Dissolvable tobacco

Dissolvable tobacco is a tobacco product that, unlike ordinary chewing tobacco, dissolves in the mouth. Major tobacco manufacturers that sell dissolvable tobacco products include R. J. Reynolds Tobacco Company (Camel-branded "Orbs," "Strips," and "Sticks," 2009) and Star Scientific ("Ariva," 2001 and "Stonewall," 2003). The move of the major players into the smokeless tobacco market is attributed to smoke-free laws in the United States.[1] Research into health effects of this and other new tobacco products was among the reasons of the establishment of the Tobacco Products Scientific Advisory Committee of the Food and Drug Administration in 2009.[2]

Camel Dissolvables

Camel Dissolvables is a new line of products manufactured by R.J. Reynolds. The Camel Dissolvables line includes Camel Orbs, Camel Strips, and Camel Sticks which are currently in test markets in Columbus, Ohio, Indianapolis, and Portland, Oregon. The Camel Dissolvables brands are marketed as "a convenient alternative to cigarettes, and moist snuff for adult tobacco consumers."[3] Camel Dissolvables "will not be positioned as a smoking cessation or reduced risk product," and are evolutions from the loose and pouched smokeless tobacco options.[4] With marketing still being developed, R.J. Reynolds has announced that "print ads, direct marketing, sampling at bars and nightclubs and point of purchase" advertising will support the campaign.[4]

Product constituents

The Camel Orbs contain finely grained tobacco mixed with "additives such as water, flavorants, binders, colorants, pH adjusters, buffering agents, fillers, disintegration aids, humectants, antioxidants, oral care ingredients, preservatives, additives derived from herbal or botanical sources, and mixtures thereof."[5] The Camel Orbs come in two styles, Mellow and Fresh. Each pellet contains 1 milligram of nicotine, dissolving in the mouth in 10–15 minutes.[3] The Camel Sticks product is a twisted stick the size of a toothpick that lasts in the mouth about 20–30 minutes, and contains 3.1 milligrams of nicotine. The Camel Sticks are for insertion between the upper lip and gum, and come in one style, Mellow. The Camel Strips contain 0.6 milligrams of nicotine per strip and come in one style, Fresh.[3] The Camel Strips last 2–3 minutes on the tongue, administering nicotine through thin film drug delivery technology as used in Listerine PocketPacks breath freshening strips. A specific ingredient list naming all additives has not been made public for any of the Camel Dissolvables brands.

Ariva and Stonewall dissolvables

Currently, Star Scientific manufactures two brands of dissolvable tobacco, Ariva and Stonewall. Both brands contain Virginia StarCured flue-cured powdered Virginia tobacco compressed into smoke-free, spit-free, flavored dissolvable tobacco pieces packaged in blister packages and cardboard carton.[6] The Ariva and Stonewall brands are marketed as a means of "reducing toxins in tobacco so that adult consumers can have access to products that expose them to sharply reduced toxin levels" while still providing consumers with tobacco and nicotine. The product is not marketed as a smoking cessation product, but an "alternative tobacco product" that is "not combusted."[7] Star Scientific recommends the Ariva brand for smokers whereas, the Stonewall brand is recommended for heavy smokers, defined as smokers who consume more than one pack a day, and users of other smokeless tobacco products such as snuff.[6] The Ariva brand has been shown to have significantly reduced levels of tobacco-specific lung carcinogen 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) although "exposures to other tobacco-specific nitrosamines (i.e., NNN), polycyclic aromatic hydrocarbons (e.g., benzo[a]pyrene), and metals" have not been assessed.[8] However, Star Scientific notes, "there is currently no proof that lowering nitrosamines will decrease health risk."[7]

Product constituents

The Ariva brand, introduced in 2001, contains 1.5 milligrams of nicotine in each piece and dissolves in the mouth in 10–30 minutes.[6] The Stonewall brand, introduced in 2003, have more surface area than the Ariva pieces and contain four milligrams of nicotine per piece, with each piece dissolving in 10–30 minutes.[6] The Ariva brand is offered in Wintergreen flavor and the Stonewall brand is offered in Natural, Wintergreen, and Java flavors. Other than the Virginia StarCured Tobacco and "other natural and artificial flavorings" including the non-sugar sweetener sucralose, Star Scientific has not made a specific ingredient list public because it claims to "seek to protect proprietary product information" because Stonewall and Ariva are "the only dissolvable smokeless tobacco products in the marketplace."[9]

Demise of the Ariva and Stonewall brands

On December 18, 2012, Star Scientific announced its intention to discontinue the production of its dissolvable tobacco products, citing lagging sales and marketing difficulties due to regulations contained in the Tobacco Control Act.[10]

