Research paper
Nicorette reborn? E-cigarettes in light of the history of nicotine replacement technology

https://doi.org/10.1016/j.drugpo.2015.02.002Get rights and content

Highlights

  • Analyses e-cigarettes in light of regulatory struggles surrounding first NRT.

  • Discusses nicotine substitutes as ‘scripted’ to treat or disarm addiction.

  • Uses history of nicotine replacement to advance technological studies of addiction.

  • Reveals how first NRT was closely modelled on Swedish oral tobacco.

  • Reveals how Swedish tobacco industry almost commercialized Nicorette gum in 1970s.

Abstract

Background

E-cigarettes are currently hotly debated as threatening to re-normalize cigarette smoking and make nicotine addiction publicly acceptable once more. In this paper I contextualize the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. A concerted effort to develop such technologies first emerged in Sweden at the end of the 1960s, embodying a vital tension. Two competing ‘scripts’ vied to influence and shape innovative designs. On the one hand, Nicorette chewing gum was conceived as a therapeutic device aiding smoking cessation. On the other hand, it was cast as a cigarette substitute designed to deliver nicotine ‘in the right way’, thereby advancing the creative destruction of the combustible cigarette as a drug delivery platform.

Method

Drawing on historical and archival research I outline how these two alternative innovation scripts started out entangled with each other before becoming disentangled, leading to the eventual stabilization of Nicorette gum as a therapeutic product to be deployed in the treatment of smoking as a dependence disorder.

Results and Conclusion

While a post-therapeutic future for nicotine replacement was charted by Michael Russell at the beginning of the 1990s, it is only with the rise of e-cigarettes after 2003 that such a future has started to verge on reality. E-cigarettes can be seen as resurrecting the historically marginalized script of nicotine replacement as dedicated to righting nicotine consumption and freeing it from the wrongful drug delivery of the modern cigarette.

Introduction

Much discussion currently centres on the question of whether or not e-cigarettes are responsible for re-normalizing smoking and making nicotine addiction publicly acceptable once more (Chapman, 2013, Fairchild et al., 2014). In this paper, I wish to shift the focus of attention by viewing the e-cigarette controversy in light of longstanding disagreements about the meaning and significance of nicotine replacement technologies. I argue that it is more apposite to draw attention to how e-cigarettes are making apparent the historically contingent association of nicotine replacement technology with pharmaceutical innovation and medical product development.

Designed and developed as safe and pleasurable to consume, e-cigarettes deserve recognition as reopening and restaging the controversy that engulfed the development of Nicorette chewing gum, the first commercial nicotine replacement technology launched during the 1970s. Just as the nature and identity of e-cigarettes as medical goods, tobacco-related products or general consumer goods is hotly contested today (Farsalinos and Stimson, 2014, Hajek et al., 2013), the nature and identity of nicotine-containing chewing gum remained a matter of chronic uncertainty and regulatory indecision for more than a decade after its invention at the end of the 1960s.

Section snippets

Alternative scripts of nicotine replacement

In the sociology and philosophy of technology it has become common to talk of the success or failure of innovations as hingeing upon the ‘scripts’ that are connected to and inscribed into them under their development (Akrich, 1992, Akrich and Latour, 1992, Latour, 2005, p. 79; Verbeek, 2006, p. 362; Verbeek, 2011, p. 10). Due to their novelty, innovations are obliged to prefigure the contexts of use into which they are to be inserted. Innovators must author original roles and identities for

Drug replacement as a cure for smoking: the birth of the smokers’ clinic in Stockholm 1955–1960

As already mentioned, prefiguring the rise of nicotine replacement therapies, Sweden was also the birthplace of the smoking cessation clinic. The pioneering figure behind the establishment of four polyclinics in Stockholm during the late 1950s offering a drug replacement ‘cure’ for smoking was a cardiologist called Börje Ejrup (Elam, 2014a). Initially limiting treatment to patients on a cardiac ward whose medical condition was clearly aggravated by their smoking, Ejrup was enabled by

Nicorette as a replacement for cigarettes

The Nicorette script originates from a letter sent by two doctors, Stefan Lichtneckert and Claes Lundgren, at the Department of Clinical Physiology, Lund University, to Ove Fernö, the research director at the LEO Pharmaceutical Company in nearby Helsingborg, on 8 December 1967 (Ahlin & Lundgren, 2002, p. 269; Fernö, 1994, p. 1216; Lichtneckert & Lundgren, 1967). The letter offered support for the view that the hazards of tobacco use derive firstly from the inhalation of cigarette smoke.

