Trying to quit smoking? Patches, drugs help: study

Wed Sep 5, 2012 7:33pm EDT

Cigarette butts in an ashtray in Los Angeles, California, May 31, 2012. REUTERS/Jonathan Alcorn

Cigarette butts in an ashtray in Los Angeles, California, May 31, 2012.

Credit: Reuters/Jonathan Alcorn

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(Reuters) - Trying to stop smoking? Smokers have considerably more success when they use nicotine patches or prescription medications than when they try to go it alone, an international study found.

Past research has yielded conflicting evidence on the effectiveness of such aids since they seem to work in clinical trials, but less so in a real-life setting.

But the current researchers, whose findings appear in the journal Addiction, found that some quitting aids were linked to four-to-six-fold higher success rates.

"Smokers in the United Kingdom, Canada, Australia and the United States are more likely to succeed in quit attempts when they use (drugs) or nicotine patch," wrote study leader Karin Kasza, a statistician at Roswell Park Cancer Institute in Buffalo, New York, and colleagues.

Kasza and her team surveyed more than 7,400 adult smokers in the United States, Britain, Canada and Australia on their quit attempts, including whether they even remembered every time they resolved to give up cigarettes.

They then tracked these people to see how many had succeeded in staying smoke-free for at least six months.

About 2,200 people used a prescription medication or nicotine replacement therapy, but the rest did not.

Among those who used no medication to quit, five percent managed to stay smoke-free for six months.

In comparison, 18 percent of nicotine patch users, 15 percent of people who used buproprion - an antidepressant - and 19 percent of people who used a medication called varenicline stayed off cigarettes for six months.

After taking into account factors that could affect people's success, such as how long and how heavily they had smoked, the researchers determined that buproprion and the nicotine patch were each tied to a four-fold increase in quitting success compared with those who used no medications, and varenicline to a nearly six-fold increase.

Eight percent of people who used oral nicotine replacement products, such as gum, stayed abstinent for six months.

Overall, the researchers found, people who tried to quit without any aids were likely to be younger, have lower incomes, be less addicted to nicotine and have higher confidence in their ability to break the smoking habit than those who used aids.

The study does not prove that the medications are responsible for the greater success in quitting, merely that people who use them are more likely to quit.

"The disappointing reality is that even when people use these medications to help them quit, relapse is still the norm. It's better than nothing, but it's by no means a magic bullet," Kasza said.


(Reporting from New York by Kerry Grens at Reuters Health; Editing by Elaine Lies and Paul Tait)

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Comments (1)
PolitoJR wrote:
“Considerably more success?” The authors have clearly cherry-picked quit attempt findings. When all quit attempts are considered, there is no significant effect of nicotine gum (14%), nicotine patch (15%) or bupropion (14%) versus no-medication (14%) at 6 months (see Table 1).

This 4 nation ITC survey did not find NRT effective. That conclusion was drawn by a team of researchers that included a Pfizer speaker’s bureau salesman after “adjusting” data.

Most notably, as noted by Professor Michael Siegel of Boston University School of Public Health, “the final conclusions exclude from analysis all surveyed medication quitters who retrospectively declared that they had not used NRT, bupropion or varenicline to quit ‘completely.’ ” The total number excluded was greater than the total number of successful medication quitters.

Additionally, in creating a medication comparison standard (“no medication”) the authors lumped abrupt cessation (cold turkey) with gradual weaning/tapering quitters when an earlier ITC study using the exact same survey found abrupt cessation twice as effective as weaning ( see Cheong Y, 2007 Nicotine and Tobacco Research), thus watering down the comparison standard.

Also, due to differing survey questions being asked during Wave 5 and earlier, successful non-medication quitters may have been wrongly classified as medication quitters.

While meds clobber placebo inside clinical trials, in all truly independent population level quitting method studies since 2000 (studies not authored by paid pharma industry consultants), replacement nicotine has been found to be worse or no better than quitting without it.

The pharma industry understandably wants to put a dent in real-world ineffectiveness. What you’ll never hear pharma say is the truth: that more long-term ex-smokers will stop smoking cold turkey during 2012 than by all other methods combined.

Pharma cannot point to a single independent study where any approved quitting product defeats cold turkey. To the contrary, Doran May 2006 (Addictive Behaviors) followed the smoking patients of 1,000 Australian family practice physicians. Not only did “cold turkey” generate a whopping 88% of all successful quitters, it doubled NRT and Zyban success rates.

Impossible to blind experienced quitters as to placebo group assignment, RCT efficacy findings measuring expectations, frustrations and the benefit of ongoing weekly counseling and/or support to the well fed active arm, what’s needed are intellectually honest smoking cessation studies. It’s time to pit “real” cold turkey quitters who want to quit cold turkey against real “medication” quitters who get exactly what they seek.

John R. Polito
Nicotine Cessation Educator

Sep 06, 2012 9:32am EDT  --  Report as abuse
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