NICOTINE GUM: THE DRUG THAT HELPS SMOKERS QUIT
It has already been used by 1.2 million smokers to help kick the habit, and is now widely available.
CAN NICOTINE help smokers quit? The answer, the result of more than a decade of experiments with 4000 smokers in a half-dozen countries, is yes. Nicotine, the poison found only in tobacco, can indeed help smokers kick their habit. Mixed with chemicals in a chewing-gum base, and sold under the trade name Nicorette, it is the first drug approved by the PDA as both a safe and an effective aid in smoking-cessation programs.
The gum, which in the United States contains two milligrams of nicotine, has been available in drugstores there, by prescription, since March. Sold in 13 other countries as a prescription medicine in varying strengths, and in Switzerland as an over-the-counter product, nicotine gum has been used by1.2 million smokers since 1978.
Cigarette smoking is now officially identified as an addiction or dependence by the National Institute on Drug Abuse and the American Psychiatric Association. And, according to psychologist Lynn T. Kozlowski of Canada's Addiction research Foundation, Nicorette is the only pharmaceutical product that has produced substantial evidence of helping smokers stop.
The cigarette habit, perhaps the most tenacious of all drug addictions, traps the smoker in a triangle: one side is social, inked with work, play, meals; one side is emotional, deeply involved with love, hate, fear, stress; both are locked into, and reinforced by, the often irresistible need for nicotine.
Nicorette gum can help smokers quit by breaking open one side of the triangle, providing smokeless nicotine that is quickly absorbed into the blood via the mucous membrane of the mouth. Thus, smokers can get their drug without inhaling tar and its cancer-causing chemicals, without breathing in carbon monoxide (thought to be involved in cardiovascular disease), and without ingesting other poison gases that attack the lungs.
Since nicotine is a powerful poison—60 mg. in the blood can kill an adult by paralyzing breathing how can it be safe in a chewing gum? The answer is that it's delivered in such tiny doses.
The average American cigarette gives a smoker about i mg. of nicotine. The gum must be chewed for 20 to 30 minutes to extract 90 percent of the 2 mg. of nicotine. The effect of inhaled nicotine reaches the brain in just 7 seconds; the effect of chewed nicotine is not as fast. Hence, Nicorette chewers' blood levels of nicotine are lower than those of smokers. Because the gum's nicotine is released and absorbed slowly, Nicorette does not give average smokers the repeated jolts they are used to from cigarettes. Also, it's almost impossible to overdose on Nicorette without first becoming nauseated, a built-in protective factor. The idea of using nicotine to help smokers quit originated in 1968 when two Swedish physiologists brought the concept to Ove Ferno, a chemist working for a pharmaceutical manufacturer in Helsingborg. Ferno, a heavy smoker who couldn't quit, was intrigued, over the next seven years, he and his colleagues worked out a system of binding nicotine into a chewing gum with an ion-exchange resin that released nicotine at a slow rate when it came into contact with saliva. Because nicotine penetrates the mucous membrane of the mouth only in an alkaline environment, Fern6 added antacids to permit the nicotine to be absorbed. The formula began producing astounding results.
In clinical trials in several countries, use of the gum, in conjunction with counseling, increased the initial quit rate of smokers by 47 to 90 percent, measured against those smokers given placebos. But experts caution that Nicorette is no magic panacea. Rather, it is a powerful ally to programs that aid the smoker during the quitting process.
Those programs that give the most intensive support and attract the most motivated smokers have the highest rate of success. However even the best programs using Nicorette achieve less than a 50-percent success at the end of a one-year follow-up.
Why? Because many smokers don't smoke only for the nicotine. Eliminating cigarettes deprives them of the rituals and pleasures of their habit. They have to want to quit, and work at it, to succeed. Studies show, however, that the most nicotine-dependent smokers are most likely to benefit from Nicorette.
It is estimated that nine out often smokers would like to give up their habit if there were an easy way, and that more than 30 million Americans have tried to do so at least once. Until now, they've had little help from the medical profession, even though more U.S. doctors have stopped smoking than has any other group, and their organizations have condemned the practice.
