Other Nicotine Delivery Systems

AuthorJames G. Wigmore
 6
Other Nicotine Delivery Systems
“The tobacco industry’s allegations that approval of HNB products for
marketing would improve public health by reducing tobacco-associated
deaths and diseases is at best an untested and self-serving hypothesis.
—Paumgartten, “Heat-Not-Burn and Electronic Cigarettes: Truths and
Untruths About Harm Reduction” ()
Like that mythical beast, the phoenix, the tobacco industry seems to arise
again and again from the ashes to promote its nicotine drug delivery sys-
tems in newer and dif‌ferent products, all of which promise (as did f‌ilter
and low tar cigarettes) a lower health risk. The underlying message is that
you don’t have to quit smoking to reduce your health risks, just switch to
another tobacco product.
“Like cigarettes (and e-cigarettes), IQOS uses an aerosol of ultraf‌ine par-
ticles to deliver the nicotine. These ultraf‌ine particles cause heart and
lung disease.”
—Glantz, “PMI’s Own in Vivo Clinical Data on Biomarkers of
Potential Harm in Americans Show that IQOS Is not
Detectably Dif‌ferent from Conventional Cigarettes” ()
Heated tobacco products (HTP) are also known by the tobacco industry as
Heat not Burn (HnB) products, but I would prefer the more appropriate
 | Wigmore on Nicotine and Its Drug Delivery Systems
Reference Number: 
name “Char not Burn,” as the most popular HTP, IQOS (I Quit Ordinary
Smoking), produces a large, charred butt after use (). The origin of
heated tobacco products can be traced back to the s with project
Ariel (), and in the s to Accord and Oasis ().
IQOS consists of a disposable reconstituted tobacco stick (Heet stick)
soaked in propylene glycol and VG and inserted into a computerized
heating coil that heats it to °C, a higher temperature than ECs, but a
lower temperature than combustion cigarettes (, ). The bat-
tery only allows for a -minute operation time which means that a puf‌f
must be taken every  seconds ().
The used Heet stick leaves a large amount of charred debris, f‌luid, and
fragments behind, which is required to be cleaned. Increased charring
occurs if the IQOS holder is not cleaned, and more toxic chemicals are
released as a result ().
IQOS was introduced to Japan in  and its use increased nearly
fourfold after being shown in a popular entertainment Japanese TV show
in  (, ). As usual, the tobacco industry sponsored studies
of which % showed alleged health benef‌its of IQOS ().
IQOS was found to emit the same toxic chemicals as ordinary ciga-
rettes, such as tobacco-specif‌ic nitrosamines, formaldehyde, acetalde-
hyde, acrolein, CO, and nicotine (, , –). Philip Morris
International submitted a Modif‌ied Risk Tobacco Product application to
the FDA to show the IQOS had less health risk than cigarettes, but it was
rejected (–).
It should also be noted that toxicant reduction does not necessar-
ily reduce health risk. Although the levels of tar have decreased by two-
thirds since the s, there has not been a corresponding reduction in
lung cancer ().
Reference Number: 60101
, . “On the Origins of the Electronic Cigarette: British American
Tobacco’s Project Ariel (–).American Journal of Public Health,
: –,  ( f‌igure,  references)
Abstract: The origins of heated tobacco products can be traced to the
BAT project Ariel (–) lead by Sir Charles Ellis, which tried to
reduce the harm of cigarettes by heating and not combusting tobacco.
Before the project, it was found that f‌ilters (some made of asbestos) were
Other Nicotine Delivery Systems | 
Reference Number: 
inef‌fectual in a burning cigarette. Cigarettes usually burn at –°C,
which is much hotter than the –°C required to release nicotine
from tobacco. The Ariel project developed a cigarette within a cigarette
device in which the inner tobacco tube was wrapped in aluminum foil
surrounded by an outer cylinder wrapped with tobacco on the outside.
The burning of tobacco on the outside would release nicotine from the
inside and allow the inhalation of a nicotine vapor without the other
combustion chemicals, such as tar. The initial pH of the aerosol of the
original Ariel device was ., which was highly irritating compared to the
.–. of regular cigarettes, and so citric acid was added to the tobacco
to lower the pH to ..
Ariel marks a turning point for the tobacco industry. Launched by the
discovery that nicotine is addictive, the Ariel device is the physical embodi-
ment of the moment when a major tobacco company f‌irst grappled with
the notion that it might, after all, be in the business of selling nicotine
rather than tobacco or cigarettes.
Reference Number: 60102
, ., .. , . . ,  .. . “Revolution or Redux?
Assessing IQOS Through a Precursor Product.Tobacco Control, :
s–s,  ( tables,  f‌igures,  references)
Abstract: The Accord, a clean smoke battery-operated HnB tobacco
product introduced between  and , was a precursor to IQOS.
An analysis was conducted of previously secret Philip Morris (PM) and
Philip Morris International (PMI) internal documents to compare the
IQOS to the Accord. In October , PM f‌irst marketed the Accord in
about  stores near its main manufacturing/research center in Virginia.
It released the same HTP in Osaka, Japan under the name of Oasis. The
nicotine uptake for the Accord was slower than for cigarettes, so smok-
ers inhaled more deeply to compensate, which negated potential health
benef‌its. After spending over $ million, the Accord and Oasis were
withdrawn in , because smokers did not like its taste, harshness,
and inconvenience, or the diculty in drawing in the smoke. In ,
PMI introduced the IQOS to Italy and Japan. In January , the FDA’s
Tobacco Products Scientif‌ic Advisory Committee concluded that PMI had
not proven IQOS to be safer than cigarettes.

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