How long should you use nicotine replacement?

When treating patients who are trying to quit after decades of smoking, I often hear the statement after a couple of weeks, “I’m concerned that I might get addicted to the nicotine replacement therapy, so I’m going to use as little as possible.” My reply is that you can’t become addicted to nicotine because you were already addicted to it (from cigarettes). If the whole aim of the game here is to improve your health, then the most critical thing is to successfully quit smoking (i.e. inhaling over 4000 toxic chemicals into your lungs). So you have to do whatever it takes to succeed in stopping smoking. The answer to the question, “how much nicotine replacement should I take?” is always, “enough to get your cravings and withdrawal levels down to a comfortable level so you don’t smoke". For some people that will be a single 21mg nicotine patch per day, but for others it might be the same patch plus ten pieces of 4mg nicotine gum. It is fine to use as little as possible, so long as you don’t smoke. But my advice is to take enough to reduce the discomfort and the suffering to easily manageable levels. You don’t get any extra points or credit for suffering more!

Then, assuming you quit for a month, there’s the question of how long to keep taking nicotine replacement medication. With regards to the patch on its own, I don’t see much evidence in the scientific literature to suggest that using the patch for longer than the label suggests (typically around 10 weeks) has any useful relapse prevention effect. Part of the reason for this is that the patch is not something you can take in response to a cue induced craving, or a bad mood (withdrawal?). You put it on first thing in the morning and then it’s a passive nicotine delivery system. The other NRTs, however, have the potential for acute use as a “rescue” medication. That is, when someone who has been quit for, say, 16 weeks, finds themselves at a wedding, having a drink, and chatting to someone who is smoking, they will likely experience a resurgence of craving for a cigarette. In that situation, if the person had been using 4mg nicotine gum, it is likely that use of the gum would decrease the chances of them having a lapse smoke. So even though most NRTs are intended for use for less than 12 weeks, I recommend that ex-smokers keep using them until they have 14 consecutive days with no withdrawal symptoms, cravings or near lapses. And even once you have reduced NRT consumption down to very low levels it is a good idea to keep your favored product handy for months. It is much better to relapse back to NRT than cigarettes.

So the answer to the question is, “as long as it takes.”

Labels: jonathan foulds, Nicotine Replacement, NRT, smoking cessation

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