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Smoking Cessation Therapies


Nicotine Anonymous has no opinion on nicotine replacement therapy or any medical intervention. If you choose to go that route, it’s okay. You are still welcome in Nicotine Anonymous. I used the patch for 10 days on my last quit in 1998. It was the best I could do. I consider my quit date the date I stopped smoking, but for the purpose of nicotine anonymous it is the day I quit using nicotine. This page has been placed here only to keep the quitter informed and with options. It is up the individual for the method of recovery.



Cold Turkey

The cold turkey method of smoking cessation is a feasible initial option, as well as the least expensive option for the smoking cessation candidate. The best candidates for this method are those who smoke fewer than 10 cigarettes (half a pack) per day, have a relatively low level of nicotine dependence per the Fagerstrom Test for Nicotine Dependence (FTND) (score lower than 6 out of the possible 10 points), and individuals who don't feel they need the "extra help" nicotine replacement therapy (NRT) or bupropion could provide. Even those who smoke more than 10 cigarettes per day, or who have a high score on the FTND, can try the cold turkey method. If that method is unsuccessful in assisting the person to long-term smoke-free status, then pharmacologic (Medication) therapy can be initiated.


Nicotine Patch

The nicotine patch is first-line pharmacotherapy to be recommended in the smoking cessation clinics due to long-term success rates, safety, ease of use, and cost associated with this method. The 24-hour patch is associated with an increase of adverse events (eg, skin irritation, vivid dreams) but is definitely indicated for people who get up at night to smoke or those who smoke first thing in the morning (within 30 minutes of awakening) due to the pharmacodynamics of this delivery system. It is recommended to limit duration of therapy with the patch to no longer than 6-8 weeks, because little benefit of a longer duration has been reported in the literature. Tapering of the patch is also discouraged based on reports from the literature. Recommendations secondary to the wants and needs of each person should be created.



Nicotine Gum

Nicotine gum is also adequate first-line therapy, but it is recommended to smokers only if relapse occurred with the nicotine patch or bupropion or if smoker did not want to use the patch. The reasons for this are the extensive education that is required for proper use of the nicotine gum and the higher cost of the gum than the nicotine patch. Nicotine gum should be scheduled (eg, 1 piece every hour while awake) instead of used on an as-needed basis. This is due to the pharmacodynamics of the nicotine gum, as it takes up to 30 minutes for the nicotine from the gum to reach the central nervous system via buccal (Of or relating to the cheeks or the mouth cavity) absorption. Tapering of the nicotine gum is also strongly encouraged, as smokers may become addicted to this cessation modality. Incorrect use of the nicotine gum is evidenced by hiccups, indigestion, and rapid chewing motion by the smoker. Rotation of the buccal site where the nicotine gum is "parked" is done to minimize mouth sores commonly associated with the use of this agent.



Bupropion is first-line therapy for those who have failed other NRTs, in combination with the nicotine patch, or in those who specifically request this modality to facilitate a quit attempt. Information on the use of bupropion is provided in Table 5. Drug interactions with bupropion are important to be aware of, and one should avoid this agent in smokers with a history of seizures. Smokers could be started on bupropion 1-2 weeks prior to the quit date, and total duration of therapy should last no longer than 12 weeks with no tapering of the medication. Commonly reported side effects are headache, insomnia, and dry mouth. Combination therapy with bupropion and the nicotine patch are considered to be an option in smokers based on prior quit attempts, number of cigarettes per day (> 30 cigarettes per day), and Fagerstrom test (score of 6 or greater). Because of the higher cost of bupropion, nicotine patches were often more attractive to consumers as first-line therapy.

Nasal Spray Inhaler and Nicotine Inhaler

The nicotine nasal spray is an alternative for smokers who have failed to stop smoking through nicotine patch or nicotine gum therapy, but bupropion is an equally effective and more convenient method for this group. Because of its quick onset of action, the nicotine nasal spray may benefit heavy smokers (those smoking 2 packs or more per day) and smokers with higher levels of nicotine addiction. Frequent dosing and education is vital to success with the nicotine nasal spray. The method of delivery may cause bothersome adverse effects, limiting the use of this product by many people.

