Nicotine replacement before quitting cigarettes?

Starting nicotine-replacement therapy before actually giving up smoking may be somewhat helpful for people’s long-term quit efforts, a new study suggests, although the jury is still out.

Normally, nicotine replacement therapy (NRT) - including nicotine patches, gum, lozenges and nasal sprays - is begun once a smoker quits. But some recent studies have looked at whether “pre-quitting” NRT, begun a few weeks before a smokers’ scheduled quit date, can help boost success rates.

In theory, this tactic could help by familiarizing smokers with NRT before they quit, by curbing their desire to smoke due to nicotine “saturation,” or by separating the reward of nicotine from the act of smoking itself. However, study results so far have been mixed.

For the new study, published in the journal Addiction, New Zealand researchers recruited 1,100 smokers who had called the country’s national Quitline for help in giving up the habit.

Normally, people who register with the program are mailed vouchers for heavily-subsidized nicotine patches or gum (to be used for eight weeks after the quit date, as manufacturers suggest). They also receive phone calls from their Quitline “adviser” for support.

In this study, half of the participants were randomly assigned to follow the usual Quitline procedure, while the other half began their NRT two weeks before their scheduled quit date.

Six months later, the researchers found, there was no significant difference in quitting success between the pre-quitting NRT group and the standard-care group. In the former group, 23 percent said they had been abstinent over the past week, versus 21 percent of those in the standard-care group.

A sub-group of study participants also had their abstinence verified through tests that detect cotinine, a metabolic byproduct of nicotine, in the saliva. Again, there was no difference between the two treatment groups in long-term quit rates.

However, when the researchers combined their results with those of the previous studies on pre-quitting NRT, they found that there was an overall benefit of the tactic - roughly a one-quarter increase in the chances of staying abstinent in the longer term.

That latter finding suggests there may be a “small-to-moderate” benefit to pre-quitting NRT, write the researchers, led by Dr. Chris Bullen of the University of Auckland.

Still, the current study was designed to simulate as closely as possible the way that many smokers’ quit in the “real world,” rather than the research setting. The lack of any benefit from pre-quitting NRT leaves the question of how effective the approach would be for the typical smoker.

As far as the safety of using NRT while still smoking, the rates of side effects were nearly identical in the two study groups - affecting roughly 45 percent of participants in each group, according to Bullen’s team.

One side effect - “unspecified” chest pain - was more common in the pre-quitting NRT group; nine people reported the problem, versus one in the usual-care group. But none of those instances of chest pain was severe, the researchers note.

In general, some of the most common side effects of nicotine-replacement therapy include headache, dizziness, upset stomach, sleep problems and increased heartbeat. More research is still needed to see whether any of those effects are more common with pre-quitting NRT.

The current study was funded by the Health Research Council and the Heart Foundation of New Zealand. Two of the co-researchers on the work have served as consultants to manufacturers of NRT products.

SOURCE: Addiction, online June 7, 2010.

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