Addiction to the nicotine gum in never smokers

Internet questionnaire in 2004–2006 in a self-selected sample of 434 daily users of nicotine gum. To assess dependence on nicotine gum, we used modified versions of the Nicotine Dependence Syndrome Scale (NDSS), the Fagerstr？m Test for Nicotine Dependence and the Cigarette Dependence Scale.Five never smokers used the nicotine gum daily. They had been using the nicotine gum for longer than the 429 ever smokers (median = 6 years vs 0.8 years, p = 0.004), and they had higher NDSS-gum Tolerance scores (median = 0.73 vs = -1.0, p = 0.03), a difference of 1.5 standard deviation units. Two never smokers had never used smokeless tobacco, both answered "extremely true" to: "I use nicotine gums because I am addicted to them", both "fully agreed" with: "after a few hours without chewing a nicotine gum, I feel an irresistible urge to chew one" and: "I am a prisoner of nicotine gum".This is to our knowledge the first report of addiction to nicotine gum in never users of tobacco. However, this phenomenon is rare, and although the long-term effect of nicotine gum is unknown, this product is significantly less harmful than tobacco.Nicotine replacement therapy (NRT) is effective to treat tobacco dependence, and about one third of smokers ever used NRT products [1-3]. In many countries, NRT products can be obtained on general sales, in drugstores or on the internet, without a medical prescription and without counselling [3]. NRT products are therefore easily accessible to nonusers of tobacco. Since nicotine has the potential to be addictive, there is a possibility that non-users of tobacco may become addicted to NRT products. There is to our knowledge, however, no published case of addiction to NRT products in never smokers or in never users of tobacco. Among former smokers who used the nicotine gum to quit smoking, the prevalence of dependence on the gum is very low, about one percent [4-6]. The proportion of never-smokers and never-users of tobacco among regular nicotine gum users