pharmacologic therapy. This typically includes identifying use triggers and modifying behaviors that increase the risk for relapse.


Smokeless Tobacco Treatment Medications Recommendation

  • NICOTINE PATCH

  • NICOTINE LOZENGE AS MONOTHERAPY

  • NICOTINE GUM AS MONOTHERAPY

  • COMBINATION NRT THERAPY

  • SNUFF SUBSTITUTES (AKA, HERBAL CHEW)

  • BUPROPION SR AND VARENICLINE

References:

Benowitz NL. Pharmacology of Smokeless Tobacco Use: Nicotine Addiction and Nicotine-Related Health Consequences. In: Smokeless Tobacco or Health: An International Perspective. Smoking and Tobacco Control Monograph No.2. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 93-3461, 1992b:219-228. Accessed at: http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_4.pdf on September 29, 2009.

National Institute of Dental and Craniofacial Research. Spit Tobacco: A Guide For Quitting. September 2006. Accessed at: www.nidcr.nih.gov/NR/rdonlyres/DF314871-B0A6-4171-B831-C472F543C154/0/SpitTobacco.pdf on September 29, 2009.

Hatsukami KD, Gust SW, Keenan RM. Physiologic and subjective changes from smokeless tobacco withdrawal. Clin Pharmacol and Ther. 1987;41:103–107.

Ebbert JO, Dale LC, Patten CA, et al. Effect of high-dose nicotine patch therapy on tobacco withdrawal symptoms among smokeless tobacco users. Nicotine Tob Res. 2007;9:43–52.

Ebbert J, Montori V, Vickers K, et al. Interventions for smokeless tobacco use cessation.

Dale LC, Ebbert JO, Glover ED, et al. Bupropion SR for the treatment of smokeless tobacco use. Drug Alcohol Depend. 2007;90:56–63.

American Cancer Society. Cancer Facts & Figures 2010. Atlanta, Ga. 2010.

Severson HH. Enough Snuff: A Guide for Quitting on Your Own. 6th ed. Eugene, Oregon: Applied Behavior Science Press. 2002.

Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ. et al, for the Guideline Panel. Treating Tobacco Use and Dependence: 2008 Update. In National Library of Medicine (NLM). Treating Tobacco Use and Dependence: 2008 Update. Accessed at www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.section.28165 on September 29, 2009.

American Cancer Society - The STOP Guide: Smokeless Tobacco Cessation Accessed at: www.cancer.org/cancercauses/tobaccocancer/SmokelessTobaccoandHowtoQuit/smokeless-tobacco-ref

http://www.ctri.wisc.edu/HC.Providers/spit/Spit_tobacco_treatment.pdf
Treating Spit Tobacco (ST) Dependence: What You Need to Know as a Primary Care Provider
Jon O. Ebbert, MD, MSc
Assistant Professor of Medicine Lowell C. Dale, MD
Associate Professor of Medicine
Mayo Clinic College of Medicine