January 10, 2012
New Doubts Surface About Nicotine Replacement Therapies
According to a rigorous long-term study of so-called nicotine replacement therapy, nicotine gum and patches that millions of smokers use to help kick their habit have no lasting benefit and may backfire in some cases, reports Benedict Carey for the NY Times.
The study of 787 people attempting to quit smoking over a period of several years is likely to inflame a long-running debate about the value of nicotine alternatives. In surveys smokers who have used the over-the-counter products, either as part of a program or on their own, have reported little benefit.
The new study followed one group of smokers to see whether nicotine replacement affected their odds of kicking the habit over time. Even if they also received counseling with nicotine patches, gum, inhalers or nasal sprays, results were very poor over the long term.
Those who had used replacements were just as likely to relapse as those who had quit without them, researchers from Harvard University and the University of Massachusetts found.
“This may indicate that some heavily dependent smokers perceive NRT [nicotine replacement therapy] as a sort of ℠magic´ pill, and, upon realizing it is not, they find themselves without support in their quitting efforts, doomed to failure,” the researchers wrote.
The new study examined former smokers three times over a five-year period. At the midpoint of the study, 30.6 percent of recent quitters had gone back to smoking. By the end, 31.3 percent had relapsed.
We were hoping for a very different story,” said Dr. Gregory N. Connolly, director of Harvard´s Center for Global Tobacco Control and a co-author of the study. “I ran a treatment program for years, and we invested” millions in treatment services.
“Patient compliance is a very big issue,” Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic, who was not involved in the study told the NY Times reporter. Hurt continues by claiming products like nicotine gum and patches “are absolutely essential, but we use them in combinations and doses that match treatment to what the individual patient needs,” unlike smokers who are self-treating.
However, GlaxoSmithKline Consumer Healthcare, makers of Nicorette, Nicoderm, Commit lozenges and other smoking cessation products, explain that relapse rates are due to users not completing the recommended program instructions.
The company noted that most of the adults in the study who used nicotine replacement products didn´t use them for the recommended eight weeks. Had those people followed directions, they might have had more success.
“Hundreds of clinical trials involving more than 35,000 participants and extensive consumer use for more than 20 years have proven both the efficacy and safety of NRT when used as directed,” the company said in a statement. “NRT products have helped millions of smokers quit by gradually weaning them off of their tobacco addiction and is recommended as a first-line therapy for quitting,” they told Karen Kaplan of the Los Angeles Times
Professor of medicine in the division of cardiology at the University of California, San Francisco´s Center for Tobacco Control Research and Education, Stanton Glantz, tells USA Today 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.”
The stusy was published Monday in the journal Tobacco Control.
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