- Cigarettes and Other Tobacco Products DrugFacts | National Institute on Drug Abuse
- How do people use tobacco?
- How does tobacco affect the brain?
- What are other health effects of tobacco use?
- How does tobacco use lead to addiction?
- How can people get treatment for nicotine addiction?
- Behavioral Treatments
- Nicotine Replacement Therapies
- Other Medications
- Can a person overdose on nicotine?
- Learn More
- Nicotine Is Why Tobacco Products Are Addictive
- What Is Nicotine?
- What Makes Tobacco Use Harmful?
- What Are Nicotine Replacement Therapies (NRTs) and How Can They Help?
- Where Do E-Cigarettes Fall on the Continuum of Risk?
- Is Nicotine Hazardous Waste?
- Why Can’t My Teen Quit Smoking or Vaping?
- Will Smoking or Using Tobacco Products Containing Nicotine Hurt My Baby?
- Is FDA Lowering the Levels of Nicotine in Cigarettes?
Cigarettes and Other Tobacco Products DrugFacts | National Institute on Drug Abuse
Tobacco leaves drying in a row.
Tobacco is a plant grown for its leaves, which are dried and fermented before being put in tobacco products. Tobacco contains nicotine, an ingredient that can lead to addiction, which is why so many people who use tobacco find it difficult to quit. There are also many other potentially harmful chemicals found in tobacco or created by burning it.
How do people use tobacco?
People can smoke, chew, or sniff tobacco. Smoked tobacco products include cigarettes, cigars, bidis, and kreteks. Some people also smoke loose tobacco in a pipe or hookah (water pipe). Chewed tobacco products include chewing tobacco, snuff, dip, and snus; snuff can also be sniffed.
How does tobacco affect the brain?
The nicotine in any tobacco product readily absorbs into the blood when a person uses it. Upon entering the blood, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline).
Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate. As with drugs such as cocaine and heroin, nicotine activates the brain’s reward circuits and also increases levels of the chemical messenger dopamine, which reinforces rewarding behaviors.
Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.
What are other health effects of tobacco use?
Although nicotine is addictive, most of the severe health effects of tobacco use comes from other chemicals. Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema.
It increases the risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to other cancers, leukemia, cataracts, Type 2 Diabetes, and pneumonia. All of these risks apply to use of any smoked product, including hookah tobacco.
Smokeless tobacco increases the risk of cancer, especially mouth cancers.
Electronic cigarettes, also known as e-cigarettes or e-vaporizers, are battery-operated devices that deliver nicotine with flavorings and other chemicals to the lungs in vapor instead of smoke.
E-cigarette companies often advertise them as safer than traditional cigarettes because they don't burn tobacco. But researchers actually know little about the health risks of using these devices.
Read more about e-cigarettes in our Electronic Cigarettes (e-Cigarettes) DrugFacts.
Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birth weight. Smoking while pregnant may also be associated with learning and behavioral problems in exposed children.
People who stand or sit near others who smoke are exposed to secondhand smoke, either coming from the burning end of the tobacco product or exhaled by the person who is smoking. Secondhand smoke exposure can also lead to lung cancer and heart disease.
It can cause health problems in both adults and children, such as coughing, phlegm, reduced lung function, pneumonia, and bronchitis.
Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, lung infections, and death from sudden infant death syndrome.
How does tobacco use lead to addiction?
The Surgeon General’s Report on Smoking Cessation, released in January 2020, offers evidence that smoking cessation is beneficial at any age, improves health status and enhances quality of life. It also reduces the risk of premature death and can add as much as a decade to life expectancy.
For many who use tobacco, brain changes brought on by continued nicotine exposure result in addiction. When a person tries to quit, he or she may have withdrawal symptoms, including:
- problems paying attention
- trouble sleeping
- increased appetite
- powerful cravings for tobacco
How can people get treatment for nicotine addiction?
Both behavioral treatments and medications can help people quit smoking, but the combination of medication with counseling is more effective than either alone.
The U.S. Department of Health and Human Services has established a national toll-free quitline, 1-800-QUIT-NOW, to serve as an access point for anyone seeking information and help in quitting smoking.
On May 5, 2016, the FDA announced that nationwide tobacco regulations now extend to all tobacco products, including
- e-cigarettes and their liquid solutions
- hookah tobacco
- pipe tobacco
This ruling includes restricting sale of these products to minors. For more information, see the FDA's webpage, The Facts on the FDA's New Tobacco Rule.
In December 2019, the federal government raised the legal minimum age of sale of tobacco products from 18 to 21 years, and in January 2020, the FDA issued a policy on the sale of flavored vaping cartridges.