Early controlled and ‘open’ clinical trials of Nicorette gum

By envisioning nicotine chewing gum as a substitute for cigarettes and oral tobacco alike, Fernö and his colleagues were intent on delivering a new therapeutic tool capable of re-galvanizing the development of the Ejrupian smokers’ clinic. The Lund clinic which had closed down in 1967 due to the lack of a viable treatment technology was re-opened at the beginning of 1970 precisely to carry out preliminary trials of Nicorette gum (Ahlin & Lundgren, 2002, p. 272; Ohlin & Westling, 1972). Fifty

The parallel emergence of Nicorette gum and the first ‘Portionssnus’

Writing together with Lichtneckert and Lundgren in the early 1970s, Öve Fernö described the cigarette substitute he was engaged in developing as follows:

“It should reduce the medical risks compared to smoking

It should provide a pharmacological reward comparable to smoking

It should preferably imply the possibility of habit formation and conditioning to substitute for the habits and conditioned reflexes related to smoking

The time required to teach or apply the method should be minimal”

(Fernö,

Nicorette as an object of parliamentary controversy

By the summer of 1975, Swedish Tobacco had taken the initiative of drawing up a draft agreement for the joint commercialization of Nicorette gum with LEO. A two-stage market launch was planned with initial sale through pharmacies directed towards the flourishing informal network of smoking cessation clinics which had emerged as lead-users of the gum. Thereafter, Swedish Tobacco would take charge of the more general distribution of the product through the channels already established for oral

Nicorette gum becomes a therapeutic tool with global reach 1977–1983

Neither a medicine nor a foodstuff, Nicorette gum was outlawed in Sweden in the middle of 1977. The supplies of gum that LEO had distributed free of charge to a growing informal network of smoking cessation clinics for more than seven years had to be stopped (Fernö, 1994, p. 1223). Simultaneously, and much to the relief of LEO, the product was successfully registered as a prescription-free medicine in Switzerland, with a market launch in summer 1978 (Ahlin & Lundgren, 2002, p. 274).

After LEO

Michael Russell's vision of post-therapeutic nicotine replacement

Within four years of the first NRT becoming available as a prescription medicine in the United States, the 20th report of the US Surgeon General on the health consequences of smoking was able to officially confirm that “cigarettes and other forms of tobacco are addicting” and that in treating the tobacco user “health professionals must address the tenacious hold that nicotine has on the body” (US Department of Health and Human Services, 1988, pp. iii–vii). Thus, 20 years after Lichtneckert and

Conclusion

If Michael Russell's future for nicotine replacement failed to materialize during the 1990s, it has come several steps closer to reality with the controversial rise of e-cigarettes after 2003. Without question, the global diffusion of e-cigarettes represents a turning point in the history of nicotine replacement technology. E-cigarettes have resurrected the script of nicotine replacement as the righting of nicotine consumption as opposed to the treatment of nicotine addiction. Corresponding

Acknowledgement

This work arises out of research supported by the Swedish Research Council (contract number 90197701).

Conflict of interest statement: None declared.

References (58)

  • D. Courtwright

    Forces of habit: Drugs and the making of the modern world

    (2001)
  • B. Ejrup

    Försök till avvänjning från tobak medelst injektionsbehandling

    Svenska läkartidningen

    (1956)
  • B. Ejrup

    Rökavvänjningspoliklinikerna

    Svenska läkartidningen

    (1959)
  • B. Ejrup

    The role of nicotine in smoking pleasure, nicotinism, treatment

  • B. Ejrup et al.

    Konsten att sluta röka

    (1959)
  • B. Ejrup et al.

    Försök med nikotin, lobelin och placebo

    Svenska läkartidningen

    (1959)
  • M. Elam

    Pharmaceutical incursion on cigarette smoking at the birth of the brain disease model of addiction

  • M. Elam

    ‘From the birth of the smokers’ clinic to the invention of Nicorette®: Problematizing smoking as addiction in Sweden 1955–1971

    Nordic Studies on Alcohol and Drugs

    (2014)
  • M. Elam

    The technopolitics of nicotine replacement from Nicorette® gum to e-cigarettes

  • K. Fagerström

    A comparison of psychological and pharmacological treatment in smoking cessation

    Journal of Behavioral Medicine

    (1982)
  • A. Fairchild et al.

    The renormalization of smoking? E-cigarettes and the tobacco “Endgame”

    New England Journal of Medicine

    (2014)
  • W. Fee et al.

    A controlled trial of nicotine chewing gum in a smoking withdrawal clinic

    The Practitioner

    (1982)
  • O. Fernö

    The development of a chewing gum containing nicotine and some comments on the role played by nicotine in the smoking habit

  • O. Fernö

    Conversation with Ove Fernö

    Addiction

    (1994)
  • O. Fernö et al.

    A substitute for tobacco smoking

    Psychopharmacologia

    (1973)
  • P. Feurst et al.

    Snuskungen: Ljunglöfs Ettan och Det Svenska Snuset

    (1999)
  • J. Hartelius et al.

    Nikotintuggummits tänkbara för och nackdelar

    Läkartidningen

    (1976)
  • J. Hartelius et al.

    Abuse and intoxication potential of nicotine chewing gum

    British Medical Journal

    (1976)
  • T. Jadestig et al.

    Motion: Om försäljningen av nikotintuggummi. 1976/77

    (1977)
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