patch and gum no magic bullet

By ANNE MCILROY, The Globe and Mail

Tuesday, September 17, 2002 - Print Edition, Page R8

OTTAWA -- Smokers who want to kick the habit may not get the help they expect from the nicotine patch or gum. New research shows the products, which have grown rapidly in popularity, are no longer effective in helping smokers quit.

Cancer researchers at the University of California in San Diego came to that conclusion after studying the data from three large telephone surveys carried out on smokers and former smokers in California in 1992, 1996 and 1999.

In 1992, the smokers who used the nicotine replacement therapies had a significant advantage in quitting smoking. By 1999, there was no difference in their success rates. The turning point, according to John Pierce, came in 1996, when the products became available in the United States without a prescription. That's when the companies that make the products began heavily promoting them through advertising campaigns that Dr. Pierce says were misleading.

"In 1992, all of the ads were saying you use the patch with behavioural therapy," said Dr. Pierce in an interview. "If you look at the advertising for it now it says this is a magic bullet." The products are designed to lessen the symptoms of nicotine withdrawal, including anxiety, irritability and intense cravings. But cigarette addiction is not only a physical addiction to nicotine, said Dr. Pierce.

"If you think about a smoker who is a writer, and finds that smoking helps with writer's block. The patch won't help him when he sits down to write and finds himself wanting a cigarette to help him get words on the page," he said. "You have to handle the situation where smoking helped you, or else you are going to go back. Nicotine replacement doesn't do that, all it does is take away the cravings as you quit so you can manage the behaviour."

In Canada, the nicotine patch became available without a prescription in 1998.

No prescription means smokers don't have to talk to their doctor or pharmacist about the product, said Elizabeth Gilpin, co-author of the paper published last week in The Journal of the American Medical Association. This means they may not be using the product properly, or be as motivated to quit.

Legions of smokers attempt to quit every year. The survey found that nearly 61 per cent of the Californians interviewed in the 1999 survey had tried, compared to only 38 per cent in 1992. One out of seven used a nicotine patch or gum to help, a four-fold increase. Dr. Gilpin said the patch and nicotine gum may help heavy smokers, but would work best in combination with counselling or therapy to help smokers modify their behaviour.

"I would recommend they get some assistance, but behavioural assistance would be as important as pharmaceutical assistance. But doing anything to try to quit is better than nothing," she said.

Most smokers need at least three attempts to quit, she said, so the patch may help abstain for longer, and make them feel more positive about trying again