In Vietnam, it is most commonly smoked after a meal on a full stomach to "aid in digestion", or along with green tea or local beer (most commonly the cheap "bia hoi"). A "hit" of thuoc lao is followed by a flood of nicotine to the bloodstream inducing strong dizziness that lasts several seconds. It should be said however that even heavy smokers have had trouble with the intense volume of smoke and that side effects include nausea and vomiting.
The main difference between smoking thuoc lao and the use of other tobaccos is in the method of consumption, in that they are consumed with water pipe. The smoker is presented with either a bamboo pipe called a ?i?u cê y (literal translation: farmer's pipe) or a ceramic hookah called a ?i?u bát. The pipe is filled with an appropriate amount of water and a small amount of thuoc lao is pressed into the bowl.
Flowering Nicotiana rustica.
One then ignites the tobacco and inhales to create a body of smoke inside the pipe, before exhaling the smoke, reversing the process of air in the pipe by blowing into it to pop out the tobacco. The smoker then sharply inhales, usually tilting the pipe upwards to an almost horizontal position (but not completely as the water would drain out the mouth).