Policy Brief: A Proposal to remove Non-Therapeutic Nicotine from Pharmacies in School Zone Vicinities
Written by: Naren Krishna Jegan
Summary:
Issue: Nicotine Cessation and Exposure Prevention
Why it matters now: Currently, no major legislation targets nicotine regulation (the active ingredient in tobacco), allowing the tobacco/nicotine industries to swiftly create new products that bypass current legislation to sell harmful, addictive products to minors/adolescents. The enactment of this policy marks a first in anti-nicotine legislation and can mark an offensive strategy in preventing nicotine and downstream tobacco addiction.
Recommended Policy Action / Bill: Remove non-therapeutic nicotine products from pharmacies in school-zone vicinities
Expected Impact: Reduced nicotine/tobacco exposure among minors/adolescents, increased adolescent health.
Background & Current Landscape:
The American Cancer Society is an advocate for tobacco cessation and use prevention. A key factor in tobacco addiction is early exposure to stimulating chemicals present in tobacco products. Nicotine is a key derivative that makes tobacco products such as cigarettes, vapes, and nicotine pouches highly addictive. While nicotine has therapeutic purposes for over-the-counter nicotine replacement therapy to help quit smoking, misuse and integration into various products such as nicotine pouches remains a popular, non-smoking way that many individuals at the middle-school to college age get addicted and exposed to harmful chemicals.
The difference between nicotine and tobacco is commonly misunderstood, leading to both being used interchangeably. According to the National Library of Medicine, “Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed. Tobacco contains a chemical called nicotine. Nicotine is an addictive substance.” Nicotine can be a part of tobacco, or isolated and inserted as a key element in various products such as Zyn nicotine pouches [1].
According to the CDC, 9/10 adults who smoke cigarettes daily first try smoking by age 18 [2]. Due to current campaigns such as TUPE or the progression of harmful second-hand smoke, adolescents are shifting to other alternatives to cigarettes such as vapes, puff bars, pouches, etc. While avoiding the harmful aspects of toxic inhalation associated with smoking, studies show that the chronic adolescent nicotine exposure may cause deficits in working memory and attention, and alterations in reward processing that increase the potential for subsequent drug abuse and addiction [3].
The State of California and the United States have taken aggressive action for tobacco cessation policies. Notably, key actions include raising the age of purchasing tobacco from 18 to 21 (Tobacco 21), enforcing smoke-free workplaces (Labor Code 6404.5), and the development of the California Tobacco Control Program, which target tobacco cessation through various programs studying family, societal, environmental and disease-related perspectives. Currently, AB957 (Ortega) is an active bill that aims to prohibit the sale of tobacco and cigarette products in pharmacies. While these are steps in the right direction to eliminating tobacco cessation, they do not eliminate the problem of getting addicted to nicotine and tobacco products.
Problem & Gap to Address:
Although longitudinal human data on the effects of pure nicotine products on cancer risk have been conducted, observational studies on smokers and users of oral tobacco where nicotine concentrations can rise as high as 10-45mg/dose provide important context towards the long-term effects of nicotine in the cellular and molecular level. Such studies have shown that nicotine can activate signaling pathways and cellular changes that increase stemness/malignant phenotypes, suggesting tumorigenesis/angiogenesis. Moreover, nicotine is hypothesized to suppress/inhibit anti-tumor immune responses. While extensive research is underway on long-term studies, these chronic issues along with the high rate of addiction mark a problem in adolescent health. While current legislation works toward the elimination of tobacco products from markets, the tobacco industry has been known to frequently shift strategies to bypass regulations by using a mixture of digital marketing, wording changes, and exploiting flavor restrictions.
Policy Proposal:
We write this proposal to ban the sale of non-therapeutic nicotine-containing products from pharmacies in school zone vicinities. Research indicates that while nicotine has therapeutic potential for helping quit smoking in the successive use of lower doses, early exposure can have severe detrimental impacts to adolescent health. Like AB957 proposes, pharmacies should exist to serve as a place to find products that alleviate pain, not sell products that can adversely impact one’s health. Moreover, we aim to increase the rigidity of the regulation of sale of non-therapeutic nicotine products within 1000 feet within a school zone, similar to AB957 during after-school hours. The effects of the proposal would have net positive yield on the adolescent health while also combating the tobacco/nicotine industries tactics to avoid regulations. Moreover, this proposal will continue to expand upon past groundbreaking work on tobacco cessation by targeting the active ingredients/chemicals that can be extracted and preventing their installation into other products to cause addiction.
Conclusion:
Throughout my time as a student, I have seen firsthand students get addicted or exposed to nicotine through what they consider “harmless ways,” in the form of nicotine pouches or lozenges. While policies are currently focused on tobacco regulation, regulating the sale of nicotine products is equally if not more important for their addictive, harmful nature. The enactment of this policy marks a first in anti-nicotine legislation and can mark an offensive strategy in preventing nicotine and downstream tobacco addiction.
