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Medically reviewed by, Russell Braun RPH
Trying to quit smoking? Finally had enough but now you need to understand how to use nicotine replacement?
You are not alone, according to the Centers for Disease Control (CDC) in 2017, 14% of U.S. adults over 18 smoked. Smoking is the leading cause of preventable death in the U.S. accounting for nearly 20% of all deaths!
The good news on cigarettes
The CDC also states that smoking has declined from ~21% of the adult population in 2005 to 14% in 2017. That means other people have been able to quit, and so can you. Remember, more people in the U.S. have quit smoking than currently smoke today.
The body will become dependent on nicotine and the act of smoking itself after being a smoker for even a small amount of time.
There are many reasons people smoke. Stress, busy lives, multiple responsibilities, needing a break are some of the most common reasons given. At first cigarettes can provide relief from these “problems”, but over time the dependance on the nicotine in the cigarettes drive anxiety. This causes patients to think they are having one of these issues when really they are dependent on nicotine.
What are your smoking habits? Do you only smoke with a friend or multiple friends? Do you smoke when drinking? Or maybe you smoke when you have a break from work.
Do your best to try and break these habits up.
Can you walk with that friend instead of smoke? Is it possible to stay away from spots where you smoke if you are drinking, or not drink? Can you find something to do on your break that is away from the smoking area?
Today the majority of businesses, public places and homes in the U.S. do not allow smoking. This makes it easier for you to avoid the temptation to smoke by seeing others who are smoking. Do your best to avoid those places where other smokers are congregated so you can avoid a powerful trigger.
A book called Easy Ways to Stop Smoking is a great resource to help you move from bad habits and into ones that will let you stop smoking.
Nicotine gum facts
Nicotine gum has been around since the late 1970’s and was the first option for smoking cessation. For years gum was only available with a prescription. In 1996 the Food and Drug Administration (FDA) approved nicotine gum available for sale over the counter. Now it can be bought over the counter at most pharmacies and on many online websites.
Today nicotine gum is sold under many different brand names, such as:
- Various store brands
The gum is sugar free and come in several different flavors.
With nicotine gum, the patient controls the dosage based on urges to smoke. This is different than the nicotine patch another common form of nicotine replacement. The gum also acts more quickly in the body than the patch due to the way it enters the bloodstream directly from the mouth.
Nicotine gum Strengths
2mg typically best for 1 pack per day smokers or less
4mg typically best for over 1 pack per day smokers
Here are some general equivalents
1mg nicotine (For almost all brands/types) = 1 cigarette
5mg nicotine = 1 Cigar
1 pipe = 5mg nicotine
It take an average of 7 minutes to smoke 1 cigarette. The gum on the other hand lasts for 30 minutes and in that time you are getting either 2mg or 4mg of nicotine
1 pack of cigarettes has 20 cigarettes, if you were smoking 1 pack per day you were taking 20mg of nicotine. That comes out 10 of the 2mg pieces or 5 of the 4mg pieces per day.
It is very important that you make sure you figure out how much nicotine you were getting while smoking. If you want to be successful with your attempt to quit then getting full nicotine replacement is a must.
Use the gum correctly, don’t waste your money
Since nicotine products can be bought over the counter, most people do not get adequate advice on using the products from their doctor or pharmacist. This results in not getting the proper dose of nicotine from the gum to replace what they were getting from smoking.
I want to make sure that doesn’t happen to you so please follow these instructions.
- Place gum in your mouth and chew slowly, soon you will notice a tingling sensation in your mouth. You will notice this in 5-10 chews.
- Once you notice tingling stop chewing.
- Place or “park” the gum between your cheek and gums usually on the lower jawline on either side of your mouth.
- After roughly one minute, you will notice that the tingling sensation is gone.
- Once the tingling is gone you can start to chew the gum again, the tingling will return in another 5-10 chews.
- When tingling returns park the gum between your cheek and gums on the side of your mouth again.
- You will continue to repeat this process until the gum no longer make a tingling sensation when you chew it.
- This typically take about 30 minutes, at that point you have removed all the nicotine from the gum and you can dispose of it.
What if I forget and just chew this like regular gum?
The nicotine from the gum is released in your mouth. The area where you park the gum between your cheek and gums is a very good place to absorb certain drugs. Nicotine is one of the drugs that is very well absorbed from your mouth. The word absorbed in this case means the drug is able to make it into your bloodstream where it provides the effect you feel from it like you would a cigarette.
If you chew the nicotine and don’t stop to park it you are essentially having the nicotine get washed away into your esophagus and then stomach as you chew since you are making saliva to wash down your food your body thinks you are chewing up. Your mouth doesn’t realize you are chewing gum vs eating food you are trying to digest and creating saliva is step one in digestion that comes along with chewing food.
Nicotine not well absorbed in stomach. The reason is that the acid that is released in your stomach prevents nicotine from being absorbed. This means that if you swallow the nicotine you are essentially wasting your money because it will not be absorbed and not help with your nicotine cravings.
