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Smoking and Tobacco

What could this be?

07/05/2007

Question:

I have been using Copenhagen for 10 years. Recently when I put it in my mouth I instantly become sick. I feel a lump in my throat, my stomach turns in knots, and I vomit. As soon as I remove the chew, I am fine. What are my possibilities?

Answer:

Copenhagen is moist snuff. Users usually place a small wad of it or a prefilled packet between their cheek and gum, and let the nicotine (and other chemicals) seep in through the mucous membranes (lining) of their mouth. My first impression is that you are overdosing on nicotine. All the symptoms you describe can all be caused by high blood levels of the drug and are similar to the overdose that can occur in tobacco farmers who touch the leaves too much (green tobacco sickness).

How could this happen to a 10-year regular user? Either your body's tolerance for the drug has gone down or you are getting more drug delivered by the tobacco. Nicotine is metabolized (broken down) by the liver. Therefore, in theory, bad liver disease could cause more blood nicotine, but I don't find any evidence of this happening in a quick review of the medical literature. Nonetheless, it might be worthwhile talking with your doctor. You don't describe what type of Copenhagen you use, but maybe something in the manufacture has caused a higher delivery of the drug for the amount you use (packet or wad).

Another real possibility is that somewhere along the line, the tobacco has become contaminated. Insecticides, fungicides or herbicides can contaminate tobacco and could clearly cause these kind of symptoms. The tobacco could also have become infected with a fungus or bacteria that left a residual toxin, or some solvent or machine degreaser could have contaminated the process. The tobacco industry is virtually the only consumed product which by law is totally unregulated in the US, although there is a move currently in Congress to allow the FDA to monitor them.

Something else to consider: maybe your brain is giving an unsubtle message to your body, "this-is-totally-stupid-why-don't-you-quit?" While chewing tobacco is not nearly as harmful as smoking -- kind of like jumping out of a two story window isn't as bad as jumping out of a ten story window -- it is still destructive. It's an addiction that causes a host of dental problems, lost teeth, bad breath, mouth and throat cancer and a slight rise in heart disease and lung cancer.

Bottom line: see your doctor, kick the can. You'll do more kissing and get a lot less sick.

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Response by:

Rob  Crane, MD Rob Crane, MD
Clinical Associate Professor of Family Medicine
College of Medicine
The Ohio State University