Do Nicotine Patches Actually Work?
The NEJM ran an editorial to accompany this paper. This was almost comical in its lack of understanding. It said that the findings of this research were consistent with previous research:
The finding that nicotine-replacement therapy did not improve long-term quit rates in pregnancy is consistent with two other, smaller, placebo-controlled studies of nicotine gum or patches in pregnant smokers. In these studies, adherence to therapy was also low with respect to dose (number of pieces of gum per day) and duration of treatment; the average duration of use of nicotine-replacement therapy was less than 20% of the recommended duration for the patch and less than 50% of that recommended for gum.
And it went on to lament like a voice crying in the wilderness:
Adherence to therapy is a well-recognized determinant of efficacy. With low adherence rates in placebo-controlled trials of nicotine-replacement therapy in pregnant smokers, it is difficult for clinicians to counsel their patients regarding whether such treatment would be efficacious or safe if used as directed.
Of course, the human tendency to weakness of will is the problem: if it weren’t, people wouldn’t need nicotine patches in the first place.
Despite the absence of evidence that nicotine patches do any good in pregnancy, they have been widely, almost routinely, recommended. This is because the desire to do something rather than nothing is among the strongest known, if not to man, then at least to the medical profession. When in doubt, prescribe.
Uh… I’m confused. If a pregnant woman uses a nicotine patch, doesn’t she still load up on nicotine and doesn’t that nicotine still dose up the fetus? What’s the gain? Reduced tar only? Sounds like a great way to make the woman feel good about herself but damage her baby all the same?
The nicotine is what makes the cigarettes addictive, but it isn’t the harmful cancer-causing agent – so patches are indeed a better option than cigarettes while pregnant.
The problem is not fetal or newborn cancer. It is prematurity.
I know that nicotine patches work. I am now 44 years old and smoked since I was sixteen (It was the legal age in Arizona at the time.) Four years ago, I started using the patch and quit as a birthday present to my wife.
Being a man, I, of course, have no idea whether the experience would be different if I was a woman, or a pregnant woman, as was studied in the paper mentioned in the column.
But for me, the patch worked and worked perfectly. I quit smoking, never did have a serious craving. Yes, there have been times, even recently where I thought to myself, “Damn, right now sure would be an ideal time to have a smoke” or “I sure could go for a cigarette right now.” I never had a physical craving though. It was more of breaking the habit than anything else.
As was prescribed in the directions, I started with one patch for a couple weeks, then stepped down to another patch with less nicotine and then, after a few more weeks, stepped down to a third patch with almost no nicotine. As I said, I never had a craving. I’ve haven’t been seriously tempted to go back to smoking since.
So why couldn’t these pregnant women quit? It has nothing to do with whether the patch works or not. Obviously, it does work. They should put on the box that for the patch to be most effective, the person using it must WANT to quit. I had tried quitting a number of times before – the last time was about seven years before I actually quit.
Back then though, I didn’t want to quit. I made it forty-eight hours and was ready tear the house apart to find a cigarette. When I did quit, I wanted to quit. Prices were going up, I was getting up in age and I was starting to see the physical effects that smoking was having on me and my wife. By that time, I wanted to quit.
The article didn’t say how many of the studied pregnant woman actually really truly wanted to quit. If they all seriously wanted to quit, then there is obviously a problem with the patch. If they were just trying to quit to save their baby, but not truly wanting to quit, they had already failed before they ever put the patch on.
Jefferson, I’m not sure how important wanting to quit really is. It certainly sounds like it was vital in your case but one of my co-workers had a very different experience.
This was 20 years ago so I don’t recall exactly how much she smoked but I’m pretty sure it was at least a pack a day. She was a single woman but she’d bought a house and was working three jobs and enduring a difficult roommate just to try to keep up with the mortgage. She enjoyed smoking and admitted to having absolutely no concerns about the health aspects. However, she did want to save some money so she decided to try quitting cigarettes. She knew she couldn’t go cold turkey and looked at various methods to quit smoking. She decided that laser therapy was the best fit for her and booked an appointment with a clinic offering this therapy. Despite that, she was so sure the therapy would fail that she brought cigarettes with her to the appointment, so that she could smoke on the drive home! It would be hard to imagine someone who had less actual desire to quit or less confidence that the treatment would work. Both of those factors should almost certainly have doomed the treatment to failure.
Much to her surprise, the treatment was a complete success. Apparently, the laser was fired at the back of her knees and elbows – if I’m remembering this correctly – and she immediately lost any desire whatever to smoke.
She moved on to another job very shortly after that so I never heard whether the treatment worked in the long term but it does suggest that you can quit smoking even without any real desire to quit. Of course this is a single example and she may have been very different than most people. I don’t think it’s fair to assume that if this one woman could quit without really wanting to quit so easily, that everyone else could do so just as easily.
Or maybe the desire to save money was enough and replaced the desire not to smoke in the psychological side of things….
