An NRT expert breaks down misconceptions and shares best practice tips to help patients quit smoking
“We think we’ve dealt with smoking in Australia, but we haven’t,” said Dr Colin Mendelsohn, founding chairman of the Australian Tobacco Harm Reduction Association, at the recent APP2021 conference on the Gold Coast.
Smoking is still the leading cause of preventable death in Australia, with smokers dying 10 years younger than non smokers.
“It’s urgent because if they quit, before the age of 35, they will have a normal life expectancy and unlikely to have any lingering health complications after smoking,” said Dr Mendelsohn.
Nicotine replacement therapy (NRT) is a treatment to help people quit smoking, by resolving background cravings due to low nicotine levels.
While NRT works, the outcomes are “modest” due to current issues with use, said Dr Mendelsohn.
“Patients are poorly informed about NRT,” he said.
It’s underused, it’s not used properly, the don’t use enough, they don’t use it long enough and they don’t use it correctly.
The success rates are not high enough, and when people buy NRT over the counter, their success rates are even lower.
But one review study on pharmacists in the community found the intervention doubled success rates, said Dr Mendelsohn. Another study found NRT and counselling tripled success rates.
“That argues for pharmacists being involved in maximising the potential of this product,” said Dr Mendelsohn.
“Pharmacists can and need to make a difference because we’re just not getting good enough results.”
Different treatment options
There are two types of craving to take into account when quitting smoking, said Dr Mendelsohn.
Firstly, there are background cravings due to low nicotine levels, which can be alleviated by the nicotine patch.
Secondly, there are cue-induced cravings that can be triggered from the smell of smoke, coffee, stress, or even regular meal times such as lunch or that drink after work.
Cue-induced cravings can be tackled by use of other NRT such as gum and mouth spray.
Combination NRT relieves both types of cravings and provides a higher nicotine dose, he said.
It is significantly more effective than monotherapy and it’s as effective as varenicline (Champix).
Breaking down common misconceptions
Dr Mendelsohn highlighted the following points:
Nicotine is not a carcinogen and is not the main cause of harm from smoking.
NRT is always far less harmful than smoking.
There is a very low risk of abuse with NRT.
The addictive risk of long-term use is very small.
Long-term use may assist with abstinence and prevent relapse to smoking – it can only be a good thing.
If they’re dual using (NRT and still smoking), it’s less bad because if they’re using gum, they’re more likely to be smoking less.
“Studies show if you can correct misconceptions, people do use it more and more appropriately,” he said.
“If we reassure them that it does work for some people, the risk of addiction is low and it’s very safe, we get higher usage and compliance rates.”
Here is his advice and things to remember for pharmacists regarding the treatment:
- Make sure people use enough nicotine to relieve cravings.
- Most people don’t use it for long enough, they should use NRT for at least 8 weeks.
- Make sure you use combination NRT. Recommend that for everyone. Combination NRT is significantly more effective than monotherapy, and it’s as effective as varenicline (Champix).
- Start patch two weeks before quitting.
- Check that they’re using it correctly, because they’re almost certainly not. For example, people shouldn’t eat or drink for 10 minutes before using oral NRT. This is because NRT is alkaline and food or drink is acidic.