History and Development of Nicotine Gum
Nicotine gum was one of the first modern nicotine replacement therapies developed to help smokers quit. In the 1970s, researchers at the Karolinska Institute in Sweden were the first to study how nicotine administered through gum or skin patch could satisfy nicotine cravings without the other chemicals in tobacco smoke. This led to the first nicotine gum being approved for medical use in Sweden in the late 1970s under the brand name Nicorette. It took several more years of clinical studies before nicotine gum was approved for over-the-counter sales in the United States in 1984 and many other countries through the 1980s and 1990s.

How Nicotine Gum Works
Nicotine Gum works by delivering nicotine to the body through the inner lining of the mouth and saliva. When a piece of nicotine gum is chewed, the nicotine is released and absorbed into capillaries located in the oral cavity. This raises nicotine levels in the bloodstream, which is sensed by the brain. This satisfies cigarette cravings by activating the nicotine receptors in the brain that normally get stimulated from cigarette smoking. Nicotine gum is designed to release nicotine slowly over 30 minutes of chewing, mimicking the way cigarettes slowly administer nicotine. This helps prevent nicotine spikes and crash that could occur from other forms like nicotine inhalers or nasal sprays.

Types of Nicotine Gum Available
There are two main types of nicotine gum formulations - 2mg and 4mg. The 2mg gum is designed for regular to moderate smokers, releasing about 1mg of nicotine per piece over 30 minutes of chewing. The higher nicotine 4mg gum is meant for heavy smokers, releasing about 2mg of nicotine per piece over the same time period. All nicotine gums start with a strong initial nicotine release when first chewed to provide fast relief of cravings. The nicotine level then tapers off gradually over the chewing period to avoid spikes. Most gum packages contain 7-14 pieces depending on the strength, lasting 1-2 days when used as directed.

Effectiveness for Quitting Smoking
Numerous clinical trials and quitting studies have proven nicotine gum to be effective for helping smokers quit. On average, nicotine gum roughly doubles a person's chances of successfully quitting smoking long-term compared to trying to quit cold turkey or using willpower alone. The key to maximizing nicotine gum's effectiveness is following usage directions closely. This includes chewing each piece slowly until most of the flavor is gone. Many ex-smokers report that nicotine gum works best when a piece is chewed anytime cigarette cravings arise during the first few weeks after quitting. Continued gum use for 3-6 months after quitting substantially improves chances of long-term abstinence from smoking. Nicotine gum alone typically leads to long-term smoking cessation rates of 15-30% after 6-12 months.

Safety and Side Effects of Nicotine Gum
When used as directed, nicotine gum poses very minimal health risks. Common minor side effects during the initial weeks of nicotine gum use include hiccups, indigestion, a bitter taste in the mouth and headaches. These usually subside within a few weeks as the body adjusts to lower nicotine levels without cigarettes. Serious side effects from nicotine gum are very rare in normal, healthy adults. Nicotine poisoning requiring medical treatment is unlikely unless a chewed piece is swallowed or a whole unchewed piece is ingested. Nicotine gum should not be used by non-smokers or pregnant/breastfeeding women without medical advice due to potential nicotine exposure to the fetus or infant through breastmilk.

After over 40 years on the market, nicotine gum remains a popular and first-line medical option for smoking cessation. However, new alternative nicotine replacement therapies have emerged like patches, lozenges, inhalers and vaporizers that provide more discreet nicotine dosing. Novel nicotine gum formulations are also being researched including gums with electronic devices that monitor usage and chewing behaviors. Sustained nicotine gum research and developments are expected to continue improving this proven nicotine replacement therapy for even higher quit rates in coming years. Overall, nicotine gum still has an important future role to play for smokers making a serious attempt to quit tobacco forever.

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