Behavioral treatments use a variety of methods to help people quit smoking, ranging from self-help materials to counseling. These treatments teach people to recognize high-risk situations and develop strategies to deal with them. For example, people who hang out with others who smoke are more ly to smoke and less ly to quit.
Nicotine Replacement Therapies
Nicotine replacement therapies (NRTs) were the first medications the U.S. Food and Drug Administration (FDA) approved for use in smoking cessation therapy.
Current FDA-approved NRT products include chewing gum, transdermal patch, nasal sprays, inhalers, and lozenges. NRTs deliver a controlled dose of nicotine to relieve withdrawal symptoms while the person tries to quit.
Bupropion (Zyban®) and varenicline (Chantix®) are two FDA-approved non-nicotine medications that have helped people quit smoking. They target nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people start smoking again.
Can a person overdose on nicotine?
Nicotine is poisonous and, though uncommon, overdose is possible. An overdose occurs when the person uses too much of a drug and has a toxic reaction that results in serious, harmful symptoms or death.
Nicotine poisoning usually occurs in young children who accidentally chew on nicotine gum or patches used to quit smoking or swallow e-cigarette liquid. Symptoms include difficulty breathing, vomiting, fainting, headache, weakness, and increased or decreased heart rate.
Anyone concerned that a child or adult might be experiencing a nicotine overdose should seek immediate medical help.
The Food and Drug Administration has alerted the public to hundreds of reports of serious lung illnesses associated with vaping, including several deaths. They are working with the Centers for Disease Control and Prevention (CDC) to investigate the cause of these illnesses.
Many of the suspect products tested by the states or federal health officials have been identified as vaping products containing THC, the main psychotropic ingredient in marijuana. Some of the patients reported a mixture of THC and nicotine; and some reported vaping nicotine alone.
No one substance has been identified in all of the samples tested, and it is unclear if the illnesses are related to one single compound. Until more details are known, FDA officials have warned people not to use any vaping products bought on the street, and they warn against modifying any products purchased in stores.
They are also asking people and health professionals to report any adverse effects. The CDC has posted an information page for consumers.
- Tobacco is a plant grown for its leaves, which are dried and fermented before being put in tobacco products. Tobacco contains nicotine, the ingredient that can lead to addiction.
- People can smoke, chew, or sniff tobacco.
- Nicotine acts in the brain by stimulating the adrenal glands to release the hormone epinephrine (adrenaline) and by increasing levels of the chemical messenger dopamine.
- Tobacco smoking can lead to lung cancer, chronic bronchitis, and emphysema. It increases the risk of heart disease, which can lead to stroke or heart attack. Smoking has also been linked to other cancers, leukemia, cataracts, and pneumonia. Smokeless tobacco increases the risk of cancer, especially mouth cancers.
- Secondhand smoke can lead to lung cancer and heart disease as well as other health effects in adults and children.
- For many who use tobacco, brain changes brought on by continued nicotine exposure result in addiction.
- Both behavioral treatments and medication can help people quit smoking, but the combination of medication with counseling is more effective than either alone.
- Nicotine overdose is possible, though it usually occurs in young children who accidentally chew on nicotine gum or patches or swallow e-cigarette liquid.
- Anyone concerned that a child or adult might be experiencing a nicotine overdose should seek immediate medical help.
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Nicotine Is Why Tobacco Products Are Addictive
Nicotine. Tobacco products are addictive because they contain nicotine. Nicotine keeps people using tobacco products, even when they want to stop.
What Is Nicotine?
Nicotine is a highly addictive chemical compound present in a tobacco plant. All tobacco products contain nicotine, including cigarettes, non-combusted cigarettes (commonly referred to as “heat-not-burn tobacco products” or “heated tobacco products”), cigars, smokeless tobacco (such as dip, snuff, snus, and chewing tobacco), hookah tobacco, and most e-cigarettes.
Using any tobacco product can lead to nicotine addiction. This is because nicotine can change the way the brain works, causing cravings for more of it.
Some tobacco products, cigarettes, are designed to deliver nicotine to the brain within seconds,1 making it easier to become dependent on nicotine and more difficult to quit. While nicotine naturally occurs in the tobacco plant itself, some tobacco products contain additives that may make it easier for your body to absorb more nicotine.2
What Makes Tobacco Use Harmful?
Nicotine is what keeps people using tobacco products. However, it’s the thousands of chemicals contained in tobacco and tobacco smoke that make tobacco use so deadly. Some of these chemicals, known to cause lung damage, are also found in some e-cigarette aerosols.
