What Works: Part II—Drug Treatment
Thomas C. Rowe in Federal Narcotics Laws and the War on Drugs, 2013
In many ways this treatment protocol is similar to the nicotine patch for smokers. We substitute a different form of drug for the damaging habit and slowly reduce our dependence on this new form. Clearly this will work for some motivated people but, just as clearly, it is not a panacea, and many people are not successful in stopping tobacco use even by using a nicotine patch. Still others revert to smoking at a later point in time. If all we do is provide a way for patients to eliminate narcotics from their systems we have addressed only one of the issues involved in their being an addict in the first place. Despite some early success stories (see Kosten, 2003, for a review) this is not likely to be a viable solution for a majority of users. For instance, a recent Australian study of fifty-one patients who were switched from methadone maintenance to buprenorphine found that 69 percent had gone back to either heroin or methadone within one month of withdrawal from buprenorphine (Breen et al., 2003).
Smoking
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Nicotine patchFDA classifies it as a drug with known human risk in pregnancy.Nicotine patches during pregnancy have been associated with nonsignificant effects on smoking cessation in pregnant smokers [63, 64, 66, 67]. Multiple meta-analyses of studies on other nicotine replacement therapies in pregnancy indicate that there is insufficient evidence that NRT (mostly patch) is effective or safe in prenatal smoking cessation [52, 68, 69]. Myung et al. concluded that there is a 13% mean abstinence rate in their meta-analysis; they included seven studies of which one is s a prospective study of bupropion, one is a quasi RCT that studied use of a multimodal intervention, and the other five were RCTs of NRT that did not show an effect [69]. Adding a nicotine patch (15 mg per 16 hours) to behavioral cessation support for women who smoked during pregnancy did not significantly increase the rate of abstinence from smoking until delivery or the risk of adverse pregnancy or birth outcomes [65]. No significant effect on birth-weight or preterm birth were associated with nicotine patch use [61, 63, 67].
Tobacco Use Disorder
James MacKillop, George A. Kenna, Lorenzo Leggio, Lara A. Ray in Integrating Psychological and Pharmacological Treatments for Addictive Disorders, 2017
An important NRT consideration is determining the optimal dosage and treatment course. In general, an eight-week course is recommended, and patients who smoke more than 10 cigarettes daily are recommended to begin with a 21 mg patch, and those who smoke fewer than 10 are recommended to begin with 14 mg. However, a logical consideration is that highly dependent smokers may benefit from an increased dosage and duration of NRT. A clinical rule of thumb is to approximate the number of milligrams of transdermal nicotine to the typical number of cigarettes per day (e.g., one 20-cigarette pack/day = 21 mg, two packs/day = 42 mg). However, in a pooled analysis of eight studies, a higher-dose nicotine patch, either 42 mg/24-hour or 25 mg/16-hour, was only slightly more effective than the standard-dose patch [21]. Nonetheless, level of nicotine consumption and severity of nicotine withdrawal are “two sides of the same coin,” meaning that the dose of nicotine replacement should attempt to scale to the individual’s consumption. In terms of extended duration, using NRT beyond an eight-week course appears to have minimal impact on long-term rates of abstinence [28–30]. However, one study found extended use of the patch and long-term counseling led to a significant reduction in cigarettes smoked per day [29], supporting NRT as a possible harm reduction strategy in those who are unable to achieve abstinence. Somewhat counterintuitively, it has also been found that initiation of NRT while still smoking is both safe and may increase the likelihood of long-term abstinence [29, 31–33].
Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond
Published in Critical Reviews in Toxicology, 2019
A. R. Kolli, A. K. Kuczaj, F. Martin, A. W. Hayes, M. C. Peitsch, J. Hoeng
Nicotine replacement therapy (NRT) aims to reduce the motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms while still delivering nicotine and has been shown to be less harmful than consuming tobacco (Silagy et al. 2004; Prochaska 2015). NRT products are delivered in various forms, including gum, transdermal patch, nasal spray, oral inhaler, and tablet. Transdermal delivery of nicotine via a patch is successful, as the nicotine penetrates rapidly, allowing the delivery of fairly large doses. The nicotine patch is a slow, sustained-release form of nicotine delivery that is intended to gradually lower users’ dependence on tobacco and ultimately eliminate this dependence (Figure 1) (Benowitz et al. 2009). Acute dosing products allow users to titrate the timing and dose of nicotine. Products such as nicotine gum and lozenges are buffered to alkaline pH to facilitate increased absorption. Despite their formulations, NRTs were unable to mimic the plasma concentrations of nicotine following inhalation, as the absorption of nicotine from the buccal cavity is slower, and a portion of the dose is swallowed and subjected to first-pass metabolism (Benowitz et al. 2009). Nicotine nasal spray is absorbed more rapidly than other NRTs but does not reach the maximum nicotine concentration (Cmax) of inhaled nicotine, thus requiring larger doses (Lunell et al. 2000).
Self-treatment attempt of tobacco use disorder with Melissa officinalis: a case report and brief review of literature
Published in Journal of Addictive Diseases, 2023
Baris Sancak, Gizem Dokuzlu, Ozan Özcan, Urun Ozer Agirbas
The authors could not find a study in the literature on the use of Melissa herb as a cigarette in the treatment of nicotine cessation. For this reason, nicotine patch replacement therapy, which he had benefited from in the past, was recommended to the patient. He continued to drink one cup of Melissa tea a day, as there was evidence that it could be beneficial in the nicotine cessation process. In addition, he was advised to do daily mindfulness exercises. The patient was treated with NRT for a month along with psychotherapy for three months. Nicotine patch replacement therapy was started with a dose of 21 mg/day in the first week and was reduced to 14 mg/day the following week. Next week it was used 7 mg/day and stopped, but then it was continued for another week when the patient felt moderate cravings. During the psychotherapy process, 12 weekly cognitive-behavioral therapy sessions, including psychoeducation, were applied. At the end of the treatment, the patient stated that he stopped consuming the Melissa herb as a tea. No return to use was reported by the patient at his six month follow up. However, he started to consume Melissa tea in the fifth month from time to time when he had an urge to smoke. The oral cotinine-sensitive strip test result applied to the patient was level 0 (0–6 Ng/mL).
Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army
Published in Drug and Chemical Toxicology, 2022
Marc A. Williams, Gunda Reddy, Michael J. Quinn, Amy Millikan Bell
These studies are tempered by a larger meta-analysis of population-based studies that showed users of e-cigs were markedly less likely to have ceased smoking than non-e-cig users (Grana et al.2014). In addition, a longitudinal study in cancer patients found e-cig users twice as likely to also be smoking conventional cigarettes at the time of follow-up as compared to non-e-cig users (Borderud et al.2014). The only available randomized smoking cessation study found showed that e-cig use was not significantly more effective than nicotine patch therapy; this finding counters some of the earlier logic on the use of e-cigs as smoking-cessation tools (Bullen et al.2013b). Further, a survey sponsored by e-cig manufacturers, and conspicuously not cited by harm-reduction advocates, found that only one percent of e-cig users achieved sustained abstinence from smoking by using e-cigs (Heavner et al.2010).
Related Knowledge Centers
- Cognitive Behavioral Therapy
- Nicotine
- Smoking Cessation
- Transdermal Patch
- Attention Deficit Hyperactivity Disorder
- Pharmacokinetics
- Dementia
- Pain
- Nicotine Replacement Therapy
- Nicotine Dependence