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Patches, medication help in quest to quit tobacco products: research

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, the 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, 5 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 sixfold increase.

Eight percent of people who used oral nictoine 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.”

1 Comment
September 6, 2012    John R. Polito - john@
This superficial review of Kasza ITC fails to advise readers that the study found no benefit ("clear effects") for those using the nicotine gum or nicotine lozenge.

This 4 nation survey did NOT find NRT effective. That conclusion was drawn after a team of researchers that included a Pfizer speaker's bureau salesman cherry-picked and adjusted data (see 8/21/12 study review by Dr. Michael Siegel entitled "New Study Reports Effectiveness of Smoking Cessation Medication But is Biased Towards Finding an Effect; Financial Conflict of Interest Present").

Most notably, the study's 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 two recent studies found abrupt cessation twice as effective as weaning (including an earlier study using this exact same ITC survey - see Cheong Y, 2007 Nicotine and Tobacco Research), thus watering down the comparison standard.

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

As noted by Dr. Siegel, "The study finds that the effectiveness of medication greatly increases among subjects who report having made their most recent quit attempt in the past month or two. When all quit attempts are considered, there is no significant effect of nicotine gum, the nicotine patch, or bupropion" (no medication 14% vs. medication 16%).

While meds clobber placebo inside clinical trials, in all truly independent population level quitting method studies since 2000 NRT has been found to be worse or no better than quitting without it. Understandably, pharma wants to put a dent in real-world ineffectiveness.

There's consensus that more smokers will stop smoking cold turkey during 2012 than by all other methods combined. Also, pharma cannot produce a single independent study where any approved quitting product defeats cold turkey. To the contrary, Doran May 2006 (Addictive Behaviors), followed smoking patients of 1,000 Australian family practice physicians. Not only did cold turkey account for a whopping 88% of all successful long-term quitters, it doubled NRT and Zyban success rates.

The medicinization of smoking cessation has ground successful quitting to near standstill. Hundreds of thousands of needless deaths, it's my opinion that the pharma industry's unwillingness to promote intellectually honest quitting product research (medication vs. "real" cold turkey quitters) has left it with blood on its hands.

John R. Polito - Nicotine Cessation Educator
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