The nicotine-candy connection

A tobacco company’s new, dissolvable nicotine pellet — which in some cases resembles popular candy — could lead to accidental nicotine poisoning in children, according to a new study. The researchers also say the candylike products could appeal to young people and lead to nicotine addiction.

The study by the Harvard School of Public Health (HSPH), the Northern Ohio Poison Control Center, the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA) appears in the April 19 online edition of the journal Pediatrics, and will appear in a later print issue.

Last year, the R.J. Reynolds Tobacco Co. launched a dissolvable nicotine product called Camel Orbs, which, according to the company’s promotional literature, contains 1 mg of nicotine per pellet and is flavored with cinnamon or mint. The company also introduced Camel Strips (0.6 mg nicotine per strip) and Sticks (3.1 mg nicotine per strip).

The product apparently is intended as a temporary source of nicotine for smokers in settings where lighting up is banned. However, the potential public health effect could be disastrous, particularly for infants and adolescents, said Professor Gregory Connolly, lead author of the study and director of the Tobacco Control Research Program at HSPH.

Ingestion of tobacco products by infants and children is a major reason for calls to poison control centers nationwide. In 2007, 6,724 tobacco-related poisoning cases were reported among children 5 and under. Small children can experience nausea and vomiting from as little as 1 mg of nicotine.

“This product is called a ‘tobacco’ product, but in the eyes of a 4-year-old the pellets look more like candy than a regular cigarette. Nicotine is a highly addictive drug, and to make it look like a piece of candy is recklessly playing with the health of children,” said Connolly.

The researchers computed, based on median body weight, how much nicotine ingestion would lead to symptoms of poisoning in children. A 1-year-old could suffer mild to moderate symptoms by ingesting eight to 14 Orbs, 14 Strips, or three Sticks. Ingesting 10 to 17 Orbs, 17 Strips, or three to four Sticks could result in severe toxicity or death. A 4-year-old could have moderate symptoms by ingesting 13 to 21 Orbs, 14 Strips, or four Sticks, and could suffer severe toxicity or death by consuming 16 to 27 Orbs, 27 Strips, or five Sticks. The researchers reported that a poison control center in Portland, Ore., a test market for Orbs, reported a case in which a 3-year old ingested an Orbs pellet.

R.J. Reynolds says the Orbs packaging is “child-resistant,” but the researchers say adults could unknowingly leave the pellets out in the open where children could easily access them. The researchers also say that the candylike appearance and flavoring and ease-of-use of the product can appeal to children.

The report is called “Unintentional Childhood Poisonings Through Ingestion of Conventional and Novel Tobacco Products,” and its other authors are Patricia Richter, Alfred Aleguas Jr., Terry F. Pechacek, Stephen B. Stanfill, and Hillel R. Alpert.