NEW YORK, Feb 18 (Reuters)--The use of over-the-counter nicotine patches may be more effective at helping people stop smoking if they are used at different strengths according to the smokers' nicotine dependency. concludes a new report.
In a study conducted by Danish researchers, heavy smokers had the best results when they started on the highest level patch and gradually worked their way down to lower levels. Lighter smokers had similar results when started on a lower level patch. But heavy smokers who started on the lower level patches perceived a lessened effect and quickly stopped the treatment, probably because the nicotine level in the patch was not strong enough initially to meet their nicotine need, according to Dr. Jorn Olsen of the University of Aarhus in Denmark.
"Transdermal nicotine treatment in an over-the-counter situation should probably be allocated according to a nicotine dependency score," write the study authors.
The 522 people in the study were enrolled when they sought to purchase the patches at drug stores in Aarhus or Copenhagen. They were told that they could receive the patches free if they agreed to participate in the trial. According to the researchers, the fact that the study participants intended to purchase the patches themselves indicated that they already had a greater desire to quit smoking. Participants were also told that they may be given a placebo patch, in order to determine the extent of the patch's assistance in stopping smoking.
Half of the study participants were given nicotine patches, the other half, placebo patches. The placebo patches did contain a "negligible" amount of nicotine in order to give them the same color and odor as the pharmacologically active patches. The nicotine patches used in the study delivered a continuous, steady nicotine dose for 24-hour periods. People who reported smoking 20 more cigarettes per day were initially started on patches that delivered 21 milligrams of nicotine per day and gradually worked their way down to 7 milligrams per day over a three-month period. People who reported smoking less than 20 cigarettes per day were initially given patches that delivered 14 milligrams of nicotine per day and worked their way down to the 7-milligram patch over the same period.
A significant percentage of people dropped out before completing the program, but more smokers who received the 21-milligram nicotine patch stopped smoking than their peers who received either the placebo patch or the 14-milligram nicotine patch.
Until recently, nicotine patches were sold only by prescription in most countries. Since the introduction of over-the-counter patches, few studies of their use in "real-world" situations have been documented. In most of the studies, people using the patches under a doctor's supervision have also been offered support systems and given detailed instructions on using the patch. The current study involved no intervention beyond giving the patches to the smokers and questioning them about their progress periodically on the telephone. However, they were instructed not to smoke while using the patch.
The authors concluded that people who are serious about stopping smoking, and who smoke more than 20 cigarettes a day, can use over-the-counter patches successfully by themselves and still have a higher quit rate than previously thought. Additionally, these heavy smokers should be started on the highest level patch so as to provide them with enough nicotine to comfortably work their way down to lower levels and to reduce their risk of discontinuing the treatment.
After four weeks on the 21-milligram patch, 44.1% of people in the study stopped smoking entirely compared with 37.3% of those on a placebo patch. People who started on the lower dose patch were not as successful at quitting.
The high percentage of quitters in the placebo group has been seen before in previous studies, write the study authors. But the effect does not usually last beyond the study period in the placebo group, they comment, and may result from trying to meet the expectations of the study.
Side effects from the patches were few, with the most common reaction being skin reactions at the site of the patch. However, side effects were one of the main reasons reported for dropping out in the nicotine patch group.
"Cigarette smoking is the single most important preventable cause of cancer and premature death, and 20% of all deaths in developed countries are presently attributed to tobacco smoking," write the researchers.
SOURCE: The American Journal of Epidemiology (1997;145:309-318)