This toxic mix of chemicals—not nicotine—cause the serious health effects among those who use tobacco products, including fatal lung diseases, chronic obstructive pulmonary disease (COPD) and cancer.3
Tobacco products containing nicotine pose different levels of health risk to adult users. Combustible products, or products that burn tobacco, are the most harmful. An example of a combustible product is cigarettes, which deliver more than 7,000 chemicals1 along with nicotine that makes it hard to quit.
FDA-approved nicotine replacement therapies (NRTs), such as gums and lozenges, are the least harmful. Noncombustible products, such as heat-not-burn tobacco products, smokeless tobacco, and e-cigarettes, fall somewhere in between combustible products and NRTs.
If you’re an adult and don’t use tobacco products, we strongly encourage you to stay tobacco-free. If you’re an adult who currently uses tobacco products, there are resources to help you quit.
To learn about the additional harms tobacco can have on young people and their developing brains, read “Why Can’t My Teen Quit Smoking or Vaping?”
What Are Nicotine Replacement Therapies (NRTs) and How Can They Help?
FDA-approved nicotine replacement therapies, also known as NRTs, are products that contain nicotine and are designed to help adults quit smoking by delivering small amounts of nicotine to the brain without the toxic chemicals found in cigarette smoke.
NRTs such as nicotine skin patches, gum, and lozenges can help you through the early part of quitting by relieving cravings and lessening nicotine withdrawal symptoms. When used properly, NRTs are a safe and effective way to help quit smoking and can double the chances of successfully quitting cigarettes.4
While there are no FDA-approved NRTs for youth use, talk to your health care provider about treatment options for youth.
Where Do E-Cigarettes Fall on the Continuum of Risk?
FDA is committed to protecting the public health of all Americans while regulating an addictive product that carries health risks.
We’re conducting ongoing research on potentially less harmful forms of nicotine delivery for adults, such as electronic nicotine delivery systems (ENDS), or e-cigarettes.
Though more research on both individual and population health effects is needed, many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes.
A 2020 Cochrane Library review of ENDS for smoking cessation found:
- ENDS may help more people to stop smoking for six months or longer than using NRTs or nicotine free e-cigarettes.
- ENDS may increase quit rates compared to no support, or behavioral support alone.
- The overall incidence of serious adverse effects related to ENDS is low.5
While these findings back up anecdotal reports, there is not yet enough evidence to support claims that e-cigarettes and other ENDS are effective tools for quitting smoking. The effects are particularly unclear when it comes to newer types of e-cigarettes that have better nicotine delivery, and the effect of ENDS when combined with an NRT.
To date, no e-cigarette has been approved as a cessation device or authorized to make a modified risk claim, and more research is needed to understand the potential risks and benefits these products may offer adults who use tobacco products.
Is Nicotine Hazardous Waste?
Yes. Nicotine, including nicotine salt, is listed by the Environmental Protection Agency (EPA) as an acute hazardous waste.6 E-cigarettes and e-liquid waste should be disposed of safely and properly.
Why Can’t My Teen Quit Smoking or Vaping?
Because their brains are still developing, young people have a higher risk of becoming addicted to the nicotine in tobacco products than adults.
Many teens don’t understand how easy it is to become addicted to tobacco products. The younger a person is when they start using tobacco, the more ly they are to become addicted.7
Nicotine exposure during adolescence can disrupt normal brain development and may have long-lasting effects, such as increased impulsivity and mood disorders, such as depression and bipolar disorder.7
Because of nicotine’s powerfully addictive nature and major effects on the developing brain, no tobacco products are safe for youth to use.
If you’re trying to teach your children or students about the dangers of tobacco use, there are tobacco education resources for parents and teachers that can help.
Will Smoking or Using Tobacco Products Containing Nicotine Hurt My Baby?
Nicotine can cross the placenta when a pregnant person uses tobacco products. This can negatively impact the baby, including, but not limited to: premature labor; low birth weight; respiratory failure at birth; and even sudden infant death syndrome (SIDS).3, 8, 9, 10
People who use tobacco products can experience negative health effects on their reproductive health, their pregnancies, and their babies. If you use tobacco products and are considering having a child, consult your doctor and learn more about how you can quit smoking.
Is FDA Lowering the Levels of Nicotine in Cigarettes?
Lowering nicotine in cigarettes to a minimally or non-addictive level through the creation of a potential nicotine product standard could decrease the chances that future generations become addicted to cigarettes, and could make it easier for more currently addicted smokers to quit.
On March 15, 2018, FDA issued an advance notice of proposed rulemaking (ANPRM) seeking public comment on issues and questions related to such a potential nicotine product standard. FDA is constantly gathering new evidence and considering evolving data regarding tobacco products and use, and continues to review all submitted comments in response to the ANPRM.