Overdose symptoms and positive affect in never-established smokers are moderated by nicotine patch type: A between-subjects experimental investigation [version 1; peer review: awaiting peer review]

Background: A growing number of studies have assessed the effects of acute nicotine on affect, cognition, and brain activity in never-established smokers in attempts to identify mechanisms by which nicotine promotes progression to dependence. However, these acute administration studies have not adequately addressed the problem of potential adverse side effects due to lack of tolerance, such as nausea, feelings of sickness, lightheadedness, and general negative affect and malaise – a term referred to as nicotine overdose events (NODEs). Thus, we report the first study to carefully characterize the prevalence, intensity, and effects of NODEs in never-established-smokers after acute nicotine administration. Methods: We compared the subjective effects of two different 7 mg nicotine patches that have different pharmacokinetics on never-established smokers ( n = 67). One patch produces gradual increases in blood nicotine and the other produces more rapid increases in blood nicotine. Results: The findings suggest that in never-smokers, the lowest dose (7 mg) of rapid blood nicotine-rise patches are associated with a high prevalence of NODEs (45.83%) and decreased positive affect (PA) (54.17%) compared to a placebo patch (8.34% for NODEs and 33.34% for PA). The slow-rise patch did not significantly affect nicotine overdose symptoms or PA. Conclusions: Fast blood-rise nicotine patches may not be an ecologically valid method of nicotine delivery to never-smokers, while slow-rise nicotine patches, lower dose, and self-paced dosing may be more appropriate in this population. Findings also highlight the importance of the careful assessment of NODES in this population.