Consumption patterns and biomarkers of exposure in cigarette smokers switched to Snus, various dissolvable tobacco products, Dual use, or tobacco abstinence.

The objectives of this clinical study were to evaluate changes in tobacco product use behavior and levels of selected biomarkers of exposure (BOEs) for smokers who switched to one of six conditions during clinical confinement: exclusive use of; Camel Snus, Sticks, Strips or Orbs, controlled Dual use of cigarettes and Camel Snus, or tobacco abstinence. The controlled Dual use (DU) condition mandated a 60% reduction in cigarettes smoked per day (CPD). 167 healthy U.S. male and female smokers were randomized to the six groups (n=25-30/group). Subjects smoked their usual brand of cigarette for 1 day prior to switching to their designated intervention condition. Levels of thirty-two BOEs in plasma, whole blood, urine and feces were determined before and after switching. Questionnaires that scored nicotine dependence and withdrawal discomfort were also administered. After 5 days, exclusive Snus, Sticks, Strips, or Orbs use averaged 6.1, 5.9, 13.5, and 8.5 units/day, respectively. DU subjects smoked 7.6 CPD and used 3.2 Snus pouches/day, on average. After 5 days, substantial reductions of most biomarkers, including nicotine, were observed in all groups. Toxicant exposures were similar to being tobacco abstinent after switching exclusively to Camel Snus, Sticks, Strips or Orbs. DU reductions were more modest.

Comparison of consumption patterns, biomarkers of exposure, and subjective effects in cigarette smokers who switched to dissolvable tobacco (Camel Orbs), dual use, or tobacco abstinence.

INTRODUCTION: The objectives of this trial were to investigate short-term changes in product usage, tobacco-related biomarkers of exposure, and subjective effects in smokers who switched to dissolvable tobacco (Camel Orbs) use. METHODS: Participants were randomized into 1 of 4 groups (continued smoking, switched to consuming Orbs, switched to dual use of cigarettes and Orbs, and tobacco abstinent) and confined for 6 days with dietary restrictions. Most measurements were at baseline and days 1, 3, and 5 of intervention. Mouth-level tar and nicotine exposures were estimated by filter tip analysis. Twenty biomarkers were quantified in 24-hr urine; 4 were quantified in blood/plasma (carboxyhemoglobin, nicotine, cotinine, and thiocyanate). Ratings for nicotine dependence and withdrawal symptoms were scored. RESULTS: After 5 days, substantial and statistically significant reductions (~30%-90%) in all biomarkers were observed in the Orbs and abstinent groups compared to baseline. Numerous smaller reductions (~7%-30%) were also noted in the continued smoking and dual-use groups (generally similar in magnitude for both groups). Subjective questionnaire findings indicated greater withdrawal discomfort levels throughout the intervention period for the nonsmoking groups. For subjects that continued smoking, clinical confinement conditions did not significantly alter product use behavior and toxicant exposure profile compared to baseline. CONCLUSIONS: Substantial reductions in toxicant exposure occurred for participants that did not smoke. Cigarette smokers that switched to Orbs use showed reductions in all biomarkers, similar to abstinent group. Changes in toxicant exposure for the dual-use group were similar to the continued-smoking group, consistent with minimal changes observed in that group's product use behavior (small reduction in cigarettes per day and small increase in Orbs use).