Nicotine patches and gums have been helping smokers quit for decades. Right?
Even President Obama, once the Smoker in Chief, has kicked the habit with the help of nicotine replacement therapy, according to his doctor’s latest report.
Well, not so fast. A study out this week from researchers at the Harvard School of Public Health and the University of Massachusetts in Boston raises questions about just how effective nicotine replacement is over the long haul.
The findings, published online in the journal Tobacco Control, found that over a 5-year period, former smokers who used nicotine-replacement products were just as likely to relapse as those who quit on their own. If true, the results stand at odds with the long history of clinical trials showing nicotine replacement does help people quit — not to mention Food and Drug Administration approvals and government recommendations that quitters use products like the patch.
So what’s the real story? Shots asked Stephanie O’Malley, head of substance abuse research in the psychiatry department of Yale’s medical school. She wasn’t involved in the latest study. Here are highlights from our conversation, edited for length and clarity.
Q: Does this study cast doubts on the effectiveness of nicotine replacement products?
O’Malley: I think we have to be careful not to take these findings and draw conclusions that the treatments are not helpful. There have been over 100 randomized controlled trials of over 40,000 participants, and they have found that nicotine replacement therapy is effective.
Q: Why was the result of this research so different from all those other studies?
A: There is a bias in research called an indication bias. That’s when the more severely ill receive a treatment, and the less ill do not.
In this study, they’re comparing people that used nicotine replacement therapy to quit versus people who didn’t. So in this case we would anticipate that the ones with more severe problems were the ones who chose to use nicotine replacement therapy. Sometimes an effective treatment can help more people quit in the first place, but some of those may be individuals who are more at risk of relapse. There is clearly some evidence that suggests people who choose to use nicotine replacement therapy have had more past failures, for example.
Q: Are there people or circumstances for which nicotine replacement therapies do seem to be effective as part of a long-term strategy to quit nicotine products?
A: Each of these treatments increases the likelihood that someone will be successful in quitting. But not everybody is helped. There may be some subgroups of individuals for whom a longer-term use of these nicotine replacement products is helpful. Certainly anything we can do to help people use the medications correctly would increase the effectiveness of them.
Q: Is there a benefit to using nicotine replacement therapies even if they aren’t a long-term solution?
A: Not everyone who quits will “stay quit.” We know that. But the odds of quitting in the first place are higher when people use these treatments. So the proportion of people who are initially successful goes up, and that’s a good thing. I think in general the conclusion is that smoking-cessation treatment is one of the most cost-effective interventions that’s out there in terms of saving money, quality of life and other health indicators.
Q: What would you tell someone who is thinking about using nicotine replacement therapies to help them stay off nicotine over the long term?
A: For anyone who is thinking about quitting smoking using over-the-counter products, my advice would be to take advantage of their state’s quitline, which is free of charge to them. They can get help to plan their quit attempt, get advice in using these products properly and support their quit attempt to really maximize their success.