Smoking-Cessation Drugs Health Article

Definition

Smoking cessation drugs are medicines that help people stop smoking cigarettes or using other forms of tobacco.

Purpose

People who smoke cigarettes or use other forms of tobacco often have a difficult time when they try to stop. The difficulty is partly psychological; they get in the habit of using tobacco at certain times of day or while they are doing certain things, such as having a cup of coffee or reading the newspaper. But the habit is also hard to break for physical reasons. Tobacco contains nicotine, a drug that is as addictive as cocaine or heroin. Of those who have ever tried even a single cigarette, about a third will become nicotine-dependent. A person who is addicted to nicotine has withdrawal symptoms, such as irritability, anxiety, difficulty concentrating, and craving for tobacco when he or she stops using tobacco.

Some people can stop smoking through willpower alone, but most do better if they have support from friends, family, a physician or pharmacist, or a formal stop-smoking program. Heavy tobacco users may find that smoking cessation products also help by easing their withdrawal symptoms. Most smoking cessation products contain nicotine, but the nicotine is delivered in small, steady doses spread out over many hours. In contrast, when a person inhales a cigarette, nicotine enters the lungs and then travels to the brain within seconds, delivering the "rush" that smokers come to crave. Another difference is that smoking cessation products do not contain the tar, carbon monoxide, and other toxins that make cigarettes so harmful to people's health. According to one Canadian study, tobacco smoke contains over 40 different chemicals known to cause cancer.

The importance of smoking cessation is reflected in legal penalties against the tobacco industry for its longstanding denial of the harm caused by tobacco products. Recent legal findings against the tobacco industry have led to legislation in three states concerning lawsuits against the industry. In Florida, state agencies can sue on behalf of Medicaid recipients for repayment of benefits. Maryland allows the use of statistical analysis in lawsuits against tobacco companies. In Vermont, the state can bring direct lawsuits against tobacco manufacturers to recover Medicaid benefits for tobacco-related illnesses paid after April 1998. Nineteen states (Alabama, Alaska, Connecticut, Florida, Hawaii, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Montana, New Hampshire, New York, Rhode Island, Texas, Vermont, Virginia, Washington, and Wisconsin) have set aside as of 2001 a portion of their money from tobacco settlements to smoking prevention programs.

Nicotine replacement products

Smoking cessation drugs that contain nicotine are also called nicotine substitution products or nicotine replacement therapy. There are four forms approved by the Food and Drug Administration (FDA) as of 2001— chewing gum, skin patch, nasal spray, and inhaler. The nasal spray and inhaler are available only with a prescription, but the gum and some brands of the patch can be bought over the counter (without a prescription). People who buy the nonprescription products should check with a physician before starting to use them. The patches are sold under the brand names Nicotrol, Nicoderm CQ, and Habitrol (prescription only). The gum is sold under the brand name Nicorette. The nasal spray and inhaler are marketed as Nicotrol NS and Nicotrol respectively. The costs of these products are about $30 for a box of 48 pieces of the gum and about $30 per week for the patches.

Other medications

Another type of smoking cessation drug, bupropion (Zyban), also reduces craving and withdrawal symptoms, although it is not a nicotine replacement product. Bupropion is an antidepressant medication that is thought to help people stop smoking by mimicking some of the effects of tobacco on brain tissue. Bupropion can be used together with nicotine replacement products; several studies indicate that the combination helps more smokers quit than either method by itself.

Buspirone (BuSpar) is a tranquilizer that appears to be effective in helping smokers deal with feelings of anxiety resulting from tobacco withdrawal.

Alternative approaches

Other approaches that have been used to help smokers quit include hypnosis and acupuncture. The evidence for the usefulness of hypnosis is largely anecdotal; it appears to be most helpful when used in combination with nicotine replacement products or bupropion. Although acupuncture has been used in Western countries since the 1970s to help people quit smoking, it does not appear to be particularly effective in this regard. A British study that was published in 1999 found that smokers who received acupuncture did not have a higher quit rate than those who received only sham acupuncture.