title: Constituents of smoke from cigarettes made from diverted nicotine replacement therapy patches.
abstract: OBJECTIVE
  Anecdotes of nicotine replacement therapy patch misuse associated with the introduction of smoke-free prisons have been reported by media internationally, including Canada in 2006, New Zealand in 2011 and Australia in 2014. This study identifies chemical compounds released through diverted nicotine replacement therapy patches when they are smoked.
  
  
  METHODS
  Two samples were produced: (i) shredded 21 mg nicotine replacement therapy patches rolled with tea leaves into a cigarette; and (ii) patches boiled in water and tea leaves, and then dried tea leaves rolled into a cigarette. The smoke was tested for nicotine, caffeine and toxins. High-performance liquid chromatography, mass spectrometry and spectrophotometry were used to detect the presence and quantity of nicotine and caffeine. A specialised laboratory was contracted to test the presence of toxins.
  
  
  RESULTS
  Nicotine was liberated when the two samples were burnt but not if the nicotine replacement therapy patches were boiled in water alone. High concentrations of formaldehyde, acetaldehyde, acrolein, toluene, xylene and heavy metals were also released.
  
  
  CONCLUSIONS
  Nicotine is released when diverted nicotine replacement therapy patches are smoked, as are caffeine and harmful toxins. These toxins have the potential to cause short- and long-term health damage.
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia.
authors.forename: Hana
authors.initials: H
authors.lastname: Morrissey
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ball
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Boland
authors.affiliation: Tobacco Control Research Program, Menzies School of Health Research, Royal Darwin Hospital, Darwin, Australia.
authors.forename: Marita
authors.initials: M
authors.lastname: Hefler
authors.affiliation: Tobacco Control Research Program, Menzies School of Health Research, Royal Darwin Hospital, Darwin, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Thomas
mesh_terms: D002110:Caffeine / Q000737:chemistry*; D002851:Chromatography, High Pressure Liquid; D006801:Humans; D013058:Mass Spectrometry; D009538:Nicotine / Q000737:chemistry*; D011330:Prisons; D012906:Smoke / Q000032:analysis*; D012907:Smoking / Q000009:adverse effects; D013053:Spectrophotometry; D013662:Tea / Q000737:chemistry; D062789:Tobacco Products / Q000032:analysis*; D061485:Tobacco Use Cessation Devices
chemical_list: D012906:Smoke; D013662:Tea; D002110:Caffeine; D009538:Nicotine
keywords: nicotine; pharmacology; prison; smoke-free policy; smoking cessation