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Dissolvable tobacco products under FDA scrutiny

The Food and Drug Administration will meet this week to discuss the public health impact of tobacco products known as dissolvable tobacco, which some say resemble candy, including their use by children.

Dissolvable tobacco products, which include Camel Orbs, Camel Strips and Camel Sticks, made by R.J. Reynolds Tobacco Co., are relatively new. The company introduced these products in 2009, promoting them as a way to enjoy tobacco in areas where smoking is not allowed. They all contain nicotine and dissolve in the mouth. They are not intended to help people quit smoking.

Because they produce no second-hand smoke or cigarette litter, "they are more in line with societal expectations about tobacco product use today," according to a 2010 statement from R.J. Reynolds.

However, doctors have expressed concern that these products may appeal to youth and lead to nicotine addiction at a young age. Camel Orbs are round, come in mint and cinnamon flavors, and resemble Tic Tacs or M&Ms, noted the authors of a 2010 paper in the journal Pediatrics.

"It's deceptive," Dan Jacobsen, a nurse-practitioner at the Center for Tobacco Control, part of the North Shore-Long Island Jewish Health System in Great Neck, N.Y., said of the products. To a child, "it doesn’t look dangerous; it doesn’t look like something they're going to become addicted to," Jacobsen said.

Trying the flavored products may start kids down a path of addiction that's hard to get off of, said Jacobsen, a former smoker. "I think it is definitely a threat to children," he said.

The company Star Scientific, Inc., also makes two tobacco products designed to dissolve in the mouth.

Nicotine overdose

One concern is that young children may mistake dissolvable tobacco for candy, and experience a nicotine overdose.

In children, nicotine can cause symptoms ranging from nausea and vomiting to seizures and death. Just one milligram of nicotine can cause vomiting in a child, Jacobsen said.

Camel's dissolvable tobacco products contain between 0.6 mg and 3.1 mg of nicotine, and even one high-nicotine dose Orb or Stick could lead to a severe reaction in a small child, Jacobsen said.

A concern for older children is that they could consume these products unbeknownst to adults, Jacobsen said, because the product is concealed in the mouth.

Because the dissolvable tobacco products are so new, the long-term health effects (other than nicotine addiction) are unclear.

However, studies on the composition of the products show that they appear to contain "some of the same chemicals associated with cancer risk in other tobacco products," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

"Given their close association with products known to cause egregious harm, the precautionary principle requires that we consider these products dangerous until proven safe, rather than the other way around," Katz said.

A 2008 study found that users of other smokeless tobacco products, including spit tobacco and snuff, had an 80 percent higher risk of oral cancer compared with non-users, Jacobsen said.

Change in marketing

The sale of dissolvable tobacco products is age-restricted, the packaging comes with the same health warnings as other tobacco products, and the packaging is child resistant, the 2010 R.J. Reynolds statement said.

However, even precautions such as child-resistant packaging are usually not enough to stop kids from consuming dangerous products, Jacobsen said.

The company should do away with the slick imagery on the dissolvable tobacco products and replace it with strong visual warnings of the health impacts of tobacco, Jacobsen said.

The products' flavorings should also be restricted, Jacobsen said.

"If you have something that is chocolate flavored or cherry flavored, who is that really marketing to?" Jacobsen said. "A middle-age man whose been smoking cigarettes his whole life? No, it's not."

Pass it on: Dissolvable tobacco products may pose a particular threat to children because their shape and flavors may make them appear to be candy, experts say.