Do Nicotine Patches Work? Are Nicotine Gums Effective?

Harvard study suggests nicotine patches, gums don’t work. Do nicotine patches work? If we go by the results of recent findings from the most rigorous long-term study of nicotine replacement therapy (NRT) products so far, the answer is, no.

The study, which looked at thousands of smokers, including nearly 800 people trying to quit smoking over a period of several years, shows that nicotine gum and patches have no lasting benefit and may even backfire in some cases.

The new study, published Jan. 9 in the journal Tobacco Control, runs counter to previous medical studies that showed the products effectively helped people quit, at least in the short term.

The World Health Organization and government drug regulators like the United States Food and Drug Administration used those earlier findings as a basis for their recommending NRTs.

For many years now, WHO has recommended the use of NRT products together with smoking cessation counseling as effective means to help smokers quit. Smoking cessation, in turn, is part of a six-fold strategy of the global health organization to address what it calls the “tobacco epidemic.”

“The tobacco epidemic is one of the biggest public health threats the world has ever faced,” says WHO in its website, “killing nearly six million people a year—five million are users and ex-users and more than 600,000 are nonsmokers exposed to secondhand smoke.”

At least half of all the people who smoke or use tobacco will eventually die of lung cancer or any other tobacco-related disease. Tobacco users who die prematurely deprive their families of income, jack up the costs of health care for entire communities and collectively, hinder the overall economic development of whole countries.

Tobacco is a leading cause of death, illness and impoverishment in almost all countries of the world today. Because of this, public health authorities have joined hands with doctors and communities in building a growing global tobacco control movement.

The movement, backed by WHO, has been urging governments to adopt six measures that, taken together, have been proven to cut smoking rates drastically.

The measures include:
• banning smoking in public places to protect people from secondhand smoke
• enforcing bans on tobacco advertising, promotion and sponsorship
• requiring companies to place graphic warnings on labels of cigarettes and other tobacco products
• raising tobacco taxes
• monitoring tobacco use and prevention policies
• providing smoking cessation help like putting up clinics that provide counseling and NRT products for smokers who want to quit

“We were hoping for a very different story,” Dr. Gregory N. Connolly, director of Harvard’s Center for Global Tobacco Control and a co-author of the study tells the New York Times. “I ran a treatment program for years, and we invested” millions in treatment services.

But in the study of Dr. Conolly and colleagues, smokers who used the replacement products, either on their own or as part of a program, reported in surveys that they received little benefit from the gums and patches.

The new study also followed one particular group of smokers to see if nicotine replacement affected their odds of kicking the habit over time. It didn’t, even if they also received counseling with the nicotine replacement.

Stopping addiction
About two in every three smokers want to stop smoking. But without help, many will fail. The main reason why so few smokers succeed, even though they want to stop, is that they’re addicted to nicotine—and nicotine addiction is strong and difficult to break.

Nicotine is a drug that is inhaled from the tobacco in cigarettes. From the lung, it gets into the bloodstream and stimulates the brain.

In regular smokers, when blood level of nicotine falls, they usually develop withdrawal symptoms like restlessness, increased appetite, inability to concentrate, irritability, dizziness, constipation, nicotine craving, depression and anxiety.

These symptoms begin within a few hours after having the last cigarette and when they aren’t relieved by the next cigarette, they get worse.

This is where nicotine replacement therapy (NRT) is supposed to help. NRT products get nicotine into the bloodstream without smoking. When used as indicated, they are supposed to stop, or reduce, the symptoms of nicotine withdrawal.

Aside from nicotine gums and patches, there are inhalers, tablets, lozenges and sprays. Mostly, they’re available over-the-counter, but for some NRTs, you need a prescription.

When they were first released on the market, nicotine patches were available by prescription only. But since 1996, many nicotine gums and patches for use as “stop-smoking aids” have been available OTC. In October 2002, the FDA approved a lozenge containing nicotine. Because they’re approved and allowed OTC, many state Medicaid programs cover at least one of these NRTs.

Global sales of these replacement products has soared in recent years, rising to more than US$800 million annually in 2007 in the U.S. alone, from US$129 million in 1991.

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