Now 70, I smoked for 50-years and thru two normal pregnancies. Nicotine patches were given to me when they first came out by well meaning physician friends; the patches gave me nightmares and other bad side effects. Also, the cost of the patches (they’re still pricey) added to the negative experience.
What worked for me two-years ago, with no bad effects, is the e-cigarette. I tapered the nicotine cartridges down over a period of six months until I was using the zero-level and still enjoying the sensation of being a “smoking woman”. The water vapor smoke is the key to a strong behavior based habit, once the physical addiction is controlled. And, there are no nightmares! If I had known about e-cigs years ago, I would have successfully quit then.
BTW, I’ve got two, healthy grown sons, both tax payers and both non-smokers.
I am an cigarette addict in the truest sense of the word. I love to smoke cigarettes. I quit for 10 years, tried a couple with a friend, and ended up having to kick them again. Do the patches work? Absolutely!
Here’s what worked for me: 1 cigarette per day, and then the patch. No matter what happened during the day that made me crave a cigarette, I knew that I could have one the next morning. I used the patches exactly as prescribed, and stepped down the dosage as recommended. When I got to the last week of the lightest dose, I gave up the morning cigarette, and didn’t miss it.
Ta da!
Excellent! Great job Pam.
Congrats on quitting. Hate to burst your bubble, but obviously it wasn’t because of the patch.
As with any other addiction, there’s more to it than the feel of the chemical changes within your body. The routine is an important part.
It’s been a years-plus since I quite (this time). And at the end I was smoking one cigarette a day, sometimes going days in between. But I absolutely miss the habit of that one-more before bed or that cigarette break when my husband and I are fighting, lol.
The reason the patch doesn’t work for some people has much more to do with the side effects than with the efficacy of the nicotine delivery system. I had such terrible nightmares that I simply had to stop using them. Ditto with nicotine inhalers and gum, and with Chantix as well. I could truly say I tried, but the products failed.
For me, the only effective way to quit was cold turkey — then I had only myself to point at if I failed.
Whatever method works, good for you.
Tried the patch, tried the pill- didn’t really work for me. Had my second son when I was 43, I looked down into his blue eyes and swore I’d live to see his grandkids grow (Dad and Granddad died early–heavy smokers) It completely sucked, especially living with a smoker, I was an SOB for a couple of months (no one tells you it lasts that long) got cravings for almost a year–still do,sometimes, but I won’t start again. I believe when you are ready to quit you will. If the patches or acupuncture or lasers behind the knee give you a reason to believe,then use them, find what motivates you. In the words of Alton Brown “Put it down and walk away!”
Burger
The patch worked for me…I quit smoking in 1995, and I was not pregnant at the time. The first day was pure hell, but the cravings eventually stopped. When I removed the last, lowest nicotine amount patch, I felt no need to smoke again.
I will add I couldn’t wear the patch at night…I was unable to sleep. So I just took it off at night and slapped on another in the morning.
Not less than a pack a day from the late ’60s on, and at times not less than two; always Winstons or Marlboros, no wimp smokes for me. After I retired in ’06 I decide I was tired of the first thing I did every moring being a coughing fit and the second lighting a cigarette. July 8, 2008, is my stopped smoking say; I won’t say I’ve quit, I just haven’t had a cigarette since then. Used patches, though they don’t help much if you’re a heavy smoker; that 21mg. is less nicotine than a half a pack of Winstons etc. I had a lot more trouble with the “social” aspects of not smoking; what do non-smokers do? Frankly, if you could smoke in bars in Juneau, I’d never have been able to stop smoking. How many times I’ve been off cigarettes and bummed a smoke in a bar, bought a pack but left it in the bar for the next addict, etc., and you learn quickly that even if you’ve been off smokes for awhile, you’re two puffs away from two packs a day for the rest of your life. ‘Course, that was also about 30 pounds ago; haven’t seen my belt buckle in awhile.
You say, “When in doubt, prescribe.” Patches are available over-the-counter and require no script.
In Australia, at least, doctors may write a prescription for medicines which don’t require a prescription but which are cheaper therewith. As of February 2011, for instance, smokers could receive a four-week course of nicotine patches for Aus$33.50 with a doctor’s prescription and only $5.40 for those with a concession card and a prescription.
Previously, a four-week course of nicotine patches was between $100 and $140—and required a prescription.
The question here may be which is more harmful? Cigarettes or obesity? We know what the effects of smoking are, both short and long term. It is also common for those who quit smoking to gain weight. In many cases a considerable amount of weight will be gained over a period of time. We thus need to consider the positives and negatives of smoking. Smoking does help in weight control. You don’t see very many fat smokers. There are however a lot of ex-smokers who are fat. Obesity can lead to diabetes and other diseases, and having diabetes can be expensive. My wife is diabetic and the cost of insulin, test strips, more frequent doctor visits do add up. For a person without good medical insurance, diabetes can cost a person hundreds of dollars a month depending upon medication, how frequently one tests their blood sugar, how often does your doctor want lab tests and office visits for check ups. The smoker does shorten their possible life span to some degree. Unfortunately the same is likely true of the diabetic. Prior to the high taxes now placed on tobacco products, the cost of smoking was relatively low. The negative effects of smoking generally occur later on in life. The negative effects of obesity can occur quite young in life. What would be worthwhile is a study that would determine the relative costs of smoking versus obesity. It could very well be that measured upon a basis of overall cost both to individuals and society that smokers “cost” society less than do obese ex-smokers. This is the sort of question that needs to be asked.
