The Insidious Dangers of Thirdhand Smoke

Posted under Cigarette Addiction on July 3, 2012
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We’re all familiar with secondhand smoke and how dangerous that is to others, particularly those with asthma or compromised immune systems, the elderly, pregnant women and infants and young children. But within the past couple of years, researchers have been ratcheting up warnings about the dangers of thirdhand smoke.

What Thirdhand Smoke Is

The term “thirdhand smoke” was coined by doctors from Massachusetts General Hospital for Children in a study published in 2008 in the journal Pediatrics. Dr. Jonathan P. Winickoff, the lead author of the study and assistant professor of pediatrics at Harvard Medical School, said at the time that they coined the term thirdhand smoke to describe the chemicals as they focused on the risks they posed to infants and children.

The Mayo Clinic describes thirdhand smoke as residual nicotine and other chemicals left on indoor surfaces by tobacco smoke. This residue is believed to react with other indoor pollutants to create a toxic mix – containing cancer-causing substances that pose a potential health hazard to nonsmokers exposed to it, especially children.

What’s even more worrisome is that thirdhand smoke builds up over time and resists cleaning. Washing won’t get rid of it, nor will a fresh coat of paint. You’d have to literally tear out drywall and start over to eliminate thirdhand smoke from the interior of rooms where smoking had taken place.

And the 2006 Surgeon General’s report says that there is no risk-free level of tobacco exposure. There are 250 poisonous toxins in cigarette smoke, one of which is lead. Other dangerous compounds in cigarette smoke are cyanide and arsenic, highly toxic to humans, especially infants.

More Places Ban Smoking, Period

With this as brief background, now the warnings go beyond just talking about how dangerous smoke is that lingers on the clothes, nails, hair – even doorknobs, walls, carpeting and paint – is to all of us. There are a growing number of public places where it’s now forbidden to smoke – anywhere, anytime, by anyone.

This includes Indiana University Medical Health Center which just this past week upgraded its no-smoking policy to prohibit employees from smoking during the workday – no exceptions. As reported in the Huff Post, Dr. Richard Graffis, executive vice president and chief medical officer at Indiana University Medical Health Center, thirdhand smoke is “the smoke you don’t see but that your nose tells you is there.”

The doctor said that he’s witnessed a dramatic shift in how smoking has evolved during the more than 40 years he’s been in the health care business, from the ubiquitous presence and widespread acceptance of doctors and patients smoking in the hospital to increasingly stringent bans as scientific evidence built up about the health risks posed by direct and indirect smoke.

“Now we’ve come to realize that these particles or toxins can build up in the environment over time,” Graffis said.

Dr. Winickoff, in an interview with Scientific American shortly after the publication of the study where thirdhand smoke was first described, said that the study “points to the need for every smoker to try to quit…Really, I think that what this says is that we need to have sympathy for smokers and help them quit smoking…[And also] that the introduction of this concept will lead to more smoke-free spaces in…public.”

The hard-core smokers at the Indiana University Medical Health Center had to figure it was only a matter of time. And this certainly isn’t the only location that’s likely to be affected.

It was bound to happen. Many non-smokers will applaud the decision and say it’s about time that such directives widen. But what about those who already have a smoking addiction? Even among the chain smokers at the Indiana University Medical Health Center, there’s a small glimmer of hope. The medical center has broadened its tobacco cessation programs in an effort to help employees quit.

There aren’t any hidden cameras in place to nab smokers in the act and use as evidence against them. As Graffis notes, the smokers will be found out – “if they go out and smoke, we’ll know.” That’s because the particles and toxins will cling to their hair and clothing and others will be able to detect it by smell.

Other places where the smoking ban extends to the outdoors include the University of Texas at Brownsville and Texas Southmost College (UTB-TSC), which enacted the campus-wide ban in September 2010.

Earlier this month, Maine became the first state to adopt a nonsmoking policy for all of its public housing buildings, and California may soon sign into law a bill that allows landlords to ban smoking on their properties, including inside rental units, according to a story in the San Jose Mercury News.

Where to Get Help to Quit Smoking

With the pressure to eliminate the dangers of secondhand and thirdhand smoke, what’s a current smoker to do? Of course you know that smoking is bad for you, but you also are well aware of the fact that the addictive properties of nicotine make quitting very difficult. Even though you may desperately want to quit, and make repeated attempts to do so, you may be often unable to curb your smoking habit. And statistically speaking, the quit rates are rather dismal. The U.S. Centers for Disease Control and Prevention (CDC) estimate that 70 percent of adults who smoke want to quit completely. But among those who do quit, relapse rates are extraordinarily high – about 90 percent relapse.

