Smoking-Cessation Aids Show Waning Success

Nicotine replacement products, such as gum and patches, have become readily available in recent years, but their usefulness appears to be waning when it comes to helping smokers quit for the long term.

A new study by San Diego researchers found that smoking-cessation aids were more helpful prior to the mid-1990s, when physicians had to write a prescription for the products. But since becoming available over the counter, the aids--which ease nicotine withdrawal symptoms--have not proved beneficial in promoting long-term cessation. The study, published in last week’s Journal of the American Medical Assn., is the first to examine the effectiveness of nicotine replacement products in the general population.

The authors, John P. Pierce and Elizabeth A. Gilpin of UC San Diego’s Cancer Prevention and Control Program, say more research should be devoted to how to use the products effectively. For example, the products may have worked better in their early years because doctors selected the most appropriate candidates, and when writing a prescription, were likely to instruct the patient on how to best use the product. Moreover, doctors may have been more likely to recommend behavioral counseling along with nicotine replacement.

“They are helpful with withdrawal symptoms. But unless you do something to handle the psychological dependence of smoking, people are going to go back to smoking,” Pierce says. “Smoking is much more than a physiological addiction. It’s a psychological addiction too.”

Since going over the counter, nicotine replacement therapies have been heavily advertised on television and in the print media, Pierce notes. But the ads rarely address the need for accompanying behavioral therapy to increase the chances for success, he says.

“Pharmaceutical advertisements ... started treating [nicotine replacement therapy] like it was a magic bullet,” he says. “People had the expectation that the drug would do everything. I think the advertisements should say ‘this will help you in quitting, but remember you have to substitute other behaviors for smoking.’ ”

By approving the products for over-the-counter use, federal health officials may have been hoping that more people would have access to them. But, Pierce says, nicotine replacement is being widely used “by lighter smokers who many physicians would not have recommended it to.”

The nicotine replacement products have no effect on helping these light smokers quit, the study showed. More than one-third of all users of nicotine-replacement products are light smokers, defined as smoking fewer than 15 cigarettes a day.

GlaxoSmithKline, makers of Nicorette gum and the NicoDerm skin patch, took issue with the study, however, saying that other studies have contradicted it.

“For people who want to quit without such support programs, the clinical evidence strongly suggests that [nicotine replacement therapy] on its own approximately doubles the chances of success compared to quitting without assistance,” the company said in a statement.

Moreover, the company offers a personalized support program--an online program or printed material that focuses on smoking behavior--to consumers who purchase Nicorette or NicoDerm CQ.

The new study analyzed data from more than 15,000 adult smokers statewide who participated in annual California tobacco surveys in 1992, 1996 and 1999. Both the percentage of smokers trying to quit and the use of smoking-cessation products increased over that seven-year span.

More than one-third of all smokers try to quit each year. Those who seek assistance in quitting tend to be the most dependent smokers, Pierce says.