A Fix for Your Addiction: Do Patches, Gum and Drugs Work?
NEW YORK - Any smoker will tell you there's no real replacement for a cigarette buzz. But there are a number of ways to wean the body off nicotine and ease the pain of withdrawal.
The nicotine patch, about the size of a pat of butter, seems to melt away serious tobacco cravings. So does another nicotine-delivery substance chewing gum. Both have been shown in numerous studies to double one's chances of quitting success.
Thursday's Great American Smokeout aims to encourage America's 47 million American smokers to quit. The American Cancer Society will team up with SmithKline Beecham, the manufacturer of the Nicoderm CQ patch and Nicorette Gum, to give new habit-kickers the information they need to stick with their chosen program.
These products aren't the only training wheels for the road to quitting. Nicotine nasal spray and inhalers, as well as the prescription drug bupropion (known by the brand names Zyban and Wellbutrin) have been shown to provide relief from tobacco cravings. Doctors are experimenting with combinations of these products, citing a mix of methods along with "a behavioral modification program works best," said Ron Todd, director of tobacco control for the American Cancer Society.
Patch It Up
The patch costs between $25 and $40 for a kit of seven. It adheres to the skin and is worn all day, then discarded and replaced. This method has proven safe for everyone except those with heart and blood vessel problems.
Heavy smokers those who smoke over 10 cigarettes per day are supposed to start with a 21- or 22-mg patch for the first six weeks. The seventh week, this is replaced by a 14-mg patch, the dose at which lighter smokers start. The tenth week, smokers go down to a 7-mg patch. A smoker is theoretically ready to go out into the world as a non-smoker after 12 weeks on the patch. Some form of social support is suggested on the patch directions.
Research indicates the patch works. A Mayo Clinic study published in the November 1999 issue of the American Journal of Public Health found that people who smoked at least 15 cigarettes a day and then went on a 24-hour, 22-mg nicotine patch for six weeks had double the success rates (8.7 percent vs. 4.3 percent) of those on a placebo.
But women may not benefit as men do from the patch. One study published in the August 1999 issue of the Journal of Consulting and Clinical Psychology found that women in three separate clinical trials of the patch had higher relapse rates than men. Other studies indicate women may have less of a physiological response to nicotine replacement therapy.
Zyban: A Quitting Prescription?
Approved by the FDA in 1997, Zyban works on the brain chemicals stimulated by smoking. Nicotine goes to the brain and stimulates the release of dopamine, the neurotransmitter responsible for feelings of pleasure. Once dopamine levels go back down, the brain screams for more. Zyban slows this craving cycle by blocking dopamine receptors in the brain.
Zyban has proven successful in clinical trials. A study published in the March 4, 1999 issue of the New England Journal of Medicine found that 30 percent of subjects given Zyban and 35 percent of those given Zyban along with the patch stayed smoke-free after 12 months compared to 16 percent in the placebo group.
It's not always covered by insurance, and Zyban can cost up to $115 for a one-month supply. Side effects include insomnia, dry mouth and temporary weight loss, the last of which is usually offset by the weight gain that results from quitting smoking. It is not recommended for people who have had seizures.
Nicotine the Way You Want It
Nicotine gum, nasal spray and oral inhalers offer one advantage over the patch: speedy delivery. While the patch provides a steady level of nicotine, these other products can be helpful when acute cravings strike, said Dr. Richard D. Hurt, director of the Mayo Clinic's Nicotine Dependence Center.
The nasal spray delivers nicotine to the bloodstream directly through the capillaries in the nasal lining. The inhaler, a tube a person puffs on, delivers nicotine to the bloodstream through the walls of the mouth, the same way the gum does.
Although Hurt recommends consulting with a physician before trying several smoking cessation products together, he stresses that combination therapies, such as the patch, Zyban and gum, are all safer and slower methods of getting your nicotine than continued smoking.
"Nothing delivers nicotine to your brain faster than inhalation," he said. "When you inhale a cigarette, the nicotine goes from the tip of your fingers to your brain within a few heart beats."