We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

The truth about nicotine

The tobacco industry spends billions of dollars each year to market smoking as exciting, glamorous, and safe and it’s also shown in video games, online and in film. We have all heard the nicotine warnings over the last few decades and how it’s bad for our lungs, but should this message be updated? What do we now know about nicotine?

If you need help, please call

  • Lifeline- 13 11 14
  • BeyondBlue - 1300 22 4636
  • Suicide Call Back Service - 1300 659 467
Suicide Call Back Service Online Chat

I recently ran into a former patient in the street – someone I hadn’t seen for years. He emerged from a cloud of smoke, grinning sheepishly and brandishing a shiny new vaping device for me to admire.

“Hey Doc,” he said. “See, I’ve finally given up the cancer sticks!”

About Brandon

Brandon* and I have had many conversations over the years about his smoking but, despite having a chain-smoking father who died of lung cancer, he had never been able to give up. He’d been my patient through a very nasty bout of depression during his thirties that turned out to be part of a bipolar condition and his relationship with cigarettes was complicated. Trying to give up made him anxious and angry and nicotine patches interfered with his sleep.

Brandon must be in his mid-forties now. I was stunned by his appearance. His ruddy complexion and the extra 50 kilos on his frame since I last saw him spoke of very poor physical health.  

“Such a pain that they’ve gone and made the vaping hard for me now,” he said. “If I come and see you, will you give me a script?”

Vaping has become increasingly popular as an alternative to smoking and unfortunately not just with smokers trying to give up. Many young people who’ve never smoked are taking up vaping because of the “cool flavours”, a nasty marketing device to trap the young. In response to rising concerns about the harms of nicotine vaping, the importation and supply of nicotine-containing vaping liquids without a prescription, became illegal in Australia on 1st October 2021. That’s why Brandon is keen to see me.   

“It’s OK,” Brandon said, no doubt observing the look of concern on my face.  “It’s just nicotine. It’s not harmful.”

False facts about nicotine

I was a bit surprised by Brandon’s remark but I have heard the assertion before. I have never quite known how to respond.

This week I watched a webinar featuring Professor Renee Bittoun, a Sydney-based international expert on nicotine use and smoking cessation. I learnt so much in that webinar! Had I known it sooner I might have been able to prevent Brandon from falling into the trap that claims nicotine is OK, just as long as you don’t smoke it. Brandon always knew about the risks of heart disease and lung cancer for smokers, but he didn’t realise that nicotine could cause many other problems.

So, what did I learn from the webinar?

I learnt that nicotine is bad for your mental health. The evidence is that when you stop smoking, once you get through the initial period of nicotine withdrawal, your mood improves and suicidal thoughts decrease. There are actual chemical reasons for that.  

I also learned that nicotine (and any organic substance that you smoke) induces liver enzymes, interfering with the breakdown of drugs like antipsychotics, pain killers, blood thinners, caffeine and alcohol. Brandon may have managed on lower doses of antipsychotics if he had not smoked. He may have tolerated nicotine patches better if we’d realised he needed to reduce his caffeine intake.

Nicotine also puts you blood sugar up. Smokers crave sweets when they try to give up smoking. Low blood sugar when the nicotine is dropping in your system is part of what causes you to crave another cigarette. High blood sugar is not a good thing in an obese middle-aged man like Brandon.

In short, nicotine is an addictive substance that impacts a number of body systems and functions. It’s use adversely impacts both mental and physical health. It doesn’t matter whether you smoke it or vape it, the problems it causes are the same.

Find out more

If you are a health professional and want to know more, watch the on-demand recording of the Smoking Cessation and Mental Health webinar. You’ll get some great tips about how to help people stop smoking or vaping nicotine.

*Name changed to protect identity

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. LOG IN
Dr Jan Orman

Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

View more

The latest healthcare news from medcast

Clinical Opal #12 - Deterioration post abdominoplasty
Clinical Opal #12 - Deterioration post abdominoplasty

Gail is a 63 year old post abdominoplasty who is complaining of tingling lips, abdominal cramping and watery eyes...

What makes a mental health app work?
What makes a mental health app work?

Clinicians I talk to often say that they recommend mental health apps all the time, but they find that even the most enthusiastic users seem to disengage pretty quickly.