Doctors could have a powerful influence on their patients who smoke if they took the trouble to give brief advice and help on a routine basis, says Dr. Michael A.H. Russell, head of the addiction research unit of London's Maudsley
Hospital, and a leading authority on nicotine addiction. In an experiment, Russell showed that when doctors took just a minute or two to talk to their patients about their smoking habit and gave them a leaflet to read, the doctors could persuade 4.1 percent to give up cigarettes. Those patients who were also given Nicorette did more than twice as well.
Of course, not all patients are candidates for nicotine gum. It is not recommended for some heart patients, some peptic-ulcer sufferers or women who are or may become pregnant. A doctor should decide whether to give it to a nursing mother, since nicotine will enter her milk. It has not been evaluated in children or adolescents who smoke.
The PDA advises patients not to use Nicorette for more than three months. Actually, a number of experiments show that the gum is most effective if used for 16 weeks. People who stop smoking with the gum and then stop the gum too soon are more likely to relapse.
When prescribing the product, physicians should tell smokers to quit cigarettes entirely, since cutting down gradually merely prolongs the agony. The gum will relieve physical withdrawal symptoms, so there's no reason to delay quitting.
The patient should chew a piece of Nicorette slowly (and with frequent pauses) for 30 minutes, every time he has the urge to smoke. This enables him to extract the most nicotine at a rate that will permit it to filter through the mucous membrane. Since individuals vary in their need for nicotine, the amount of gum chewed is a personal decision.
The average quitter will use about 10 tablets a day. The PDA advises that no more than 30 pieces should be chewed in one day. After about 30 days, quitters tend to cut down on the number of pieces of gum per day. By 3 months, they are usually down to 3 pieces a day.
In the United States, Nicorette is sold only by prescription, in the 2-mg. strength, in 96-piece boxes, approximately a lo-day supply. The package costs $20, but daily cost drops as the ex-smoker tapers down on gum.
And consider the hidden health costs—the increased risk of heart disease, lung cancer and emphysema—of a lifetime of smoking. A new study* conducted by Policy Analysis, Inc., in Boston, has calculated these costs as $33,300 for the middle-aged, average male smoker, $9000 for comparable females. This comes to about $3 per pack, not including the cost of cigarettes. The same study pointed out that when a smoker quits, these costs begin dropping and are typically cut by half. For an investment of about $150 in chewing gum, the smoker has a good chance of kicking a financially expensive habit that threatens health and life.
CAN NICOTINE help smokers quit? The answer, the result of more than a decade of experiments with 4000 smokers in a half-dozen countries, is yes. Nicotine, the poison found only in tobacco, can indeed help smokers kick their habit. Mixed with chemicals in a chewing-gum base, and sold under the trade name Nicorette, it is the first drug approved by the PDA as both a safe and an effective aid in smoking-cessation programs.
The gum, which in the United States contains two milligrams of nicotine, has been available in drugstores there, by prescription, since March. Sold in 13 other countries as a prescription medicine in varying strengths, and in Switzerland as an over-the-counter product, nicotine gum has been used by1.2 million smokers since 1978.
Cigarette smoking is now officially identified as an addiction or dependence by the National Institute on Drug Abuse and the American Psychiatric Association. And, according to psychologist Lynn T. Kozlowski of Canada's Addiction research Foundation, Nicorette is the only pharmaceutical product that has produced substantial evidence of helping smokers stop.
The cigarette habit, perhaps the most tenacious of all drug addictions, traps the smoker in a triangle: one side is social, inked with work, play, meals; one side is emotional, deeply involved with love, hate, fear, stress; both are locked into, and reinforced by, the often irresistible need for nicotine.
Nicorette gum can help smokers quit by breaking open one side of the triangle, providing smokeless nicotine that is quickly absorbed into the blood via the mucous membrane of the mouth. Thus, smokers can get their drug without inhaling tar and its cancer-causing chemicals, without breathing in carbon monoxide (thought to be involved in cardiovascular disease), and without ingesting other poison gases that attack the lungs.
Since nicotine is a powerful poison—60 mg. in the blood can kill an adult by paralyzing breathing how can it be safe in a chewing gum? The answer is that it's delivered in such tiny doses.