Right now, as of today, if you want to quit smoking, there are several options available. Current smoking cessation products include the following:

  • Nicotine Gum – The Food and Drug Administration (FDA) approved nicotine gum for prescription sale in 1984. Nicotine gum was the first of several FDA-approved products classified as nicotine replacement therapy or NRT. How they work is that NRT products help minimize nicotine withdrawal symptoms by delivering nicotine in small and steady doses over the course of hours, rather than the immediate rush that occurs seconds after inhaling a cigarette. The nicotine gum releases nicotine into the bloodstream through the lining of the mouth.
  • Nicotine Patch – The next smoking cessation product was the nicotine patch – actually four transdermal nicotine patches – approved by the FDA between 1991 and 1992. Whereas nicotine gum releases nicotine through the lining of the mouth, nicotine patches are designed to release a measured dose of nicotine through the skin. In nicotine patch smoking cessation, patches are switched to gradually decrease the doses of nicotine.
  • Nicotine Nasal Spray – Gum, then patch, then nicotine nasal spray. In 1996, the FDA approved the prescription-only sale of another NRT product – nicotine nasal spray. In this product, the nasal spray delivers nicotine into the user’s nose through a pump bottle. Once nicotine is inhaled in this method, it is absorbed through the nasal membranes and into the bloodstream.
  • Nicotine Inhaler – By 1997, the FDA approved yet another prescription NRT – the nicotine inhaler. The inhaler is actually a plastic tube, with a measured dose of nicotine inside in a cartridge. The nicotine inhaler is designed to deliver nicotine in vaporized form to the mouth, where it is then absorbed through mucous membranes.
  • Bupropion SR – Also in 1997, the FDA approved the prescription-only sale of the first non-nicotine smoking cessation therapy – Bupropion SR. Actually a prescription antidepressant taken in pill form, Bupropion SR is designed to mimic the effect that nicotine has on the brain. Brand names are Wellbutrin and Zyban.
  • Nicotine Lozenge – The newest form of NRT is the nicotine lozenge, approved by the FDA in 2002. This NRT product, however, is not prescription. It is sold over-the-counter. As the name implies, the lozenge is a hard candy that, as it dissolves, releases nicotine into the bloodstream through the lining of the mouth.
  • Varenicline – The most recently-approved smoking cessation product was Varenicline, approved by the FDA in 2006. Varenicline is a new medication, taken orally, that is designed to partially activate the brain’s nicotine receptor and reduce both the severity of the smoker’s craving and nicotine withdrawal symptoms. Varenicline is sold under the brand name of Chantix in the U.S.

NicVAX – New Hope for Quitting Smoking

Currently in phase III clinical trials – necessary prior to FDA approval – is a nicotine addiction vaccine called NicVAX. Nabi Biopharmaceuticals of Rockville, Maryland created the vaccine approach inherent in NicVAX and it represents a new paradigm in smoking cessation therapies.

Current smoking cessation products only reduce the urge to smoke and withdrawal symptoms. All NRTs work by controlling and reducing concentration of nicotine in the body, but they do absolutely nothing at all to stop the release of stimulants that cause smoking’s physical and psychoactive effects.

NicVAX works differently. By harnessing the immune system’s power to make antibodies that bind to make nicotine, NicVAX prevents nicotine from ever reaching the brain. This is a radically new approach.

NicVAX is a vaccine that creates antibodies that bind to nicotine in the bloodstream and block it from crossing to the brain. When tobacco smoke is inhaled, nicotine from the smoke is absorbed into the blood and, according to Nabi Biopharmaceuticals researchers, immediately bound to the antibodies. The nicotine-specific antibodies are large molecules that are unable to cross the blood-brain barrier. Thus, trapped in the blood, the bound molecules can’t reach the brain’s receptors to trigger the release of dopamine – the stimulant that produces the so-called “pleasure response.” The pleasure response is widely believed by scientists to be the main reason people can’t quit smoking.

The antibodies created by the NicVAX vaccine are long-lasting – and they can be strengthened or boosted by re-immunization. The goal in the clinical testing is to show that the NicVAX-created antibodies will not only help the smoker to quit, but also help avoid the significantly high rate of relapse common with other smoking cessation products.

NicVAX data from the Phase II clinical trials is expected in early 2012, while Nabi Biopharmaceuticals is fully engaged in Phase III clinical trials at present.

Smoking Quitlines

With the new graphic warning labels on cigarette packaging mandated by the FDA, smoking quitlines have been flooded with calls. If you’re trying to quit smoking and need direction, consider picking up the phone and calling. The national smoking cessation hotline is 1-800-QUIT-NOW.

Bottom line: The pressure to eliminate risks from all cigarette smoking, firsthand, secondhand and thirdhand isn’t going away anytime soon. Expect the number of locations where it is still permissible to smoke to rapidly evaporate. Maybe the best thing for all concerned, including current smokers, is to learn as much as possible about how to quit and then get involved in a smoking cessation program. Most important, if you do want to quit, is to keep at your efforts. That’s the only way you’ll ever be able to quit for good.