GP Educational Intervention Improves Patient Care and My Health Record Usage with Potential to Save Government Millions
GP Educational Intervention Improves Patient Care and My Health Record Usage with Potential to Save Government Millions

A two-year study titled CHIME-GP was carried out by Medcast and the University of Wollongong. It has shown that educating GPs about potentially inappropriate or unnecessary medicines, imaging and pathology test ordering in the context of using the My...

More than a race: Medcast takes on the Shitbox Rally – Autumn 2022
More than a race: Medcast takes on the Shitbox Rally – Autumn 2022

From Wollongong, NSW to Mackay, QLD in 7 days. Medcast’s own team, Tyre Kickers, are taking on Shitbox Rally – Autumn 2022.

Clinical Opal #11 - SGLT2i-related DKA
Clinical Opal #11 - SGLT2i-related DKA

Terese is a 64-year-old retired teacher who has a 12 year history of type 2 diabetes. She also has hypertension. She takes metformin 1000mg bd and irbesartan 150mg daily...

Have you lost your mojo?
Have you lost your mojo?

I’m pretty sure I’ve lost mine. I lost it in the early part of 2021 and haven’t laid eyes on it since.

Promoting reproductive choice in primary care
Promoting reproductive choice in primary care

The Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) - a network for professionals working with women to optimise reproductive health

How Doctors Think
How Doctors Think

In this short video from the 2022 'Not to be missed' webinar series, Dr Simon Morgan provides some insights into how Doctors think.

Are we all ok?
Are we all ok?

Often OK is the very best I can do (especially lately), and I try to be grateful for that, but wouldn’t it be nice to be more than OK, to be flourishing, for a little more of the time! I hope I don’t have to wait for the world to be a better place be...

Clinical Opal #10 - Pre-conception care
Clinical Opal #10 - Pre-conception care

Kelly, aged 28, presents for an appointment as she is planning a pregnancy with her husband. She has no significant medical history, is nulliparous, is a non-smoker, has normal body weight, maintains a healthy diet and exercise routine, and has a con...

How connecting to my Aboriginality helps me stay strong
How connecting to my Aboriginality helps me stay strong

Being connected to your Aboriginal heritage can bring fulfilment and a sense of identity and culture but what about wellbeing?

Navigating the consultation
Navigating the consultation

At the core of general practice is the consultation.  In its simplest form, the consultation can be regarded as the sharing of information between patient and doctor in order to facilitate both a common understanding and a plan of management.

Clinical Opal #9 - 64 year old with fever and rigors
Clinical Opal #9 - 64 year old with fever and rigors

Joan is a 64-year-old hospital cleaner who presents to you one morning feeling 'dreadful'. Joan has a past history of well controlled diabetes and takes metformin 500mg bd.

Blended care – the future of therapy?
Blended care – the future of therapy?

Psychologists and their clients are perceiving online therapy in a new light since the pandemic. Although face-to-face therapy is once again possible, psychologists are opting for a mix of in-person and online therapy as the demand for care grows. Mo...

Clinical Opal #8 - Myeloma
Clinical Opal #8 - Myeloma

Bob Georgiou, a 66-year-old retired university lecturer, presents to you with vague aches and pains, weight loss of a few kilograms and fatigue for the past couple of months.

The dilemma of treating the ones we love
The dilemma of treating the ones we love

As a health professional, we’re always going to be faced with the professional and personal dilemma of where and when to draw the line when it comes to advice or treatment of loved ones.

Clinical reasoning and the KFP exam
Clinical reasoning and the KFP exam

In our day-to-day work as a GP, we undertake clinical reasoning with nearly every patient, mostly subconsciously. However, in preparation for the KFP exam, it can be helpful to deconstruct the clinical reasoning process. Hence this blog!

Non-adherence to thromboprophylaxis prescribing in general practice – the views of GPs
Non-adherence to thromboprophylaxis prescribing in general practice – the views of GPs

Last year, I conducted a series of interviews with GPs in order to understand their experiences with anticoagulation management in patients with atrial fibrillation (AF).

What is it about New Year’s Resolutions?
What is it about New Year’s Resolutions?

It’s that time of year again where some of us convince ourselves that we’re going to “definitely” stick to those new year’s resolutions….

Summer reading
Summer reading

There's something special and therapeutic about reading. A Summer read encapsulates so much more than just words printed on paper. Dr Jan Orman

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Log In