Key takeaways
- Nicotine overdose is rare for smokers, but still possible.
- Amount of nicotine to cause overdose still undetermined
- Nicotine ingestion, not inhalation, more likely to cause overdose
- Vomiting, headaches, and diarrhoea common symptoms
- Quitting smoking prevents possibility of nicotine overdose
Nicotine overdose or poisoning is always possible for anyone consuming nicotine, including cigarette smokers, users of nicotine vaping products (NVPs), and even users of nicotine replacement therapies (NRT) like patches, sprays and gums.
If you’re a nicotine user, it’s important to know how nicotine overdose happens and how to prevent it.
Let’s take a closer look at this topic in today’s post.
Nicotine Overdose: How it Happens
Nicotine overdose can happen to anyone at any age. For instance, a small child might accidentally ingest a piece of nicotine gum which contains 2 to 4mg of nicotine, and this alone could be enough to cause nicotine poisoning.
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The chemical can be absorbed through inhalation, ingestion, chewing (in the case of gum), or through skin contact.
Nicotine absorption through the skin or eyes can cause overexposure, especially if it’s the ingestion of liquid nicotine – the most common cause of nicotine overdose. Illegal NVPs can contain as much as 357mg per disposable unit, making them extremely dangerous if they malfunction, leak, or end up being consumed in some way by a child or pet.
What are Illegal NVPs?
With the new vaping regulations implemented on 1 March 2024, it’s now illegal to buy NVPs from anywhere except registered pharmacies. However, you’ve likely seen them being sold illegally in your local tobacconist or corner store.
They’re imported under the radar and distributed by criminal groups (the same ones importing drugs) and are commonly made with very low manufacturing quality and hygiene practices. Furthermore, they’re marketed directly towards teenagers and children as young as 5 years of age.
These dangerous products have been found to have extremely high nicotine levels, have been found to contain heavy metals like nickel and lead and even traces of human saliva, and are manufactured and sold for maximum profit (a wholesale price of $1 marked up more than 3,500%).
How Much Nicotine Is Too Much Nicotine?
You may have been a nicotine user for years or decades and have never felt any symptoms of nicotine overdose.
While nicotine overdose is extremely rare, especially if it’s through inhalation via cigarettes or NVPs, the actual threshold that nicotine overdose can occur is still undetermined.
The Centers For Disease Control and Prevention (CDC) mentions that the lethal dose of nicotine inhalation for adults is between 50 to 60mg. But, this is likely not the case at all, as this figure was based on a 1969 study on nicotine overdose using lab mice and rats and a 1949 study that does not cite any relevant data at all.
Basically, nicotine overdose can occur in varying doses to anyone of any size and age and through the method of intake – such as inhalation or ingestion.
Ingestion and intravenous administration are two methods that have been suggested as having the highest probabilities to induce nicotine overdose.
A study of a nicotine-related death in 2008 had found that ingesting 2 to 4 drops of pure nicotine – each drop containing 23 to 33mg – was lethal enough for an adult of 42 years of age with a history of alcoholism and drug abuse.
One review of various research published in Archives of Toxicology in 2014 suggests that the possible minimum lethal dose of ingested nicotine is between 6.5 to 13mg per kilogram (at 6.5mg, that’s over 450mg total for a 70kg person).
In one 2019 study published in Clinical Toxicology, survivors of nicotine overdose between the age 13 to 53 were found to have ingested between 0.8mg to 1.6mg per litre of nicotine.
How Much Nicotine Is in Every Cigarette?
A single cigarette can contain as much as 12 to 15mg of nicotine with only 1 to 2mg absorbed by the body via inhalation. If you’re a 20s pack-a-day smoker, you’re probably consuming about 10 to 20mg of nicotine over the course of an entire day.
But as with cigarettes and combustion, it’s not the nicotine that would cause harm – it’s the chemicals in the smoke you inhale.
How Much Nicotine Is in Every Illegal Vape?
A single illegal NVP can contain as much as 357mg per disposable unit, which can be extremely dangerous if it were to leak or be ingested quickly – especially to teenagers and young children.
Because of the poor quality of illegal vapes in the market, their actual nicotine content varies depending on the product, and their tendency to remain leakproof and safe is also very poor.
A 2016 study showed that some of the devices yielded 10mg of nicotine per decilitre with 10 puffs – a higher amount than a single cigarette stick.
But, another study in 2019 opposes this finding and suggests that 30 puffs are needed for an illegal NVP to deliver the same nicotine amount as a single cigarette stick.
As you can see, there really aren’t any crystal clear findings at the moment.