If you notice a strong, unpleasant taste and lots of tingling you are chewing too fast and will waste the gum. This can also cause:
- Nauseous feelings
- Throat irritation
- Small ulcers in the mouth
- Jaw aches
- Headaches or dizziness
Other things to keep in mind
The stomach is not the only place where acidic substance can cause issues with the gum. You should make sure that you space out chewing the gum from other beverages that are acidic. Drinks such as coffee, drinks with lemon juice and soft drinks can cause reduced absorption of the nicotine from your mouth. You should try to space them out by at least 15 minutes from when you plan to chew the gum.
Look at the costs
Comparing nicotine replacement therapy to the cost of smoking makes another strong point for trying to quit. Look at the example below:
Cost of 1 pack of cigarettes in U.S. according to Fairreporters.net in 2017 was $7
If you smoke 1 pack per day that comes out to $49 per week.
To replace 1 pack per day you would need 10 of the 2mg pieces of gum per day. That comes out to 70 pieces. If you using the best deal I found (listed below) 384 pieces cost $59 that comes out to 0.15 cents per piece.
70 pieces per week x 0.15 cents per piece = $10.50 per week.
That saves you $38.50 per week over smoking!
You just got a $2000 per year raise, plus you will eventually use less gum and then stop it completely.
Keep in mind that Medicare does not cover nicotine replacement so you will have to pay out of pocket. Most commercial insurers follow what Medicare does and will not cover this. Below are prices found at various locations for nicotine gum.
Nicorette 2mg, 160 pieces $55
Equate 2mg, 160 pieces $42.26
Also, many employers offer wellness programs that allow you to save on your medical costs overall if you stop smoking. Enroll in that program as another motivator to quit smoking.
You can do it!
How long should nicotine gum be used?
The amount of time it take to become a non-smoker will depend on the person. Many people will have urges and cravings for years after they quit. That being said, it is important you do not try to stop nicotine replacement treatments too soon.
At least 3 months after you have stopped smoking would be the earliest you should try start to wean yourself down off of the gum. Most manufacturers do not recommend going past 12 weeks however, most doctors agree there is no harm in longer term nicotine replacement therapy. Especially if you are doing well and feeling that you no longer need cigarettes.
Typically if you are going to use nicotine replacement therapy for more than 6 months, talking to your doctor or pharmacist about your plans is warranted.
Tips for quitting
Once you taper yourself down to just a few pieces or no gum per day, don’t be afraid to keep some on hand for when you get those thoughts of “just one cigarette will be fine.” Fight the urge and use the gum!
The way you should use the gum should mirror the way you smoked. If you smoked only in the morning, at lunch and after dinner then you should only look to use the gum during those time. If you smoked 1 pack per day and more consistently during the day a good plan for gum usage and tapering is:
First through fourth week, one 2mg piece every 2 waking hours
Fifth through eighth week, one 2mg piece every 4 waking hours
Ninth through twelve week, one 2mg piece every 6-8 waking hours
Don’t be afraid to extend past 12 weeks or have more gum per hour during stressful times or when urges are strong.
Another taper option
If you like to chew the gum because it gives you “something to do” the way smoking did then you can try a different method to taper off the gum.
Chew the same amount of gum per day, but instead of chewing it until the nicotine is gone (typically 30 minutes) try throwing the gum away after 25 minutes.
If you do this for two weeks, then drop to 20 minutes for two weeks you will eventually need less nicotine as you will be getting less from the gum.
Eventually you can remove one piece of gum per day altogether and keep tapering down (SLOWLY) from there.
Other Nicotine products:
There are a few other dosage forms that you may want to look into if gum doesn’t seem right for you.
Combine gum with patches?
Nicotine patches are another form of nicotine replacement. They have been show effective at leveling off cravings as they provide a constant level of nicotine throughout the day from a patch that you place on your skin.
The patches come in 21mg, 14mg and 7mg doses so you can start with about 1 pack per day (21mg dose) and then taper off to 14mg and finally 7mg before stoping completely.
Many people like patches better than gum since they do not have to chew and have that “gross taste” that can result when people don’t use the gum correctly.
The problem with patches is that they are not effective at giving you a boost in your dose when you are having a strong craving. Thus many patients don’t have adequate support at this time and will smoke to satisfy the urge. If you find yourself having this issue, I recommend you try combining the gum with your patch.
Having the gum or the oral inhaler to fall back on when you have a craving gives you a physical touch and feel sensation similar to smoking. You are doing something with your hands to curb your craving and providing your body with a burst of nicotine.
Many patients find this to be highly effective and allows the a way to taper down the patches as directed and still have the gum as a backup. This is also recommended by the U.S. government clinical practice guidelines for smoking cessation.
Some other non nicotine ideas:
- Suck on ice cubes at home or work
- Avoid other smokers, get them to quit with you and do something like walking with them instead of smoking
- Practice deep breathing or meditation, there are many great apps for this on your phone that can be used for a quick diversion
Remember the choice is up to you
Nicotine replacement therapies are a great way to level out the nicotine cravings you have when you stop smoking. However, they will not make quitting smoking easy, but they can make it more bearable if used correctly.
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Share your story!
Have you used Nicotine gum? How well did it work for you? Please chime in below with your comments and thoughts below