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Editorial: Nicotine's Nice Side

By Abigail Trafford
Tuesday, April 22, 1997; Page Z06

Now that the tobacco industry has blinked, agreeing that cigarettes are a health hazard and discussing a $250 billion fund to pay for smoking-related illness, perhaps it's time to think about the unthinkable:

Suppose nicotine were good for you?

Behind the headlines is growing evidence that nicotine, the substance that makes tobacco addictive, may have some therapeutic effects. It's conceivable that future physicians might well prescribe nicotine -- as a drug, not a cigarette -- to relieve symptoms for a variety of diseases from schizophrenia and Alzheimer's to attention deficit disorder and colitis.

Say what?

With anti-smoking activists dancing on tobacco's grave, to say anything nice about nicotine is tantamount to public health heresy. Certainly, scientists who study the medicinal properties of nicotine are quick to point out that smoking is hazardous to health. They're even hesitant to talk about potential benefits of nicotine. "Please put in the first paragraph -- in no way am I encouraging anyone to smoke. The risks outweigh any benefits," says Edward D. Levin of the Neurobehavioral Research Laboratory at Duke University Medical Center.

Smoking is risky for many reasons. Just about everything in a cigarette is unhealthful. Much of the cancer risk comes from the stew of compounds that make up the tar in cigarettes. Nicotine also has harmful effects, especially on the heart; in pregnant smokers, it can damage brain development in the fetus. In addition, inhaling smoke increases the "hit" of nicotine and other tobacco compounds on the brain and the rest of the body.

But nicotine by itself in carefully controlled doses -- in a skin patch, for example, or synthesized as a drug -- may provide some benefits without causing the harmful effects of smoking nicotine in a cigarette. The goal is to design a therapeutic agent based on nicotine without adverse health consequences.

Doctors know, for example, that nicotine has a positive effect on ulcerative colitis, an inflammation of the stomach lining. For years, they have observed that this digestive disorder affects nonsmokers more than smokers. In several recent studies, the nicotine patch greatly relieved daily symptoms of the disorder.

More intriguing are nicotine's effects on memory, mood and mental alertness. Nicotine affects pathways in the brain that are involved with depression, anxiety, learning and appetite control. In rat studies, nicotine is found to reduce stress and relieve mental confusion -- making it a hot compound for scientists studying the treatment of neurological and behavioral disorders.

Several studies are underway to test nicotine-like drugs and skin patches in patients with Alzheimer's disease. In one small study, patients given injections of nicotine showed significant improvement on dexterity and attention tests. In another small study, nicotine led to positive changes in behavior and learning. In still another, a nicotine-like drug has been linked to significant improvements in memory. At this point, "therapeutic effects are purely investigational," says Levin, but the prospect of a drug that might improve symptoms of this devastating disorder has generated renewed interest in research on this tobacco compound.

Nicotine is found to affect other "cognitive" disorders. In a recent study, nicotine skin patches reduced symptoms in adults with attention-deficit/hyperactivity disorder. Nicotine patches have also helped patients with schizophrenia not only to deal with the overstimulation of the brain caused by the disease but to counteract the disabling side effects of standard psychiatric drugs. It seems that nicotine can help focus attention and improve concentration and memory.

Nicotine's effects on mind and mood lead scientists to believe that a certain minority of smokers are self-medicating when they smoke cigarettes. For example, nearly 90 percent of schizophrenics and 40 percent of adults with ADHD are smokers compared with about 25 percent of the general population.

Smoking is obviously a hazardous way to take a drug. But understanding how nicotine produces positive effects in the brain may lead to better medicines for these conditions. "We might be able to have a whole new family of drugs," Levin says. "I don't want to oversell nicotine as a cure-all. Further research is called for."

Scientists make the analogy with morphine. On the street, morphine is available in the form of the illegal addictive drug heroin. In the hospital, morphine is prescribed as a narcotic painkiller. Perhaps the same will be true of nicotine. While on the street, nicotine would continue to be "abused" in cigarette form, in hospitals and doctors' offices, a nicotine-like drug might be used to treat a range of disorders. As Jed E. Rose, director of Duke University's Nicotine Research Laboratory, says, "The separation between addiction and medication is so hard to disentangle."

Imagine a new Joe Camel ad: If you have symptoms of attention deficit disorder, see your doctor. You may be eligible for nicotine drug therapy. Meanwhile don't smoke -- cigarettes can kill you.

© Copyright 1997 The Washington Post Company

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