Nicotine replacement therapy (NRT) is the use of various forms
of nicotine delivery methods intended to replace nicotine
obtained from smoking or other tobacco usage. These products are
intended for use in smoking cessation efforts to help deal with
withdrawal symptoms and cravings caused by the loss of nicotine
from cigarettes. Several forms of NRT have been marketed,
including the nicotine patch, inhaler, nasal spray, gum,
sublingual tablet, and lozenge. NRT is thought to be useful and
beneficial for tobacco users who want to quit their addiction
and is for most people perfectly safe. Cigarettes on the other
hand cause the early deaths of about 5 million people each
year. These people are not killed by the nicotine in the
cigarette, but by other constituents of tobacco smoke such as
Carbon Monoxide and tars. It is the nicotine that keeps the
smoker addicted. Cigarettes can be viewed as a "dirty" and
dangerous method of delivering nicotine, while NRT is a "clean"
and safe method.
NRT delivers nicotine to the smokers brain in a much slower way
than cigarettes do. It helps to damp down the urges to smoke
that most smokers have in the early days and weeks after
quitting, rather than remove them totally. It gives the smoker
the chance to break smoking cues in their daily lives, and might
provide a more comfortable exit from the smoking habit. NRT
however is best used with some form of support, ideally from
someone who knows something about smoking cessation.
In 2005 the Committee on the Safety of Medicines recommended
that NRT be given to pregnant smokers and also to adolescent
smokers. However, in the opinion of many independent nicotine
researchers, the Committee on the Safety of Medicines has got
its new advice on NRT dramatically wrong. Tobacco researchers
who have received funding from the pharmaceutical industry have
acted as consultants to the Committee.
Ginzel et al. (2007) reviewed the dangers of nicotine for the
developing brain (Journal of Health Psychology 12, 215). Recent
diversification of nicotine products and their placement on the
free market are solely in the interest of industry and will not
help to reduce youth smoking, but could serve as a gateway drug
for nonsmokers. The recommendation of ASH to use NRT even
without stopping smoking will create dependencies on both
cigarettes and NRT (used simultaneously or alternating), again
in the interest of industry only. Family doctors will be
appropriately cautious about prescribing a drug that is a poison
and carries many potential dangers to the foetus and adolescent
smokers and indeed to all smokers who use NRT and yet continue
to smoke tobacco.
A small number of people who use NRT, especially Nasal Spray and
Nicotine Gum, will go on to use it on a longer term basis. These
are usually highly nicotine dependent smokers who would not have
been able to quit without the help of such medication. There is
currently no evidence that such long term usage is harmful to
health, especially when compared to smoking.
Findings from a recent Cochrane review of controlled trials
testing NRT products indicated that smokers
using NRT were 1.5 to 2 times more likely to be abstinent from
smoking at followup than those in the placebo or control
treatment condition. However, this statement is controversial,
and critics have pointed out that real-world trials rather than
artificial ones yield results for NRT that are hardly better
than those obtained for non-NRT controls.
Nicotine replacement
therapy Nicotine patch >>
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Smoking cessation
Statistics
Information for smokers trying to quit
1. Modalities
2. Alternative techniques
Information for healthcare professionals
1. Screening
Nicotine replacement therapy
1. Nicotine patch
2. Inhaler
3. Nasal spray
4. Gum
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