Wearing the patch prior to quitting

The normal recommended way to use the nicotine patch is to choose a “Target Quit Day”, smoke your last cigarette and get rid of all your tobacco the night before it, and then start wearing the patch instead of smoking on the morning of your quit day. The nicotine patch helps with smoking cessation by reducing the severity of nicotine withdrawal symptoms and cravings.

The labeling on the nicotine patch recommends against smoking (or using any other nicotine products) while wearing the patch. I’ve discussed previously that there is now good evidence suggesting that using another nicotine replacement therapy (e.g. nicotine gum or inhaler) while wearing the patch may aid smoking cessation. This month a new study was published by Drs Shiffman and Ferguson from Pittsburgh, which suggests that wearing nicotine patches for at least two weeks prior to the target quit date actually increases quit rates one month and six months later. Shiffman and Ferguson combined the data from four randomized trials comparing outcomes for those wearing the patch while smoking before trying to quit, with those wearing placebo or no patches prior to the quit day. The results found that those who wore the patch for at least two weeks before their quit day were almost twice as likely to still be not smoking six months later.

It seems that smoking while wearing the patch for a few weeks doesn’t really add anything to the usual risks of smoking. But perhaps the main question is why this helps people quit? We don’t know for certain but I suspect that wearing the patch while smoking for a couple of weeks serves to reduce the rewarding effects of smoking. The continuous supply of nicotine from the patch desensitizes nicotine receptors and ensures that only a few receptors are ready to be stimulated at any one time. This may reduce the down-stream stimulation of the brain’s reward pathway (and release of dopamine) when the person smokes. Perhaps a couple of weeks of less rewarding smoking is enough to weaken the strength of the addiction?

As mentioned above, this is not yet normal practice, but it shows that a more flexible approach to the use of nicotine replacement therapy can often obtain better results.

Reference:
Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis.Addiction. 2008 Apr;103(4):557-63.

Labels: jonathan foulds, nicotine patch, smoking cessation

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