Nicotine & Metabolites

Nicotine & Metabolites

 

Use of tobacco products, particularly smoking, is a leading but preventable cause of disease, disability and death.

Adverse health effects include: 

  • Cancers – lung, larynx, oral cavity, nasal cavity, paranasal sinuses, esophagus, pancreas, liver, stomach, cervix and leukemia
  • Cardiac and neurologic disease – a leading cause of coronary disease, stroke
  • Pulmonary disease – chronic obstructive pulmonary disease (includes chronic bronchitis and emphysema), asthma, respiratory infections and an overall decrease in pulmonary function
  • Pregnancy – difficulty in conceiving, intrauterine growth retardation and low birth weight
  • Second-hand smoke (a confirmed human carcinogen) is implicated in pulmonary disease, lung cancer and coronary artery disease in non-smokers

Monitoring for tobacco use is helpful in the following situations:

  • Compliance with requirements in smoking cessation programs 
  • Candidates for orthopedic surgery (particularly spinal fusion), pulmonary therapy and organ transplant programs
  • Identification of tobacco-using patients on drug therapy for a variety of health problems
  • Women on high-level estrogen therapy (increased risk for stroke and heart attack) 
  • Child custody cases when parent needs to comply with smoking cessation program as condition of visitation rights
  • Experimental nicotine therapy in cognitive degeneration disorders, e.g., Alzheimer disease, Parkinson disease and attention deficit/hyperactivity disorder (ADHD)

Laboratory Testing

  • Urine testing recommended over serum/plasma testing
    • Nicotine and related compounds are detected over a longer period of time in urine and can differentiate:
      • Active user
      • Abstinent user of more than 2 weeks
      • Passive exposure
      • Unexposed non-tobacco user
      • Anabasine in urine indicates that donor is actively using a tobacco product; anabasine does not occur in nicotine replacement products
  • Serum plasma testing is required when a valid urine specimen cannot be obtained (anuretic or dialysis patient)
    • Serum/plasma cannot distinguish between last 3 categories after 2 weeks' abstinence