Twenty million Americans have died from smoking-related disease in the past 50 years.
Among people younger than 18, the U.S. Public Health Service predicts another 5.4 million smoking-related deaths. Meanwhile, more than 21 percent of American adults use tobacco products every day. As a result, smoking remains the most preventable cause of disease, disability and death in the U.S.
Despite all that we know about the health risks of smoking, stopping the habit is not easy. This is largely because of nicotine dependence.
For those who are willing to quit, there are several medications that have been proven effective to help with tobacco cessation.
The most familiar of the treatment options is nicotine replacement. The purpose of nicotine replacement is to control the craving for nicotine while the habit of smoking is being overcome. Nicotine replacement products come in a variety of forms. Most are familiar with the nicotine patch, but short-acting forms of nicotine replacement include gum, an inhaler, nasal spray and a lozenge. The nicotine patch, gum and lozenge are all available over-the-counter without a prescription.
While each product has been found effective on its own, combination nicotine-replacement therapy is even more effective. Specifically, the long-acting patch combined with a short-acting product such as nicotine gum for as-needed use to address nicotine craving has been shown to about double the rate of success in quitting smoking, compared with a placebo.
Nicotine replacement is typically dosed based on the amount of smoking that precedes the quit attempt. Dosing is then “stepped down” over a period of several weeks to a few months. Unlike other tobacco cessation treatments, it is essential to stop smoking before starting nicotine replacement.
Several antidepressants have been studied for use in assisting smoking cessation. While most standard antidepressants have been found ineffective, one agent is considered a first-line therapy. Bupropion, also known as Zyban, is Food and Drug Administration approved for smoking cessation. There is considerable evidence that the drug can help produce long-term benefit.
Bupropion works by influencing brain chemicals involved in mood and the reward system. When started one week before stopping smoking and continued for a total of three months, the medication can help smokers permanently break the habit. In one published review of more than 14,000 smokers treated with Bupropion, compared with a placebo, smokers were 1.6 times more likely to quit on Bupropion.
Perhaps the most effective single therapy for smoking cessation is the medication Varenicline (also known as Chantix). This medication produces quit rates similar to combination nicotine replacement, more than doubling smoking cessation compared with a placebo. Like Bupropion, Varenicline should usually be started one week before stopping smoking and continued for three months.
For some smokers, a combination of treatments may be helpful. Because of the risk of potential side effects, smokers should consult with a medical provider about which strategy is right for them.
For more assistance with stopping smoking, a great resource is the Tobacco Quitline. Call (800) QUIT-NOW (784-8669).
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
