By Dr Ananya Mandal, MD
Smokers have been advised a host of choices for nicotine replacement like gums, patches and nasal sprays to help them quit. But a new U.S. study says that these do not help people quit cigarettes over the long term any better than going it alone.
The research by the Harvard University School of Public Health followed 787 adults in the state of Massachusetts who had recently quit smoking, and found that over time just as many relapsed after nicotine replacement therapy (NRT) as without - about a third. “This study shows that using NRT is no more effective in helping people stop smoking cigarettes in the long term than trying to quit on one's own,” said lead author Hillel Alpert, a research scientist at Harvard.
Study participants were surveyed over three periods: 2001-2002, 2003-2004, and 2005-2006. Not only were relapse rates about the same among those who used NRT and those who did not, the study found that heavily dependent smokers who took NRT without professional therapy were twice as likely to relapse as those who did not use NRT.
The participants told whether they had used a patch, gum, inhaler, or spray. They told how long they used the product continuously. The recommended practice is to use the product for eight weeks. Most did not use the products. For instance, at the first interview, 77% did not use them. Those who did use them did so for various time periods. At the first interview, the 33% of those who used the products did so for more than six weeks. About one-third of the quitters had relapsed at each of the three time periods.
“This may indicate that some heavily dependent smokers perceive NRT as a sort of 'magic' pill, and upon realizing it is not, they find themselves without support in their quitting efforts, doomed to failure,” said the study in the journal Tobacco Control.
This study refutes earlier randomized controlled studies that have shown NRT to be effective in helping smokers quit. These authors show the weakness of those trials among the general population in a real-life setting. The study also showed that very few people follow the recommendations of using NRT for eight weeks, with many opting for shorter periods of use.
The NRT industry has boomed since nicotine gum was introduced in 1984, according to background information in the article. Back then, NRT products were a $US45 million industry in the United States. Since over-the-counter sales of NRT were approved in 1996, the industry has soared to $US800 million ($787 million) per year. On top of that, sales of prescription drugs to stop smoking reached $US841 million in 2007. More public funds are also helping to subsidize stop-smoking therapies to low-income Americans, with 39 state Medicaid programs covering one or more kinds of NRT in 2011, compared to 17 states in 1996.
Meanwhile, rates of smoking in the United States have leveled off at about 20 per cent of the population in the past five years after a steady period of decline. “What this study shows is the need for the Food and Drug Administration...to approve only medications that have been proven to be effective in helping smokers quit in the long-term and to lower nicotine in order to reduce the addictiveness of cigarettes,” said co-author Gregory Connolly, director of Harvard's Center for Global Tobacco Control.