Amid vaping ban, a quiet club of nicotine addicts may add members

Nicotine gum and lozenges were not designed to be used long term. They are supposed to be smoking cessation aids. Then again, so are e-cigarettes.
Nicotine gum and lozenges were not designed to be used long term. They are supposed to be smoking cessation aids. Then again, so are e-cigarettes. Blindfire/Adobe Stock/Adobe Stock

She’s a fortysomething woman from an affluent suburb, and she does not want to be named in the newspaper talking about this because “it’s embarrassing.”

Plus, one of the best parts of her long-term addiction — other than the fact that it is safer than the addictions it replaces — is that it can happen in stealth.

“I’ve been dating a guy for three years and even he doesn’t know,” she said.

The only way her secret ever comes out is if someone notices her chewing gum and asks for a piece. Then she has to confess.

It’s not just gum. It’s nicotine gum.


Nicotine addiction is a huge topic in the news at the moment, as an explosion of vaping-related illnesses and a state ban on all vaping products have raised fears that people will seek to get their nic fix from tobacco.

That concern has public health officials shining a bright, positive light on the quietest club of nicotine users, the secret chewers who get their fix from so-called nicotine replacement therapies.

Without the clouds left behind by vaping or smoking, it is a club that has long been hidden in plain sight. But it is anything but small. Nicotine replacement therapies are a multibillion-dollar industry of gum and lozenges and patches and inhalers that are often known by the brand name Nicorette.

And after decades on the market — nicotine gum was approved by the Food and Drug Administration in 1984 — nicotine replacement therapies are thought to be more or less harmless.

“They’re good. They work. They’re safe,” said Dr. Nancy Rigotti, director of the Massachusetts General Hospital Tobacco Research and Treatment Center. “It isn’t the nicotine that kills you, it’s the delivery system. There’s a famous quote that says ‘People smoke for the nicotine but die from the tar.’ Based on the evidence we have, nicotine by itself is not thought to be harmful. It doesn’t seem to be associated with increased cardiovascular disease, cancer, and chronic lung disease.”


Which is why the state is engaged in a concerted effort to steer vapors toward nicotine replacement therapies. The Department of Public Health is offering people a free eight-week supply of gum, patches, and lozenges — double what it had been offering — if they agree to accept cessation coaching. The state has also implemented a standing order making nicotine replacement therapies a covered benefit through insurance, without requiring an individual prescription.

This push comes at a unique time in the history of nicotine, as youth smoking rates are at a record low and most young nicotine users have come to their addictions not through tobacco but through so-called “e-cigarette” products like Juul.

But the health concerns with vaping are much like the concerns with tobacco: It’s not the nicotine itself that has doctors worried, it’s the delivery method.

Of course, nicotine gum and lozenges were not designed to be used long term. They are supposed to be smoking cessation aids.

Then again, so are e-cigarettes.

But for many, each has become a nicotine lifestyle, one they’re not interested in quitting. Many users of nicotine replacement therapies stay on them for years or decades.

So as experts try to determine the root cause of the vaping-related illnesses, public health workers are holding up users of nicotine gum and lozenges — even those who use them for much longer than intended — as symbols of a better way.


“They should not feel bad about it,” Rigotti said. “They’re not failures. They’re successes.”

It’s a strange position for the secret gum-chewers and silent lozenge-suckers, as many have kept their habit to themselves because it has always come with a secondhand association with smoking.

“When someone asks you for a piece of gum and you have to shamefully admit that it’s nicotine gum, it comes with a look,” said Matt O’Malley, a Boston city councilor who says he was addicted to nicotine gum for eight years, more than twice as long as he actually smoked. “It wasn’t quite a look of disgust, but there was some silent judgment.”

O’Malley eventually quit the gum, listing two oft-cited drawbacks: cost, and his dentist’s concerns about the effect of all that chewing on his jaw.

“But I’m not complaining, because it worked. I did not smoke during that time, and that slight tinge of shame when I’d have to admit I was chewing a smoking cessation tool was less than the heavy shame of smoking.”

Billy Baker can be reached at billybaker@globe.com. Follow him on Twitter @billy_baker.