Abuse liability of transdermal nicotine patch: a case of “nicotine buzz”

Background: Transdermal nicotine patches are widely used for the treatment of nicotine dependence. The abuse liability of nicotine replacement therapies is considered low because of an absence of peaks observed with smoking. While typically well-tolerated, higher doses of transdermal nicotine patches may pose risks of adverse effects, as illustrated by a case of a young adult experiencing euphoria with a 63 mg patch. Case report: A 27-year-old male with a history of multiple substance use, including cannabis, alcohol, and tobacco, was abstinent from tobacco with the use of a 21 mg/day transdermal nicotine patch. He increased the dosage to 63 mg/day temporarily, experiencing heightened alertness and a cannabis-like “buzz” sensation. Subsequent education on appropriate patch use led to a reduction in dosage and the disappearance of the sensation. Conclusions: While higher doses have been utilized to manage cravings, associated adverse effects and potential for abuse emphasize the need for careful monitoring and individualized dosing strategies. Healthcare professionals should educate patients on the appropriate use of transdermal nicotine patches to mitigate risks and maximize therapeutic benefits.