Nicotine Patches, Gums Won’t Help Smokers Quit Long-Term: Study

MONDAY, Jan. 9 (HealthDay News) — Nicotine patches and nicotine
gum — the popular mainstays of so-called “nicotine replacement
therapy” — don’t help many smokers kick the habit and remain
cigarette-free over the long haul, new research suggests.

This conclusion is based on results of several surveys conducted among
nearly 800 adult smokers that revealed that those who used nicotine
replacement therapy (NRT) did not gain any advantage over non-users in
terms of relapse rates.

This observation held up among both heavy and light smokers, regardless
of whether or not nicotine replacement therapy was accompanied by
professional cessation counseling.

“Even though other well-controlled studies have shown that nicotine
replacement therapy can be effective, our study looked at real-world use
over the long-term,” said study lead author Hillel Alpert, a research
scientist with the Harvard School of Public Health‘s Center for Global
Tobacco Control in Boston. “And in the real world, cigarettes are simply a
very powerful addiction. And NRT is apparently not an effective
replacement for that addiction.”

Alpert and his colleagues published their findings in the Jan. 9 online
edition of Tobacco Control. The research was funded by the U.S.
National Cancer Institute.

The study authors noted that an estimated 70 percent of smokers
interviewed said they wanted to quit, and more than 45 percent said they
made an effort to do so in the past year.

The researchers looked at the experiences of nearly 800 Massachusetts
residents who had recently quit smoking before enrolling in the study.

During three two-year “waves” (starting in 2001 and ending in 2006),
each of the participants was asked about any nicotine replacement therapy
use, which in addition to patches or gums could also include nicotine
inhalers and nasal sprays. All were also asked if they had received
counseling from a doctor or other professional, or whether they had joined
any program designed to help them quit. Relapse rates were also noted.

The result: Within each two-year survey time frame, about one-third of
the quitters had begun to smoke again. Nicotine replacement therapy
appeared to have no impact on the relapse rate, meaning that those who
used the therapy for six weeks or longer were as likely to relapse as
those who hadn’t.

The study authors concluded that the findings raise “serious questions”
about the effectiveness of nicotine replacement therapy as experienced by
most smokers: namely, outside a carefully controlled clinical setting.

The researchers suggested that the findings might have broad public
health implications, given pending plans under the federal health reform
law that Medicare, Medicaid and private insurance plans cover the costs of
nicotine replacement therapy.

“The FDA (U.S. Food and Drug Administration) has the responsibility for
regulating medications to help smokers quit, as well as new
responsibilities concerning tobacco products themselves,” Alpert said.
“So, on the one hand, it (the FDA) should only approve medications that
are proven to be effective in helping smokers quit long-term. And it has
the authority to intervene to actually reduce the addictiveness of
cigarettes, which is what this study suggests is the real issue rendering
NRT ineffective.”

Stanton Glantz, a professor of medicine in the division of cardiology
at the University of California, San Francisco‘s Center for Tobacco
Control Research and Education, said the new study “is a real challenge to
the routine use of over-the-counter NRT outside of a clinical
setting.”

“The findings don’t surprise me,” he added. “And they perhaps serve as
an important cautionary tale about the way we might want to use our public
dollars, and what is, and what is not, good public health policy.”

“For example, we already know that increasing the price of cigarettes,
public messaging, and strong legislation restricting indoor smoking work,
and work very well, as a matter of policy,” Glantz noted. “But this study
suggests that NRT doesn’t actually buy you anything when used over the
counter. So using public funds to support NRT use in that way may not be
such a great idea.

“But at the same time,” he added, “this is just one study, and it’s not
terribly huge. And this study isn’t saying that these pharmacologic aids
don’t work at all. It just says that NRT doesn’t work in the unsupervised,
over-the-counter context. So we don’t necessarily want to throw out the
baby with the bathwater.”

More information

For more on nicotine replacement therapy, visit the U.S. National Library of Medicine.

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