Effects of nicotine replacement for smoking reduction

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This week, Dr David Moore and colleagues at the University of Birmingham (UK) published a review of randomized controlled trials of nicotine replacement for reducing smoking in smokers who initially did not plan to quit. The review, published in the BMJ, included 7 trials involving 2767 smokers.

They found that of smokers entering these trials intending only to reduce their smoking almost 7% of those who used nicotine replacement and just over 3% of those who used placebo NRT eventually quit smoking for 6 months.

The study also examined whether there were any signs that it is unsafe to use nicotine replacement therapy while still smoking. They found that discontinuation of treatment due to serious adverse events was rare (less than 2% for both NRT and placebo groups). The only symptom that appeared to be significantly more frequent in those receiving NRT (rather than placebo) was nausea. 9% of those using NRT experienced some nausea and 5% of those receiving placebo reported nausea. So there does not appear to be any serious safety concerns with using NRT while reducing smoking.

The authors concluded that nicotine replacement therapy is an effective intervention in achieving sustained smoking abstinence for smokers who have no intention or are unable to attempt an abrupt quit. Most of the evidence, however, comes from trials with regular behavioral support and monitoring and it is unclear whether using nicotine replacement therapy without regular contact would be as effective.

In one sense it is impressive that NRT is able to produce significantly more long term quitters, given that none of the people recruited to these trials wanted to quit at that point. On the other hand, the quit rate is not very high (under 7%).

For me, the other practical problem that wasn’t really addressed in the main conclusions was the issue of cost/payment for NRT. In these research trials participants are typically provided with NRT for free. But I don’t see many smokers, who are not trying to quit, paying out of pocket for NRT for 6-18 months while still paying for their cigarettes. Similarly, why publicly funded healthcare systems may subsidize NRT and counseling for those trying to quit, I don’t see this happening for smokers simply trying to gradually reduce with no intention of quitting.

So while it is good to know that NRT is safe and effective as an aid to reduced smoking, and that when used that way more smokers actually quit, I don’t see NRT being widely used in the real world the way it was in these clinical trials.

It is interesting that exposing smokers who arn’t planning to quit to NRT results in more of them quitting. I suspect that the same thing would happen were NRTs promoted as a treatment for nicotine withdrawal symptoms during periods of brief/temporary abstinence (eg while at work, in smokefree environments etc). Some are concerned that such use would diminish quitting. I suspect it would just teach many smokers that they can function quite well by getting their nicotine from a less harmful source…and prompt more to switch to NRT completely.

You can read the full report at: http://www.bmj.com/cgi/content/abstract/338/apr02_3/b1024
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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