Most smokers try to stop multiple times before finally kicking the habit, and fewer than 10% will succeed in permanently abstaining without medicine or counseling. Nearly 1 in 5 Americans are at least occasional smokers, risking cancer, heart disease and a shortened life span -- and costing the nation more than $193 billion annually, including healthcare costs and decreased workplace productivity among smokers, the CDC says. They continue to light up even as employers increasingly charge higher health insurance premiums for smokers. Nicotine’s hold on the brain is not easily broken, as the struggles of President Obama – a very self-disciplined man by all accounts – illustrate. Many would-be quitters, like the president, relapse when the appeal of nicotine is simply too strong. For the vast majority who can’t go it alone, researchers and pharmaceutical companies are developing new treatments that can help smokers stub out that final butt. And they are finding newer, more effective ways to use nicotine-replacement therapies such as gum and patches.
Nicotine replacements Nicotine replacement therapies, which have been around since the 1980s, work by fulfilling the desire for nicotine in a noncigarette form. Nicotine replacements come in patches, gum, lozenges, inhalers and nasal sprays. In a recent analysis, published in 2008 in the journal Addiction, Saul Shiffman, a psychologist from the University of Pittsburgh, concluded from four separate studies that starting the nicotine patch two weeks before quitting cigarettes doubles a smoker’s chance of success. Some subjects used the patch before quitting, while others did not, and Shiffman’s analysis examined whether people were smoke-free six weeks, and then six months, after a target quit date. In three of the studies, patch users were smoking fewer cigarettes even before their planned quit day, though they had not been told to do so.
Zyban Zyban, the commercial name for bupropion, is a smoking cessation aid that contains no nicotine. It was first marketed as the antidepressant Wellbutrin by Brentford, England-based GlaxoSmithKline. Unexpectedly, smokers using the pill reported that their cigarette cravings decreased. After three studies confirmed the effect, the company in 1997 repackaged bupropion as Zyban. Bupropion battles the irritability, depression and restlessness that come with nicotine withdrawal. Scientists think it might act by blocking the brain chemicals norepinephrine and dopamine. An independent 2006 review by the nonprofit Cochrane Collaboration pooled 40 studies on bupropion and found that it doubled a person’s chance of quitting. Studies haven’t found this effect with selective serotonin reuptake inhibitors, the antidepressants class that includes Prozac and Zoloft. A handful of studies suggest that the antidepressant nortriptyline also helps people quit, but the FDA has not evaluated this medication for smoking cessation use.
Chantix Varenicline, marketed in the U.S. since 2006 as Chantix by New York-based Pfizer Inc., was the first new smoking-cessation drug in nearly a decade.The drug works by attaching to the brain’s nicotine receptors, preventing nicotine from stimulating them. (Since it interferes with the brain’s ability to sense nicotine, it is not recommended in combination with nicotine-replacement therapies.) Varenicline also dampens the symptoms of nicotine withdrawal by partially activating the nicotine receptors. The most common side effect is nausea. Some patients also report vivid dreams. A 2007 Cochrane report examined nine studies on varenicline, encompassing more than 7,000 subjects. Overall, varenicline doubled or tripled quit rates compared with inactive placebos. It also worked somewhat better than the nicotine patch or bupropion, making it a top choice among many physicians and patients.
Nicotine vaccines In the next several years, doctors may have a new anti-smoking aid in their tool kit: a nicotine vaccine. The vaccine encourages the body to produce antibodies that bind to nicotine, preventing it from reaching the brain.When nicotine is blocked, smoking isn’t satisfying anymore. In preliminary results announced in 2007, Nabi Biopharmaceuticals of Rockville, Md., found that its NicVAX more than doubled quit rates. In the study of 301 patients, of those receiving NicVAX, 14% to 16% managed to stay off cigarettes for one year, compared with 6% of people who received a placebo. Last fall, Nabi reached a special agreement with the FDA to fast-track approval of the vaccine if a larger drug trial shows positive results. Nabi uses a slow-vaccination strategy, with patients getting a shot every month for four months before they quit. Subjects did not experience cravings or withdrawal, and some quit smoking before the target date of four months, says Nabi President Raafat Fahim. For more information on quitting, visit smokefree.gov.
Source: Dance, Amber. “Ready to Quit Smoking?” www.latimes.com. Los Angeles Times. n.d.Web. 7 Oct. 2009