Advance Patch Helps Smokers Quit

Smokers who want to give up cigarettes may be able to double their chances of success by wearing nicotine patches before quitting, new research suggests.

Currently, the patches are not recommended for use by people who have not yet quit smoking, and researchers say it is too soon to recommend that smokers use any nicotine replacement products in this way.

"Smoking remains an enormous public health problem," says Jed E. Rose, PhD, who directs the Duke University Center for Nicotine and Smoking Cessation Research.

"A treatment strategy that doubles success rates over and above conventional ways of using the same treatment could have a significant and positive effect on public health."

Most Smokers Want to Quit

There are roughly 50 million smokers in the United States, and two out of three say they want to give up the habit for good.

Nicotine replacement products are widely used for quitting and are available in a variety of forms including skin patches, gum, nasal sprays, inhalers, lozenges, and tablets.

Because of concerns about nicotine overdose, none of the products is recommended for use by people who are still smoking, and the labeling for the products specifically warns against using them while smoking. Symptoms of nicotine overdose can range from nausea and vomiting to death.

But active smokers are exactly the people who may derive the most benefit from them, Rose says.

Rose and Duke University colleagues tested the theory in a study of 96 one-pack-a-day cigarette smokers who wanted to quit. Their findings are published in the Feb. 1 issue of the journal Nicotine and Tobacco Research.

Nicotine Patch Boosts Success

Half of the study participants wore nicotine patches two weeks prior to quitting, and the other half wore placebo patches that did not contain nicotine. People were also assigned to certain kinds of cigarettes to use for the two weeks prior to the quit date. Some smoked their regular cigarettes, some were assigned low-tar and low-nicotine cigarettes, and some received cigarettes with almost all nicotine removed. On the target quit date, the participants were assigned to receive different amounts of nicotine patches and some received placebo patches. All participants were given the smoking cessation drug Inversine.

A month later, half the smokers who had worn the nicotine patches before quitting were still not smoking, while only about a quarter of those who initially got the placebo patches remained smoke-free.

Rose tells WebMD that preliminary findings from a larger study involving 400 smokers confirm the results. He plans to present that research at the annual meeting of the Society for Research on Nicotine and Tobacco in two weeks.

A similar study by different researchers, published in 2004, included 100 smokers who wore nicotine patches two weeks before quitting and an equal number of smokers who wore placebo patches.

Six months after the target quit date, 22% of the pre-cessation nicotine patch users were still not smoking, compared with 12% of the participants who wore the placebo patches.

"All three studies suggest a doubling in the quit rate," Rose says. "That is a significant effect."

Strategy Appears Safe

Rose says the FDA may need to re-evaluate its current warning against smoking while wearing the nicotine patch if the findings are confirmed.

Nicotine overdose has not been found to be a problem in any of the studies.

Smoking cessation expert Scott J. Leischow, PhD, tells WebMD that early concerns about nicotine overdosing have not been borne out by the research.

"What these studies seem to show is that rather than getting a lot more nicotine, people tend to compensate for the nicotine they get through the patch," he says.

In other words, when smokers get the nicotine their bodies crave they tend to smoke fewer cigarettes.

Rose likens it to sitting down to a big meal when you are already full.

"When wearing a nicotine patch, the body and brain already have a certain level of nicotine, so the cigarette's delivery of nicotine is not as noticeable," he says.

Leischow, who is deputy director of the Arizona Cancer Center at the University of Arizona, says smokers who use nicotine replacement medications for a short time before quitting may end up using them more effectively.

He is a former senior advisor for tobacco policy for the U.S. Department of Health and Human Services and former chief of the Tobacco Control Research Branch for the National Cancer Institute.

"This approach looks very promising," he says. "Clearly, a more effective method of using these medications could be very beneficial."

Sources: Rose, J.E. Nicotine and Tobacco Research, Feb. 1, 2006; online edition. Jed E. Rose, PhD, director, Duke Center for Nicotine and Smoking Cessation, Duke University Medical Center, Durham, N.C. Scott J. Leischow, PhD, deputy director, Arizona Cancer Center, University of Arizona; former senior advisor for tobacco policy, U.S. Department of Health and Human Services.

By Salynn Boyles
Reviewed by Louise Chang, MD
© 2006, WebMD Inc. All rights reserved