Smokers Pin Hopes on Nicotine Skin Patch : Health: Demand is high for new anti-smoking method. But experts warn the transdermal device may not be the perfect cure for the addiction.
Brian Bennett of Garden Grove heard about it over a computer network: a patch you wear like a Band-Aid that helps you quit smoking.
A 15-year smoker working in a no-smoking office, Bennett had failed to quit with hypnosis, acupuncture or raw willpower and thought he’d give the patch a try.
Now he can’t say enough good things about it:
“It’s going great. I don’t call it easy. I call it the least difficult way I’ve ever tried. I’m nine weeks into the program, and I don’t think about smoking anymore.”
Hitting the market in December, just before the New Year’s resolution season, the no-smoking patch has ignited a demand manufacturers now admit surprised them.
At least two manufacturers have resorted to seven-day-a-week round-the-clock production, and one of them cannot keep up, what with word-of-mouth testimonials such as Bennett’s fueling much of the demand.
But if they believe the new nicotine patch is a painless magic escape from smoking, “they’re going to be disappointed,” says UCLA research psychologist William J. McCarthy, who calls smoking “the most tenacious addiction we’ve ever seen.
“There’s much more to being a smoker than the nicotine. There are strong psychological components.”
Brian Bennett knows.
“What’s so hard for a smoker is dealing with both addictions at the same time,” says Bennett. “You’re trying to overcome the psychological addiction at the same time your body is giving you a headache or making you edgy.
“The patch gets rid of the physical part--or delays it. Eventually you have to deal with it, but it gives you time.”
The patch uses transdermal technology, which is based on the discovery that some drugs will dissolve into the skin like sugar DRUGdissolves into wet cloth. With the patch, nicotine leaches through the skin and into the blood to reduce smoking withdrawal symptoms.
It is available only by prescription, yet one firm already reports $109 million in sales since December. The most potent patches cost $112 to $120 for a 30-day supply.
At the start of a program--which typically lasts 10 to 12 weeks--the smoker stops smoking and begins applying one patch per day to the upper body. About four hours after applying the strongest patch, the nicotine in the blood has risen to a concentration somewhat below that of a one-pack-a-day smoker.
Studies show that is more than enough to forestall the usual nicotine withdrawal symptoms: irritability, frustration, anger, anxiety, scattered concentration and restlessness. The higher concentration is needed, however, to allay nicotine craving.
Through the weeks, smaller patches administer less nicotine and finally the supply is cut off.
“The proof of the pudding is going to be when I don’t have this patch anymore and I’m cold-turkey like the rest of them,” Bennett says.
One study published last December in the Journal of the American Medical Assn. reported on 935 people who enrolled in six-week quit-smoking programs, some using nicotine patches, some using placebos. Of those who used the full-strength patches, 26% were still abstaining from tobacco six months later.
On the other hand, quit-smoking programs run by such organizations as the American Lung Assn. and the American Cancer Assn. typically have not used nicotine substitutes, and 20% to 25% of their graduates remain nonsmokers after a year, McCarthy says.
“That’s not so good, but they are the state-of-the-art programs. Other programs--hypnosis, acupuncture, aversion therapy--work for some but are unproved for the general population.
“The most effective method of smoking cessation is a heart attack,” he says. “Of those who survive, 50% quit smoking over the long term.”
He cautions smokers against quitting without a support network.
“When they quit smoking . . . they’re creating a whole new identity,” says McCarthy.
“I have never seen as much palpable anxiety as when I walk into a roomful of people who are about to stop smoking. How are they going to look sexually attractive without a cigarette when they’ve gone their whole lives using cigarettes to look sophisticated and mature?
“Now they’re treated as pariahs, spreaders of disease. They’re barred from restaurants, meeting rooms, ostracized from everywhere but home. A lot are quitting for that reason.”
California, which in 1988 voted to tax cigarettes 25 cents a pack to fund anti-smoking efforts, now has a national reputation as a quit-smoking capital, and statistics bear out the image.
A survey by the federal Office on Smoking and Health showed that in 1985, 29% of men and 22% of women in California smoked cigarettes. In a survey five years later by state health officials, the percentage of men smokers had fallen by 8%, women by 4%.
“California has had such an incredible push to get people to stop smoking, a very successful campaign, that people are eager to quit,” says Dr. Alfred Munzer, a director for the national American Lung Assn. “People really want all the help they can get.
“In the past, most people could quit smoking without outside help. The thing is, as the number of smokers has gone down, the smokers remaining are more and more hard-core smokers who are heavily addicted and do need some help.
“For them, the patch is a breakthrough, especially compared to the (nicotine) chewing gum, which did not work all that well. With the gum, the craving would come back periodically. With a constant level of nicotine (from patches), you really get rid of the craving.”
McCarthy estimates that the nicotine patch might double the number of people who can quit smoking for the short term. “It gets them started. The question is: What good will it do for permanent cessation?”
Says Bennett: “I feel confident, because I’ve built up a reservoir of days. It’s given me a 90-day start I’m not willing to throw out the window.”
How the Nicotine Patch Works
Seventeen million Americans try to quit smoking every year, but only 1.3 million succeed, according to the surgeon general. However, a nicotine replacement therapy developed by drug companies may help some smokers gradually overcome their addiction.
NICOTINE’S JOURNEY:
1. A skin patch containing nicotine is attached to the torso, lower back or upper arm. Each lasts 24 hours and should be applied to a different site every day.
2. Nicotine passes from skin into the blood vessels, where it travels to the brain via the bloodstream.
3. In the brain, the nicotine binds to receptor cells, helping to reduce nicotine withdrawal symptoms.
4. Smokers are gradually weaned from nicotine through a series of reduced dosages. Typical treatment begins at 21 mg. reduced to 14 mg. and 7 mg. over an interval of 10 to 12 weeks.
DISADVANTAGES: Some users have reported skin irritation from the nicotine patches. Should not be used by pregnant women.
ADVANTAGES: Reduced withdrawal symptoms such as depression, inability to concentrate and cravings for cigarettes. Nicotine is delivered to the body in a less toxic form, without inhalation.
Sources: Geigy Corp.-pharmaceuticals division, ALZA Corp.
Researched by JANICE L. JONES / Los Angeles Times
