Panther Profiles is a Q& A feature that highlights Panthers of all stripes -- students, faculty, staff, alum, board members or anyone else in the campus community.
Dr. Wallace Pickworth ’69 is a member of the ACPHS Board of Trustees. He is a pharmacologist with extensive preclinical and clinical experience. He worked for the National Institute of Drug Abuse, part of the National Institutes of Health, for nearly 30 years, starting in a post-doctoral position and progressing to tenured staff scientist. For the past 10 years, Dr. Pickworth has directed clinical research on tobacco and nicotine for Batelle. He has also worked as a pharmacist, continuing to hold licenses to practice in two states, and serves as an adjunct faculty member at two colleges of pharmacy.
After earning his Ph.D. in pharmacology in 1974, Dr. Pickworth’s early work at NIDA involved hallucinogens, opiates and stimulants. He began studying nicotine around 1980, when the understanding began to emerge that the drug was not only hazardous to health but actually an addictive substance.
In this Q&A, Dr. Pickworth shared some of his knowledge about nicotine, in advance of this Thursday's Great American Smokeout, an annual American Cancer Society event that encourages smokers to quit.
You’ve been involved in nicotine research since it was first considered an addictive substance. What were those days like?
I was in a lab with Jack Henningfield, who was really one of the leaders in tobacco research – he and John Slade and Neil Benowitz and some other people. They were the ones that really led the charge to promote the idea that nicotine had addictive properties: You saw tolerance. You saw rapidly escalating doses. You saw the evidence of withdrawal. You saw people using it despite clear reasons for quitting – they could not quit. These are all characteristics of any drug of addiction. Until then, it was just generally accepted that smoking was a bad habit, you could stop any time. When you look at it closely you find that, in fact, it is very addictive.
It took a lot of persuasion and a lot of research before 1988, when the Surgeon General's report was published that said nicotine is addictive. The importance of that date was that it was said by the Surgeon General, a person of authority. That really began the road to regulation of tobacco and nicotine.
It wasn't until 2009 that the Family Smoking Prevention and Tobacco Control Act passed and the President signed it. That established the current regulatory authority of the FDA in tobacco sales and advertising.
All my life I have heard about the negative effects of tobacco and nicotine, so it's surprising to learn how long it took for these things to occur.
Even though it's a harmful substance, it is a legal one, and there's a lot of money in it – tobacco lobbies and so forth have a great deal of pull.
I know that’s true. There's lobbying. There's advertising. Newer nicotine products have been marketed with flavors. But is it surprising at all that nicotine remains in use as much as it is, given how long we've known that it's bad for us?
Yes and no. You would think it would be more under control by now. But on the other hand, it is powerfully addictive. The detrimental effects of smoking are not realized for 20 or 30 years after people begin to smoke, so it's not like an immediate relationship between when you're smoking and you get cancer, COPD [chronic obstructive pulmonary disease] or heart disease.
And we are seeing changes, to be fair. That's the one thing I have hope about – there is a general trend away from combustible nicotine. Cigarette smoking, at least in the United States, has decreased. Almost 45 percent of adults were smokers in the mid ‘60s. And now it's certainly less than 15 percent. So that's a major decrease.
We are also seeing other products which are probably less harmful come to the fore. So people may continue their addiction, but they may do so using products that are less likely to cause harm overall.
Do you view vaping and e-cigarettes as a generally positive trend?
Generally positive – anything that gets people away from smoking cigarettes.
In Europe, there is a quite a bit of evidence that these products are being used to help people stop smoking – as smoking cessation devices. They're promoted as that by their manufacturers here in the United States, but the data do not really support that’s how they’re being used. Most people here use these in addition to cigarettes, or they use them and then begin using cigarettes later on. And it's kind of the Wild West in this area, so we can't tell for sure.
It's a new attraction for young people. More people use vaping products than they do cigarettes now. That change occurred about four or five years ago. There's a number of these small modular units that are very attractive to children and easy to conceal. And they're available in flavors – although there have been bans on the flavors.
They were a major game changer. When they wrote the Tobacco Control Act, the FDAcontrolled tobacco. So a lot of the newer products are nicotine delivery products. At the beginning there was even a question whether FDA had the authority (to regulate these products). Now, there is what they call “deeming rules,” where the FDA is deemed to have authority. But that is subject to challenge still, in the courts. At one point, the FDA assumed the authority because all the nicotine in these products came from tobacco. But now, there are products getting out on the market are totally synthetic, they not from tobacco. So then that begs the question, does FDA have the authority for that? Each one of these things is a legal challenge.