The average American cigarette gives a smoker about i mg. of nicotine. The gum must be chewed for 20 to 30 minutes to extract 90 percent of the 2 mg. of nicotine. The effect of inhaled nicotine reaches the brain in just 7 seconds; the effect of chewed nicotine is not as fast. Hence, Nicorette chewers' blood levels of nicotine are lower than those of smokers. Because the gum's nicotine is released and absorbed slowly, Nicorette does not give average smokers the repeated jolts they are used to from cigarettes. Also, it's almost impossible to overdose on Nicorette without first becoming nauseated, a built-in protective factor. The idea of using nicotine to help smokers quit originated in 1968 when two Swedish physiologists brought the concept to Ove Ferno, a chemist working for a pharmaceutical manufacturer in Helsingborg. Ferno, a heavy smoker who couldn't quit, was intrigued, over the next seven years, he and his colleagues worked out a system of binding nicotine into a chewing gum with an ion-exchange resin that released nicotine at a slow rate when it came into contact with saliva. Because nicotine penetrates the mucous membrane of the mouth only in an alkaline environment, Fern6 added antacids to permit the nicotine to be absorbed. The formula began producing astounding results.
In clinical trials in several countries, use of the gum, in conjunction with counseling, increased the initial quit rate of smokers by 47 to 90 percent, measured against those smokers given placebos. But experts caution that Nicorette is no magic panacea. Rather, it is a powerful ally to programs that aid the smoker during the quitting process.
Those programs that give the most intensive support and attract the most motivated smokers have the highest rate of success. However even the best programs using Nicorette achieve less than a 50-percent success at the end of a one-year follow-up.
Why? Because many smokers don't smoke only for the nicotine. Eliminating cigarettes deprives them of the rituals and pleasures of their habit. They have to want to quit, and work at it, to succeed. Studies show, however, that the most nicotine-dependent smokers are most likely to benefit from Nicorette.
It is estimated that nine out often smokers would like to give up their habit if there were an easy way, and that more than 30 million Americans have tried to do so at least once. Until now, they've had little help from the medical profession, even though more U.S. doctors have stopped smoking than has any other group, and their organizations have condemned the practice.
Doctors could have a powerful influence on their patients who smoke if they took the trouble to give brief advice and help on a routine basis, says Dr. Michael A.H. Russell, head of the addiction research unit of London's Maudsley
Hospital, and a leading authority on nicotine addiction. In an experiment, Russell showed that when doctors took just a minute or two to talk to their patients about their smoking habit and gave them a leaflet to read, the doctors could persuade 4.1 percent to give up cigarettes. Those patients who were also given Nicorette did more than twice as well.
Of course, not all patients are candidates for nicotine gum. It is not recommended for some heart patients, some peptic-ulcer sufferers or women who are or may become pregnant. A doctor should decide whether to give it to a nursing mother, since nicotine will enter her milk. It has not been evaluated in children or adolescents who smoke.
The PDA advises patients not to use Nicorette for more than three months. Actually, a number of experiments show that the gum is most effective if used for 16 weeks. People who stop smoking with the gum and then stop the gum too soon are more likely to relapse.
When prescribing the product, physicians should tell smokers to quit cigarettes entirely, since cutting down gradually merely prolongs the agony. The gum will relieve physical withdrawal symptoms, so there's no reason to delay quitting.
The patient should chew a piece of Nicorette slowly (and with frequent pauses) for 30 minutes, every time he has the urge to smoke. This enables him to extract the most nicotine at a rate that will permit it to filter through the mucous membrane. Since individuals vary in their need for nicotine, the amount of gum chewed is a personal decision.
The average quitter will use about 10 tablets a day. The PDA advises that no more than 30 pieces should be chewed in one day. After about 30 days, quitters tend to cut down on the number of pieces of gum per day. By 3 months, they are usually down to 3 pieces a day.
In the United States, Nicorette is sold only by prescription, in the 2-mg. strength, in 96-piece boxes, approximately a lo-day supply. The package costs $20, but daily cost drops as the ex-smoker tapers down on gum.
And consider the hidden health costs—the increased risk of heart disease, lung cancer and emphysema—of a lifetime of smoking. A new study* conducted by Policy Analysis, Inc., in Boston, has calculated these costs as $33,300 for the middle-aged, average male smoker, $9000 for comparable females. This comes to about $3 per pack, not including the cost of cigarettes. The same study pointed out that when a smoker quits, these costs begin dropping and are typically cut by half. For an investment of about $150 in chewing gum, the smoker has a good chance of kicking a financially expensive habit that threatens health and life.
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