In 2011, I became curious about nicotine gum/patches as a possible alternative stimulant to modafinil: its much shorter half-life makes it more useful for evenings or scenarios like needing a quick alert on a long drive. I looked briefly into the nicotine/tobacco research to see whether there was convincing evidence that nicotine on its own, without any tobacco or smoke-related delivery mechanism, is either more harmful than most stimulants or likely to lead to severe addiction to tobacco as a ‘gateway drug’. The psychological effects of nicotine as a stimulant are long established by a scattershot literature, so there are possible benefits. Cost-wise, much of the nicotine/tobacco literature willfully conflates the two, leading to misleading attribution of the harm of tobacco to nicotine; many associations with harm are confounded by past or present tobacco use, but when pure nicotine is examined, as in patch/GUM NRT, the harms appeared minimal: like all stimulants, nicotine may raise blood pressure somewhat, and is addictive to some degree, but the risks do not appear much more strikingly harmful than caffeine or modafinil (and certainly appear less than the many commonly-used amphetamines). Animal experiments are, like usual, highly ambiguous, of low quality, and of doubtful relevance to humans. There is little evidence from the NRT literature that ‘never-smokers’ like myself are all that likely to become highly addicted, and minimal epidemiological evidence of harm from NRT use over the past 3 decades it has been available. ‘Vaping’ is another story: few experiments have been done, and its popularity is recent enough that any harms are poorly understood other than it can’t possibly be remotely as harmful as tobacco smoking, and its delivery mechanism plausibly is much more addictive than gum/patch delivery would be. Overall, I am personally comfortable using nicotine gum (but not vaping) once in a while, and have done so since 2011 without any noticeable problems or escalation in usage frequency.

One of the reasons tobacco became so popular in the 1600s, along with tea & coffee (for their caffeine), was that nicotine is a powerful stimulant. Obvious enough; it affects tons of systems. Less obvious is that nicotine has many beneficial effects (and these benefits may be related to anomalous smoking results ); the infamous deadliness of smoking would seem to be almost solely from the smoke, not the nicotine. Even less obvious is that nicotine itself may not be especially addictive, and its addictiveness is genetically modulated .

All of the harm seems to stem from tobacco, and tobacco smoking in particular; this is not necessarily obvious because almost everyone casually conflates tobacco with nicotine (especially public education programs ), treating them as a single synonymous evil I dub “nicbacco”. When someone or something says that “nicotine” is harmful and you drill down to the original references for their claims, the references often turn out to actually be talking about tobacco rather than nicotine gums or patches . Other methodological issues include comparing to current smokers rather than former smokers or failing to control for the subjects being the sort of people who would begin such a societally-disapproved activity like smoking; the studies typically aren’t designed properly even for showing an effect: you need a study which finds deficits in smokers but not in non-smokers or former smokers (eg. Heffernan et al 2011 or Sabia et al 2008/Sabia et al 2012 although neither enables nicotine inferences since there was no nicotine-only control group). The 2019 United States outbreak of lung illness linked to vaping products offers a case in point of this prejudice: despite every sign pointing to adulterants added to illegal THC/marijuana vaping fluids by fly-by-night operators rather than nicotine (such as the decades of nicotine vaping by millions of people not causing them to land overnight in hospital ICUs), the outbreak has been used as an excuse to ban legal nicotine vaping fluids instead—which is like banning aspirin as a response to the opiate crisis because they’re both used for pain relief and they both come in pill form, and some OD victims also used aspirin recently, so that makes them pretty much the same thing, right?

Conclusion So what’s the upshot? My reading has convinced me to at least give it a try and it has been useful (see the nicotine section of Nootropics). The negatives universally seem to be long-term negatives, and even if nicotine turns out to be something I haul out only in a crisis or every few weeks, it would still have been worth investigating.