The Pharmaceutical Journal
Vol 269 No 7215 p349
14 September 2002

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San Diego School of Medicine: Study (more)
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Benefits of smoking cessation aids are lost when counselling is not given

Improvements seen in smoking cessation rates from the use of nicotine replacement therapy (NRT) appear to have been lost since the products became available over the counter, say American researchers.

Researchers from the San Diego School of Medicine, University of California, used data from the 1992, 1996 and 1999 California tobacco surveys, in which interviews with more than 15,000 adult smokers were completed. Over the seven years of the surveys, the percentage of smokers trying to stop smoking increased by more than 60 per cent (from 38.1 per cent to 61.5 per cent). At the same time, NRT use increased by approximately 50 per cent.

The researchers found that NRT use had a significant effect on the duration of smoking abstinence in each of the study years. However, in contrast to 1992 and 1996, the effect in 1999 was only short term. After about three months, the effect was about the same as for those who used no smoking cessation aids, they say. In addition, the researchers point out that the short-term advantage was seen only for moderate-to-heavy smokers and not for light smokers.

They suggest that this shift happened because of the context within which NRT was available. "In 1992, NRT was prescribed by physicians only, and physicians or pharmacists may have provided counselling about product use," they say. Dr John Pierce, co-author of the study added that since becoming available in the United States without prescription in mid-1996, NRT products have been heavily promoted to the public. "Unfortunately, advertising does not distinguish between light smokers and those in the medium-to-heavy smoking category," he said. The researchers suggest that NRT should be used in combination with other types of smoking-cessation assistance, such as behavioural counselling (JAMA 2002;288:1260).

Clive Bates, director, Action on Smoking and Health (ASH) said in response to the paper: "If there is any conclusion that can be drawn from this it is that people using smoking cessation drugs should use the full dose and get as much support and advice as possible. However, we are concerned about how much can be established from surveys with no control group that rely so much on memory and self-reporting.

"Even though there are many good quality studies demonstrating the effectiveness of NRT, we should always be ready to modify recommendations on how the [products] are used in the light of experience. But there is simply not enough in the California data to change our basic recommendation to use these drugs when trying to quit smoking."

He added that NRT roughly doubles the chance of making a successful quit attempt and that smokers should use these products to give themselves the best possible chance of successfully quitting.

A spokeswoman for GlaxoSmithKline, manufacturer of Niquitin CQ and Zyban (bupropion), told The Journal that the results of this study differed from the National Institute for Clinical Excellence's wide-ranging review of smoking cessation treatments in the UK.

"The NICE guidance concluded that there was no clinical evidence that the effectiveness of NRT was significantly affected by the setting in which they were used. NICE states that NRT is effective and recommends that it should be made available to smokers who have expressed a desire to quit smoking."

She added that studies have demonstrated that smokers who use NRT plus a tailored behavioural support programme have a 26 per cent better chance of giving up smoking than those who use NRT alone. "However, not all smokers want behavioural support. For those people who choose to quit without such support programmes the clinical evidence strongly suggests that NRT on its own approximately doubles the chances of success (odds ratio) compared to relying solely on willpower," she said.