3.20 Tobacco poisoning

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3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

Smokers subject their bodies to continued exposures to low amounts of nicotine, leading to tolerance. However dizziness, nausea and vomiting may occur in response to tobacco use before tolerance is established.43 These symptoms also accompany cases of acute nicotine poisoning, which may occur through ingestion of tobacco or other products containing nicotine (such as pesticides or nicotine-replacement medications) or through absorption of nicotine through the skin, either from exposure to pesticides, unprocessed tobacco leaves (see 'green tobacco sickness' below), or nicotine-replacement medications.43

Nicotine poisoning causes nausea, vomiting, abdominal pain, diarrhoea, headaches, sweating and pallor. In more extreme cases it can lead to dizziness, weakness and confusion, followed by convulsions, a drop in blood pressure, and coma. Death may occur through respiratory failure.43 Although highly toxic, death due to ingested tobacco is extremely rare due to the unpleasant flavour of tobacco, the vomit response and early metabolism of the nicotine.43 A study of cigarette or cigarette butt ingestion by children as reported to a state Poison Control Centre in the USA has shown that vomiting is the most common response, and that significant toxicity is rare.115 Cases have also been reported in which children have ingested or had transdermal exposure to nicotine replacement therapy patches, causing symptoms of nicotine poisoning and in more severe cases requiring hospitalisation.116 (For further information on the properties of nicotine, see Chapters 6 and 12).

Nicotine is a scheduled poison in Australia, its distribution being controlled by state and territory drugs and poisons legislation, all of which refer to a nationally accepted Standard for Uniform Scheduling of Drugs and Poisons devised by the Therapeutic Goods Administration of the Australian Government.117 In an exemption considered by many public health interests to be anomalous, tobacco prepared and packed for smoking is excluded from the standard.

3.20.1 Green tobacco sickness

Green tobacco sickness (GTS) affects individuals involved in tobacco farming, especially during the harvesting season.118, 119 GTS occurs when nicotine is absorbed through the skin from direct contact with tobacco leaves and enters the bloodstream. Sufferers commonly experience dizziness, nausea, headache and vomiting; less frequent symptoms include abdominal pain, shortness of breath, diarrhoea, altered heart rate and blood pressure, sweating and increased salivation.118, 119 Non-smokers are more likely to be affected by GTS than smokers,120 which has in some cases lead to tobacco growers encouraging workers to take up smoking.119 GTS is treated with rest and rehydration, and treatment of additional symptoms if required. The incidence of GTS is reduced by provision of appropriate protective clothing and other workplace safety measures.118, 119

GTS is common, a recent international review reporting that 8–89% of tobacco harvesters may be affected in the course of a season, this wide variation probably being due to differences between study methodologies as well as a range of working conditions.119 There are an estimated 33 million tobacco farm workers in the world, a substantial proportion living in developing countries. Long-term health outcomes for individuals exposed to nicotine transdermally for extended periods of time are not known.119