Nicotine Delivery Devices Help Smokers Quit

Dear Doctor: I’ve tried quitting smoking on my own, but it never lasts. Can medication help? How does it work?

Dear Reader: Medication can help, and it has improved the “success rate.” Although smoking is a particularly hard habit to break, you can do it. Proof: there are more former smokers in the United States today than current smokers.

Cigarette smoke contains many different substances that damage body tissues and increase the risk of cancer. However, those harmful substances are not what make you addicted to cigarettes.

Nicotine, one of the many dangerous chemicals in cigarettes, is what makes you addicted. It does not damage your tissues; it simply makes you want to smoke. Each hit of nicotine produces pleasure. But as nicotine leaves the body, you begin to experience uncomfortable withdrawal symptoms, which prompt you to reach for a cigarette.

One type of smoking-cessation medication is called nicotine replacement therapy (NRT). It delivers low doses of nicotine into your bloodstream to ease or eliminate withdrawal symptoms. You begin nicotine replacement on the day you quit smoking. Instead of continuing to get the nicotine your body craves from cigarettes, you get it from replacement therapy. As your withdrawal symptoms lessen, you reduce the dose and gradually wean yourself off all nicotine, including nicotine replacement therapy.

There are several forms of NRT. Some are available over the counter, while others require a prescription:

Nicotine patches are worn on the skin like a bandage. They provide a low dose of nicotine that is absorbed through the skin into your bloodstream throughout the day.

When you chew nicotine gum, it releases a low dose of nicotine that is absorbed through your cheeks into your bloodstream.

When a nasal spray is sprayed into the nose as a mist, nicotine reaches the bloodstream within 5 to 10 seconds. This is the fastest way to relieve withdrawal symptoms.

Puffing on a cigarette-shaped inhaler (sometimes called an electronic cigarette) delivers a low dose of nicotine through the mouth, throat, and lungs. When you feel the urge for a cigarette, you use the inhaler.

Lozenges provide a low dose of nicotine that is absorbed into the bloodstream.

Two other smoking-cessation medications do not contain nicotine; they act on the brain to reduce nicotine cravings, nicotine withdrawal symptoms, or both.

Varenicline (Chantix) and bupropion (Wellbutrin, Zyban) are prescription drugs. They mimic some of nicotine’s effects, reducing cigarette cravings and withdrawal symptoms. So if you slip and have a cigarette, you will experience less reward from it.

The U.S. Food and Drug Administration reports that both varenicline and bupropion may, in a small number of people, trigger suicidal thoughts or actual suicide. Anyone starting these treatments, along with their friends and family, should watch for changes in mood and behavior.

Withdrawal symptoms are most intense when you first quit. Getting through your fifth or tenth smoke-free day will be much easier than getting through your first.