20 Nov 2006

Start patch before quitting

Giving nicotine patches a two-week "head start" more than doubles the chances they'll help smokers kick the habit, research finds.

A US team found that by applying the patch 14 days before that last cigarette, users greatly boosted their long-term success rate.

The initial study was published earlier this year in the journal Nicotine and Tobacco Research, and a second trial has now replicated those findings, according to Jed E. Rose, medical research professor and director of Duke University's Centre for Nicotine Cessation Research. He led the original study and is co-inventor of the nicotine patch.

Possibly too toxic
One concern for some experts was that wearing a patch while still smoking might prove too toxic, or actually boost addiction by putting more nicotine in the body.

Not true, Rose said. "We have also found in the recent studies that the success rate is double even when smokers switched to a low nicotine or de-nicotinised cigarettes during the two week pre-cessation treatment period, and this procedure further allays any concerns about the possibility of nicotine overdose."

In the original study, the Duke team tracked the progress of 96 smokers who expressed a desire to quit. Half wore the patch two weeks before their quit date; the others wore a "dummy" patch that had no nicotine.

After four weeks, 23 percent of those wearing the fake patch for two weeks before stopping had quit. In contrast, 50 percent of those who wore the real patch for two weeks before their quit date managed to kick the habit.

Patch tied to smoking less
Those who wore the active patch before the target quit date also smoked less than usual during the two weeks before quitting and reported fewer cravings and withdrawal symptoms. The theory is that cigarettes are less rewarding and less satisfying when there is already a level of nicotine in the body supplied by the patch.

But Rose added one caveat: "Although there is no evidence that [using the patch while smoking] poses any problem, the current labelling on nicotine replacement products advises against doing so," he said. Rose believes the labelling should be re-evaluated by the US Food and Drug Administration.

Following instructions, the typical smoker applies a new patch each day to a different area of dry, clean skin in an area that is not hairy - usually the upper chest, arm or hip. The patch is worn for about 16 to 24 hours, depending on specific product instructions.

The smoker switches to a lower-strength patch after being on the original one, perhaps after the first two weeks, and then uses the patches from six to 20 weeks, depending on the instructions.

Side effects aren't common but can include dizziness, vomiting, redness at the patch site or upset stomach, according to the US National Institutes of Health. Smokers are advised to check with their doctors about how best to use the patches and to alert doctors to symptoms such as abnormal heartbeat or difficulty breathing.

The patches deliver a low but continuous level of nicotine that helps quell cravings, according to the FDA. But, "when delivered through the nicotine patch it is not addictive," said another expert, David Kalman, an assistant professor of psychiatry at Boston University.

Delivery makes the difference
"What makes nicotine addictive is pretty much what makes any drug addictive, and that has to do with the mode of delivery," he said. "When you smoke, it gets into the arterial blood stream and goes immediately to the brain in a large dose." However, when delivered via the patch, nicotine "enters the venous system and doesn't go immediately to the brain," Kalman said.

Based on studies in the literature, Kalman said, "about five in 100 [users] quit on a given quit attempt" if they do it "cold turkey," without medication, counselling or other help.

Adding the nicotine patch bumps that quit-success rate up to 20 percent to 25 percent, he said. "Success" is defined as not smoking one year later.

While patches come in various doses, Kalman's research found no significant differences in quit rates of smokers who used 21 milligram patches vs. 42 milligram patches.

His study focused on smokers who also had alcohol dependence and was published in the April 2006 issue of the Journal of Substance Abuse and Treatment. A 21-milligram patch is roughly equal to about 15 cigarettes a day, while a 42-milligram patch corresponds to 30 cigarettes, he said.

Use for at least 8 weeks
Kalman said those who opt for the patch to help them quit should use it for at least eight weeks. Patience is key, he said.

"Years and years of smoking produces changes in the brain. When you stop smoking, it takes time for the brain to readjust," Kalman said. – (HealthDayNews)