Every drug of addiction must have its day. Morphine remains one of the most potent painkillers ever discovered. Cocaine’s chemical cousin lidocaine is still used by physicians and dentists as an effective local anesthetic. Even demon alcohol, when taken in moderation, cuts the risk of heart attacks, osteoporosis, rheumatoid arthritis and a hodgepodge of other ailments.
Now comes nicotine, perhaps the most unlikely wonder drug ever to be reviled.
If dozens of human and animal studies published over the past six years are borne out by large clinical trials, nicotine — freed at last of its noxious host, tobacco, and delivered instead by chewing gum or transdermal patch — may prove to be a weirdly, improbably effective drug for relieving or preventing a variety of neurological disorders, including Parkinson’s disease, mild cognitive impairment (MCI), Tourette’s and schizophrenia. It might even improve attention and focus enough to qualify as a cognitive enhancer. And, oh yeah, it’s long been associated with weight loss, with few known safety risks. (Although, in truth, few safety studies of the increasingly popular e-cigarettes have yet been published.)
Nicotine? Yes, nicotine.
In fact, the one purpose for which nicotine has proven futile is the very same one for which it’s approved by the Food and Drug Administration, sold by pharmacies over the counter, bought by consumers and covered by many state Medicaid programs: quitting smoking. In January 2012, a six-year follow-up study of 787 adults who had recently quit smoking found that those who used nicotine replacement therapy in the form of a patch, gum, inhaler or nasal spray had the same long-term relapse rate as those who did not use the products. Heavy smokers who tried to quit without the benefit of counseling were actually twice as likely to relapse if they used a nicotine replacement product.
And therein lies the conundrum that physicians and regulators will have to wrestle with if the promising studies about nicotine’s benefits hold up: how to endorse a drug linked to one of the greatest public health scourges the world has ever known.