I went through the classic stop smoking weight gain. You can stop it easily by doing the “Paleo Diet”.
I started smoking when I was 10 and progressed to 2 packs a day by the end of grammar school. By the time I was 63 I was smoking 45 Camel straights a day. I had two half hour coughing fits a day, one in the morning and one late afternoon. It was painful to breathe deeply. The hand writing was on the wall. The patch is useless for somebody like me unless I used 4 or 5 at a time. I had used gum to maintain sanity on long overseas flights. It worked OK, but I had to take two 4mg at a time. That’s a lot. I decided that I needed to be somewhere where cigarettes were not readily available to make the complete transition to gum. This I did in Mongolia on a 120 mile camel trip across the Gobi. Plenty of gum and only a few packs of smokes left. I ran out of Camels about noon, smoking down my last one down to my fingertips like it was a roach while sitting on top of a camel. I flipped the butt off into the desert and reached for the gum. That was 31/2 years ago. I may be ingesting more nicotine than I used to, but my lungs are in better shape and I don’t have coughing fits. I know the lung damage is still there, but it seems that I can breathe twice as deep as before. I did OK at 15,000 feet in the Andes a year and a half ago. Before the gum I might have died at that altitude.
Now and then, I cheat and mooch a smoke. About 5 or 6 a month, depending on my ability to beg. The cigarettes don’t taste as good as they used to, if they ever did. I don’t have any problem staying with the gum and I intend to stay with it. It’s not a moral issue with me to get off nicotine. Besides, my insurance pays for it by way of reimbursement. Free nicotine. Can’t beat that. Sam’s club sells the stuff cheap and I’m a cheapskate even to the point of saving my insurance company some dough.
Nicotine replacements helped me quit (gum, then when the jaw hurt lozenges, then the patch, and then I forgot the patch one day and that was it) but nothing on earth or in heaven would have gotten me to quit if I didn’t want to. I watched the old man smoke until he couldn’t wheel the oxygen tank outside anymore (so he wouldn’t blow the whole house up) and that wasn’t enough to make me quit on the spot.
Nicotine patches worked for me. Gum did not.
Patches only work if you are quitting, not “trying to quit”, and that would explain the result of their experiment.
If you are actually quitting and you know it, they take the edge off the nicotine pangs for that first month when you are going nuts. They make it doable thing. They prevent your legs from walking you to the store to buy a pack without the rest of your body realizing it. Once you’ve quit for long enough that a cigarette would taste like nasty crap, you are free and you can let the patches go away.
I quit my three pack a day habit in 1968 when I was felled by Bronchitus. Governments opposed smoking since the 17th century until they discovered that they could TAX it. Now all governments are addicted to tobacco! As I don’t smoke I enjoy the shifting of the tax burden to someone else. Here in Connecticut the Government wants to legalize “Medical Marijuana” so it can tax it. I anticipate “tax refunds” given in lotto tickets and reefers.
A friend of mine smoked about a pack or two a day from the age of about 16 to age about 50.
One day, he literallyl just told himself that he just did not want to smoke anymore.
So , he just quit.
Just like that.
I asked him; ” didn’t you have any withdrawal symptoms or an urge to smoke.”
He said, NO. He has not smoked in aboit 10 years now.
What I find really puzzling is that nicotine is supposed to be a physical addiction and that nicotine is one of the most addictive substances.
So, how can someone just go cold turkey with no symptoms or desire to smoke again?
I can only surmise that we act, speak, and behave as we have instructed – consciously or otherwise – our subconscious to direct us; as described in dozens of books on this topic.
A buddy of mine tried to quit smoking. He wondered if there was an optimal position for his nicotine patch. I suggested he place it over his mouth.
There are two aspects that need to overcome smoking: addiction and habit. It is easier to break a habit than the addiction, which is why some people who want to quit are successful. The addictive feeling of a drug is terrible and it was hard to function with that overwhelming craving throughout the day. I smoked for 47 years and tried everything from hypnosis, nicotine patches, reducing nicotine strength, etc, etc. I finally used Chantix about six years ago and it works by blocking the nerve receptors that give pleasure. It totally eliminated the addictive feeling. Once I realized I didn’t have that overwhelming need for a cigarette throughout the day, I knew I only had to overcome the habit, which I was able to do. There were numerous times during the day when I wanted a smoke, but it was the habit of just wanting it – there was no craving. That was much easier to deal with. So when people talk about being able to quit easily, they probably were only dealing with the habit and not the addiction. I smoked up to three packs a day when I quit.