March 17, 2010

Nicotine Patches: Longer is Better

Using a nicotine patch for six months, rather than the standard two, slightly raises the chances that a person will remain cigarette-free.

In a study from the University of Pennsylvania School of Medicine, smokers who used nicotine patches for six months were much more likely to kick the habit than those who used the patches for only two months. Two months is the standard recommended period for patch use.

Six months into the study, over 19% of those who used the patches for the full six months reported not taking a single puff during the trial, compared to 12.6% who used the patches for only two months. And 31.6% of the long−term patch users had not smoked in the last seven days, compared to 20.3% of the shorter term patch users.

Some municipalities have programs that provide free patches to smokers at various times of the year. These are almost always a two−month supply.

Nicotine patches are available without a prescription.

Cost may be a barrier to longer patch use. The cost of a full six−month supply is around $2,500. Few health insurers cover this cost, though Medicaid covers some patch use in 33 states. Some municipalities have programs that provide free patches to smokers at various times of the year. These are almost always a two−month supply.

The study results were less heartening after a full year. Both groups reported about the same number of successful quitters, a little over 14%. The only benefit seen in the six−month patch users was that a larger number of them reported no period when they smoked for seven days in a row during the entire year, 29% to 21% of the short−term patch users.

All this may sound very depressing to a smoker who is considering quitting. After all, the numbers clearly show more failures than successes. What they really mean is that a single attempt may not be enough. Quitting smoking is incredibly hard, but it can be done. Being highly motivated to quit is the first step.

There are both physical and psychological aspects of quitting. Nicotine is physically addictive. Some studies have shown it to be more addictive than heroin. Patches or other drugs can help with the physical addiction. But there's also a psychological component. Part of this is because cigarettes give a smoker something to do with their hands and mouth. When quitting, the hands and mouth are suddenly unoccupied. How best to deal with the psychological component varies tremendously from person to person. Many states, localities and hospitals run smoking cessation programs designed to boost the odds of success.

The study was on 568 adult smokers who had smoked at least 10 cigarettes per day over the previous year. All subjects wore 21 mg. nicotine skin patches for the first eight weeks of the study. Half of the participants continued this treatment for the next 16 weeks, while the other half wore dummy patches containing no nicotine. Information on how often the subjects smoked was self−reported 24 weeks and 52 weeks after the start of the study.

The study results appear in the February 2, 2010 issue of Annals of Internal Medicine. A patient summary of this article is supplied by the journal and is freely available.

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