Public health reactions

Underage consumption

From the introduction of Ariva in 2001 there have been several public health claims that the dissolvable tobacco products pose a serious risk for unintentional poisonings in children and adolescents. Petitions from the American Cancer Society, Campaign for Tobacco-Free Kids, Attorneys General from 39 states, and multiple public health organizations were sent to the FDA asking for regulation of the Ariva brand and similar products.[11]

A recent study by the Harvard School of Public Health and Centers for Disease Control on unintentional child poisonings from ingestion of tobacco products also assessed the toxicity of the new Camel Orbs, which "are of concern due to their discreet form, candy-like appearance, and added flavorings that may be attractive to young children."[12] The study examined two flavors of Camel Orbs to find that 42% of the nicotine was in the un-ionized form, "compared with averages of 28–30% for moist snuff and <10% for cigarettes."[12] The danger of un-ionized nicotine is its more rapid absorption in the mouth, which could increase the nicotine’s toxicity.[13] The lead researcher, Gregory Connolly, notes that "a small pellet with a rapid release of nicotine and a young child with a low body weight can be a very serious problem,"[14] by creating potential for nicotine poisoning, for example, which manifests as abdominal cramps, drooling, tremors, nausea, vomiting, agitation, and in more extreme cases, seizures, coma, and death.[13]

The study also assessed the burden of child poisonings from tobacco products across the country, finding that 13,705 tobacco product ingestion cases were reported in the two-year period, with >70% occurring in infants less than one year of age.[12]

Industry responses
  • Response from R.J. Reynolds Tobacco Company to Pediatrics Article on Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products[15]
  • R.J. Reynolds Response Statement to Camel Dissolvables Misrepresentations[16]
  • Star Scientific Statement on Tobacco Product Ingestion Study[17]

Harm reduction

Public Health researchers are now showing that the consumption of low nitrosamine smokeless tobacco (LN-SLT) as an alternative to cigarettes may have mortality and morbidity risks for oral cancer and heart disease, but "The risks of using LN-SLT products...should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past."[18]

References
  1. "Tobacco 'orbs' melt in mouth", USA Today, December 26, 2008 (retrieved November 19, 2009)
  2. "Tobacco Products Scientific Advisory Committee"
  3. "R. J. Reynolds Tobacco Company Products at a Glance: Camel Sticks, Strips, and Orbs". Archived from the original on 2011-07-11. Retrieved 2010-04-29.
  4. Beirne, Mike. R.J. Reynolds Preps Dissolvable Tobacco. Brandweek. 8 October 2008.
  5. Dube, Michael Francis, et al. Smokeless Tobacco Composition. U. S. Patent Application. 7 Feb 2008.
  6. Star Scientific. Frequently Asked Questions. 2007. Accessed 22 April 2010.
  7. Star Scientific. Questions and Answers about Ariva Toxin Levels
  8. Baumgart, et al. "Pilot study on lower nitrosamine smokeless tobacco products compared with medicinal nicotine." Nicotine & Tobacco Research. 12 December 2007.
  9. Starconsumerctr. "Other Ingredients?" General Discussion. 17 Jul 2009. Accessed 22 April 2010.
  10. CSP Daily News "Star Scientific Exiting Tobacco Business" Archived 2013-03-03 at the Wayback Machine
  11. Citizen Petitions for Regulation of Ariva. Comments In Support of the Citizen Petitions for Regulation of Ariva. In the Food and Drug Administration. 17 July 2002: 1.
  12. Connolly, Gregory N. et al. "Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products". Pediatrics. 19 April 2010.
  13. Salomon ME. "Nicotine and tobacco preparations." In: Goldfrank LR, Nelson LS, Howland MA, Lewin NA, Flumenbaum NE, Hoffman RS, eds. Goldfrank’s Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006: 1221–1230
  14. Mann, Denise. "Tobacco in candy-like form can poison kids." CNN Health. 19 April 2010.
  15. Response from R.J. Reynolds Tobacco Company to Pediatrics Article on Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products Archived May 10, 2010, at the Wayback Machine
  16. R.J. Reynolds Response Statement to Camel Dissolvables Misrepresentations Archived December 1, 2010, at the Wayback Machine
  17. Star Scientific Statement on Tobacco Product Ingestion Study
  18. Levy, David. Et al. "The Relative Risks of a Low-Nitrosamine Smokeless Tobacco Product Compared with Smoking Cigarettes: Estimates of a Panel of Experts." Cancer Epedemiology, Biomarkers and Prevention. December 2004 13; 2035.
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