In reference to the AHRQ 91 January abstract, below: The jury remains out on the question of which toxins are culpable in injuries sustained by the developing fetus, among mothers who use tobacco products. Is it nicotine, carbon monoxide, any of the complex tars that comprise the smoke, etc.? There is an enduring reversion to the notion that cigarette smoking is the needed target of our efforts; yet in so doing, we sidestep the question of the toxicity of nicotine alone – and thus the risk of lozenges, vaping, gum, any of the delivery systems.

In the words of a lay publication on alcohol use disorders from the 1930s, “The persistence of this illusion is astonishing.”  In fact, with the advent of DSM5, we have taken a step backward from the practice of identifying a specific chemical with a substance use disorder, and are now stuck with “tobacco use disorder.” In that regard, there seems little doubt: it is nicotine. It should always have been a “nicotine use disorder”, unless we wished also to return to “Willow Bark” from acetylsalicylic acid. That the fetus becomes a target of injury in conjunction with inhaled tobacco use doesn’t let other forms of nicotine off the hook, and if anything, invites a wider range of research.

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM