Smokeless tobacco: An emerging addiction

Smokeless tobacco use is prevalent in the United States and long-term use leads to significant morbidity. ST users are exposed to high levels of nicotine and are observed to graduate to higher nicotine-containing ST products, perpetuating nicotine dependence. Although few proved pharmacotherapies exist, available evidence suggests that bupropion SR might be effective for increasing ST abstinence rates. Behavioral therapies that include an oral examination may be especially effective for this population of tobacco users. Nicotine replacement therapy should be used to treat withdrawal symptoms in ST users attempting to stop.