To be fair, it's largely tobacco-derived nicotine still. The cheapest way you get nicotine is by extracting it. But there are ways to get nicotine by totally synthetic means. It's expensive, and I don't know how much of a marked influence it's going to have. But there are products on the market right now which advertise synthetic nicotine. A lot of them are in the oral tobacco products called nicotine pouches – there’s a whole line of those that are either synthetic or tobacco-derived, but no tobacco in them. There's maybe four or five out there right now that claim to be synthetic.
How you get the nicotine matters for your health, right? If you're not smoking it, it’s probably better. There are health effects, but it’s not …
… it doesn't cause cancer.
Nicotine is the very addictive ingredient, but it's not the cancer-causing agent. That’s what you're saying.
Right. The tar and the other compounds in tobacco and tobacco smoke are responsible for the cancer.
Nicotine will transiently increase blood pressure, transiently increase the heart rate. It's not really recommended for anybody that has Raynaud’s disease, or Buerger’s disease – any kind of peripheral neuropathy. So it’s not a drug without consequence even at low doses. At high doses, it’s quite poisonous quite frankly.
So the question is whether or not nicotine is different, whether you get it from a cigarette or another way. The answer’s probably no. The main addictive effects – that is, the stimulant effects and the euphoric effects – are mostly due to the speed of absorption. If you smoke, that's very rapid. Some of the oral forms that are available now – like smokeless tobacco or nicotine pouches – have a pretty quick delivery profile, and they're all quite addictive.
On the other hand, if you look at nicotine gum or the nicotine patch – they have a very slow absorption rate, right? And they are not very addictive at all. They don't really cause much change in blood pressure, heart rate or feeling the euphoria. What those products do, they maintain a certain level of nicotine. So you don't get tobacco and you don't get nicotine withdrawal.
Do you think the increasing use of marijuana will have an effect on smoking cigarettes or taking in nicotine?
I do. Nicotine is an interesting drug in that not only does it have its own psychological effects, but nicotine also seems to enhance the rewarding effects of other drugs and activities. And that's why you often see tobacco or nicotine used with other substances. For example, alcohol – people that drink and smoke often do so together. Other drugs – opiates, stimulants and even coffee – are often taken with a cigarette. There is an association between smoking marijuana – cannabis – and smoking tobacco; they tend to go together.
You know, everyone I've ever known who smoked always liked to have a cigarette with a cup of coffee or with a drink …
Or after dinner or after sex. All those rewarding experiences are often queues or keys to smoking. Some of this is probably conditioned or behavioral, but there's probably also the nicotine enhancing the dopamine release.
So you think if people smoke a joint, then they’ll want a cigarette too.
There is actually concomitant administration. That is, people use tobacco and cannabis in the same joint. You see that a lot in Australia – it’s called a spliff. In the United States, it’s blunt smoking – they do it by putting the cannabis in a cigar wrapper and the cigar wrapper contains nicotine, because it's from tobacco. So you do get co-administration of both. And there was just a recent study which showed that people that smoked blunts were much more likely to start smoking cigarettes than those that just use cannabis without using the cigar wrapper.
You work in the area of harm reduction. Where do you see hope in reducing harm from smoking?
Combustible tobacco is the dangerous form, so anything that reduces that is probably going to be much less harmful.
For years, the health message has been: “Stop smoking.” That's it. But I think public health people are realizing that it's very, very difficult for many people to do. Maybe a more helpful approach would be to say, “Okay, if you're going to use a product that delivers nicotine, use one that doesn't deliver other components – and that could be an e-cigarette. It could be a smokeless oral tobacco product like nicotine pouches. It could be a pharmaceutical product.
What about the message to not start?
“Don't start” is still more effective. A lot of money and a lot of effort have gone into prevention programs so that people do not begin smoking.
Years ago, when you talked to smokers, almost everybody started smoking when they were in their middle teenage years – 14, 15, 16 years old were common times for initiation.
And we also find that when you talk to people later on, if they were able to stop, they did not start smoking until after 21. So you see that and say, chronic smokers – almost all of them started in their teens. So one of the prevention strategies is to put restrictions on sales age, and I think now it's a national requirement to be 21 to buy tobacco products.
What do you think about the Great American Smokeout, which encourages people to commit to quitting smoking on one day each year?
It’s a great annual event. The efforts of the American Cancer Society, grass roots organizations and NGOs [non-governmental organizations] have certainly done much to spread the word about what we have learned through research.