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CONTACT: Rick Blount, 802-656-1108 ([email protected])
Dr. John Hughes, 802-656-9610 ([email protected])
REPORT BY EXPERT PANEL UPDATES SMOKING-CESSATION RECOMMENDATIONS
Smokers who didn't list quitting among their New Year's resolutions may want to reconsider in light of a new report published in the Jan. 6 issue of the Journal of the American Medical Association. The report, which notes that there are more stop-smoking treatments than ever, was written by a team led by University of Vermont/Fletcher Allen Health Care addiction expert John Hughes, M.D.
The report offers an overview of smoking-cessation strategies during "an especially crucial time" to learn about treatment options and advocate for them among those who smoke. Factors supporting that assertion include new therapies -- both prescription and over-the-counter -- new expectations of funding for treatment and research due to the tobacco settlement, and a belief that stop-smoking efforts are leaving behind a pool of smokers who are the most dependent and most resistant to quitting.
"In the future, failure to treat smoking will keep someone out of the 'good doctor's club' just as much as failure to treat hypertension," write the authors, who suggest that new tools available by prescription and over the counter mean that "every physician should intervene with every patient who smokes."
Several of these tools were not available -- at least in their current form -- in 1996, when major smoking-cessation guidelines were released by the Agency for Health Care Policy and Research (AHCPR) and the American Psychiatric Association (APA). Using data from research and clinical experience, the new report examines each of these new approaches: Over-the-counter strategies. In 1996, two forms of nicotine patches became available over the counter, joining nicotine gum, which became available over the counter as the 1996 reports were being finalized. The new report found early data that making these treatments widely available have produced a large increase in the number of smokers who quit. The report also found evidence that these over-the-counter approaches are effective at helping smokers quit for at least a year in 10 to 15 percent of cases, about twice the rate of over-the-counter placebos. By comparison, trials of various prescription strategies -- almost always used with counseling in studies -- show 20 to 30 percent effectiveness, probably because of the inclusion of counseling. The authors suggest that adding counseling to over-the-counter therapies might similarly increase the effectiveness of those strategies, even if the therapy came over the telephone.
Nicotine nasal spray and inhaler. In 1996 a nasal spray -- akin to antihistamine sprays for allergies or colds -- became available by prescription. The spray appears to be helpful for smokers who require higher doses of nicotine than patches or gum can deliver. In 1998 an inhaler that mimics the action of smoking went on the market, offering additional help to those who are dependent on the physical act of smoking. According to the report, both tend to be effective about as often as other prescription strategies and have differing profiles of benefits and risks that make them suited for different smokers.
Buproprion. As numerous television and print advertisements have announced, the antidepressant drug buproprion (brand name Wellbutrin when sold as an antidepressant) became available as the first non-nicotine smoking-cessation therapy in 1998 under the brand name Zyban. The report found that buproprion is appropriate for smokers for whom nicotine replacement strategies aren't attractive or have already failed. Its effectiveness appears to be roughly equal to other prescription strategies. The authors noted that buproprion's antidepressant effect doesn't seem to be the key to its anti-smoking abilities, making it a potential choice regardless of whether depression is a factor.
The authors argue that therapies could be more effectively compared if studies tested them head-to-head, instead of merely against placebos. And they remind readers that, on average, smokers try quitting more than five times before they find the strategy that finally works for them. However, the authors find encouraging news in the existence of such a range of effective treatments.
"Many studies have clearly shown that smoking cessation treatment works and have produced a large number of treatment options," the authors conclude. "Given this, it would be a shame if physicians were not to use this knowledge to help their patients make that most important change that can improve their health -- to stop smoking."
Hughes' co-authors include Michael Goldstein, M.D., of Brown University; Richard Hurt, M.D., of the Mayo Clinic; and Saul Shiffman, Ph.D., of the University of Pittsburgh.
Hughes is co-director of the University of Vermont College of Medicine's Human Behavioral Pharmacology Laboratory, which seeks better ways to treat drug dependence by combining pharmaceutical and psychosocial methods.
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