The Nicotrol Inhaler is a very expensive alternative that adds no added efficacy over the other methods. People who rely on the hand-to-mouth ritual may derive the greatest benefit from the nicotine inhaler.

Credit to www.MEDCEU.com " Smoking Cessation Methods" MEDCEU is available and accredited for use in virtually ALL STATES and the District of Columbia! Provider Number CEP12680. * The above document has been modified to meet the needs of a layman.

Varenicline (Chantix)

Varenicline (Chantix) is a newer medicine developed specifically to help people stop smoking. It works by interfering with nicotine receptors in the brain, which has two effects. It lessens the pleasurable physical effects a person gets from smoking, as well as reducing the symptoms of nicotine withdrawal.

Several studies have shown varenicline can more than double the chances of quitting smoking. Some studies have also found it may be more effective than bupropion, at least in the short term.

Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. Although these side effects can occur, in general, Varenicline is well-tolerated. Since Varenicline is a new drug, research has not been done to determine if it is safe to use along with nicotine replacement products

Consult your physician for doseage.


Many Former Smokers Become Hooked on Smoking Cessation Products

Excerpts from: A Quitter's Dilemma: Hooked on the Cure

By PETRA BARTOSIEWICZ The New York Times [05/02/04]

In 1989, Mr. Palagonia, who entertains at children's parties dressed as characters like Barney and Elmo, decided to quit. He turned to Nicorette gum to curb the cravings for a cigarette. The smoke savored between sips of his morning coffee was replaced with a peppery square. On breaks at work, driving his car, after dinner - all the times he had luxuriated in smoke - he would pop another piece.

"I got to the point that I was having problems with my teeth, and my jaw was killing me," Mr. Palagonia said. He eventually returned to smoking for a short time "to get off the gum." What ended up working for him was counseling, not a hit of nicotine.

A third of the nation's nearly 50 million smokers attempt to quit each year, according to the American Cancer Society, and that has made smoking-cessation products an $800 million business in the United States alone. The products include gum and patches sold over the counter; pills, inhalers and nasal sprays sold by prescription; and even more exotic products like nicotine-infused lollipops sold on the Internet.

Still, addiction to nicotine remains. The medical field has accepted that fact since the mid-80's, when the Food and Drug Administration approved, by prescription, products like gum to give would-be quitters a substitute comparable to cigarettes in price and nicotine content, but without other cigarette toxins.

Now some scientists and former smokers are voicing misgivings. No one disputes that cigarettes, which are laced with toxic additives like ammonia, pose far graver health risks than nicotine alone, but nicotine is also classified as a poison, and in recent studies it has been shown to break down into a substance that causes abnormal cell growth. In 2001, researchers at Stanford University found that nicotine speeds the growth of malignant tumors by stimulating the formation of the blood vessels that feed them, a process called angiogenesis.

For people addicted to nicotine, using the replacement products properly can be difficult. A study financed by GlaxoSmithKline , the pharmaceutical company that manufactures Nicorette and other stop-smoking products, found last November that more than a third of nicotine gum users continued chewing beyond the 12 weeks recommended under F.D.A. guidelines.

Even the companies that make nicotine-replacement products acknowledge problems with treating this particular addiction. Dr. Kenneth Strahs, GlaxoSmithKline's vice president for research and development in smoking control, said, "I wish we could tell you that if you took one piece of our gum it would be enough, but that's not the case. Nicotine addiction is a chronic relapsing condition."

When the F.D.A. approved over-the-counter sales of Nicorette gum and the NicoDerm CQ patch in 1996, sales of the two products soared. GlaxoSmithKline reported $578 million in global sales of over-the-counter nicotine replacements during 2003, down from $606 million the year before as other companies jockeyed for market position.

How effective these products really are remains a debate. Some ex-smokers and smoking-cessation experts oppose using nicotine at all when trying to quit. "It's like the difference between snorting cocaine and freebasing it," said Mr. Palagonia. He has neither smoked nor chewed nicotine gum for a decade now after years of meetings at Nicotine Anonymous, a 12-step program.