The Clinical Trial...Evidence That Smokeless Tobacco Can Help You Quit

For the past four years we have been laying the scientific foundation establishing that smokeless tobacco is 98% safer than smoking and is thus a viable harm reduction alternative for inveterate smokers. The Centers for Disease Control and Prevention report that two million smokers have used smokeless tobacco to quit on their own, but no formal program has employed this method of smoking cessation. We conducted a pilot study here at UAB to determine if smokeless tobacco could be successfully used to help smokers quit.

Participants in our study attended a lecture about the health effects of all forms of tobacco use and about the use of smokeless tobacco as an aid to quit smoking. We enrolled 63 people in our program, and after the lecture we followed their progress with quarterly telephone interviews. After one year, those people who told us they were not smoking were asked to return to our clinic for a short visit. We confirmed that they were not smoking by asking them to breathe into an instrument that measured the amount of carbon monoxide in their system. Compared with nonsmokers, smokers absorb lots of carbon monoxide from inhaling tobacco smoke.

After one year, 31 percent of men and 19 percent of women had attained smoking cessation with smokeless tobacco, for an overall success rate of 25 percent. An additional seven percent of our participants had reduced their cigarette consumption by at least 50 percent. Nearly everyone in our study had repeatedly failed to quit smoking with nicotine gum or patch. This suggests that these products do not deliver a strong enough nicotine kick for many smokers. In contrast, smokeless tobacco produces peak nicotine levels that are similar to smoking, which may help those smokers who failed to quit using other nicotine substitutes.

One important note: nearly one in five women used smokeless to quit. We believe that this level of acceptability was due to the fact that newer smokeless products can be used invisibly. In other words, the "spitting image" formerly pinned on smokeless tobacco no longer applies.

In summary, there have been few innovations in smoking cessation approaches recently. The bottom line from most programs is that to quit smoking successfully the smoker must abstain from nicotine. Our study shows that quitting smoking does not necessarily mean quitting nicotine entirely.

We encourage other smoking cessation professionals to evaluate our program, and hope that it gets serious consideration by the nation's smokers and their doctors.