Factors That Increase the Risk of Nicotine Overdose
While the actual amount of nicotine enough to cause overdose is still undetermined, the following factors can increase or decrease that risk:
Nicotine Concentration
As mentioned, every cigarette contains up to 15mg per stick wherein 1 to 2mg is absorbed in the body. However, there are some cigarette brands that could pack in higher doses of nicotine in their products.
The same can be said for illegal NVPs, which aren’t tested and do not abide by any medical standards and manufacturing practices.
Also remember that the ingestion of pure or liquid nicotine might have the highest risk of nicotine overdose as suggested by the studies above – inhalation, chewing, and topical intake may possibly reduce the nicotine you absorb.
Individual Tolerance
Young children will have a significant intolerance of nicotine as opposed to a fully-developed adult human. It’s possible that a nicotine gum or patch is enough to trigger overdose in young children.
For adults, it can be a significantly higher amount.
Weight
If you’re stockier or bigger, it might take more than the average amount of nicotine to cause an overdose.
However, with the many unknowns when it comes to the actual amount that triggers poisoning, it’s possible that your size might not insulate you against the effects of small amounts of nicotine ingestion.
For instance, if you have a negative response to nicotine absorption via inhalation, it could prove to be fatal.
Symptoms of Nicotine Overdose
Nicotine overdose symptoms can range from mild to extreme. Here is a list to help you know when to see a GP or call emergency services for immediate aid and recover from your symptoms.
- Nausea and Vomiting
- Increased Heart Rate
- Hypertension
- Dizziness and Lightheadedness
- Excessive Salivation
- Diarrhoea
How to Help Someone With Nicotine Overdose
If you discover that someone has suffered from nicotine overdose, make sure to call your local emergency services immediately.
While waiting for help, try to keep the person calm and in a comfortable position. If the person is conscious and able to swallow, give them water to drink to help dilute the nicotine in their system.
Do not induce vomiting. Instead, monitor their breathing and pulse and update the first responders about the person’s latest condition.
Pharmacy NVPs: A Medically Supported Way to Wean Off Nicotine
NVPs that you can buy from your local pharmacy are a legitimate path towards smoking cessation. While they’re second-line solutions after going through nicotine replacement therapy (NRT), pharmacy NVPs are thoroughly tested for inhalation safety, are medically supported, and are locally insured – each product is manufactured with the highest medical standards.
While a pharmacy NVP cartridge can contain up to 50mg of nicotine, this is very slowly consumed via inhalation over the course of one to three days.
With this gradual intake method, you’ll learn to feel your body, understand your cravings and thresholds, and self-titrate as needed.
Here’s how you can go about it.
Go Through First-Line Solutions First
Some motivated smokers can handle cold turkey just fine and see success within a few tries, but oftentimes, smokers have strong withdrawals that can draw them back to lighting a stick.
That’s where NRT products come in. These are readily available and stocked at your local pharmacy.
NRT products are the most trusted quitting option available for motivated smokers. They might not imitate cigarettes, but they contain a small dose of nicotine that may be enough to alleviate your withdrawals. These come in the form of patches and gums for easy and convenient nicotine delivery.
While NRTs can be effective, they don’t work for everyone. If these haven’t done the trick for you, you may now be eligible for a nicotine prescription to use nicotine vaping products (NVPs).
Chat to a GP
As mentioned, NRT products have worked for many successful ex-smokers. But, you might have ingrained behaviours and triggers that only something that mimics a cigarette can successfully address, such as the hand-to-mouth motion, and needing something to use while having a drink with friends.
That is where NVPs become very handy in helping you fight the urge to consume tobacco.
You need a nicotine prescription before you can purchase NVPs, so you’ll need to consult with a GP to help you on your smoking cessation journey.
If your GP deems it necessary, they can write you a nicotine prescription for NVPs.
Chat to your usual GP about this, or book a telehealth consult with an Authorised Prescriber of nicotine.
Visit Your Local Pharmacy
Once you have your nicotine prescription, you can pop down to your local pharmacy. Over 2,200 pharmacies across Australia hold these products in-store, but any pharmacy can order these in for you if they don’t currently stock them.
Both your pharmacist and GP can advise you on how best to use the product, such as the initial setup, and the number of puffs to take when you feel withdrawals.
Summary
Nicotine overdose is a very rare occurrence for any nicotine user – the most likely harms come from inhaling the thousands of chemicals found in cigarette smoke.
If you’re ready to start on your quit journey, we’re always here for you.
Smokefree Clinic gives you access to many medically reviewed and trustworthy resources that can inform and aid you in your path to wellness, so have a look around!
If you’re ready to get started, Smokefree can connect you to friendly Australian healthcare professionals who excel in helping patients quit smoking for good, including via the use of pharmacy NVPs.