Nicotine Patches, Gums And Drugs Won’t Help You Quit
Using traditional quitting aids such as patches, gum or even prescription drugs will not increase your chances of successfully stopping smoking a year later, according to a recent study.
US researchers observed two groups of people – 2002/03 and 2010/11 – for a period of 12 months, and found that those using varenicline (sold in Australia as Champix), bupropion (Zyban), or nicotine-replacement therapy (gums, mints or patches), were no more likely to have quit smoking for 30 days or more than those who had no help at all (around 18%).
“Our analysis of these two large population longitudinal surveys, approximately 10 years apart, supports conclusions from previous cross-sectional analyses, that pharmaceutical aids for smoking cessation, despite strong evidence for efficacy from randomized trials, have not been effective at increasing successful quitting in the United States.”
The medical community would like us to believe that the best way to stop smoking is to use prescription drugs, and apparently this is the only method supported by high-quality peer reviewed research evidence. This has generally meant nicotine-replacement therapy such as patches, gums, varenicline (Champix), and bupropion (Zyban), all of which make bold claims in relation to increasing your chances of quitting.
Some of the least trustworthy of these studies draw conclusions based on little more than anecdotes and testimony taken by the very companies marketing the products. These don’t stand up to even the most basic assessments.
On a more professional level we have the double blind, randomized controlled trials.
In double blind studies, both the researcher administering the treatment and the person being treated are kept in the dark. Neither are informed on who is being given the actual drug being tested versus who is being given the placebo or comparison drug.
Almost all of those enrolled in random studies are randomly allocated (hence the name) to the active or placebo groups. The number of individuals are normally much larger to allow for the conclusions to be considered statistically significant and not just a fluke.
Many try to discount the results from early studies on nicotine replacement therapy that found it to have quite poor performance. This was attempted by claiming that outside of the lab and in the real world, users of quitting aids generally consider themselves more hooked than the average user or have long histories of failed attempts, and are therefore more likely to fail again regardless of the effectiveness of the treatments given.
In this new study, all smokers were assessed by a ‘propensity to quit’ score given to them by the researchers conducting the study.
The score takes factors such as nicotine dependence, quitting history, smoking intensity, and whether they set rules about smoking in their homes or if they would be supported in their efforts to stop smoking during the study. Those who were given the trial drugs and those who were given the placebo were matched up based on their individual propensity scores, so they would have more likelihood of similar results in the analysis were they given the same treatments.
The final conclusions held up even when these ‘propensity to quit’ scores were taken into account, indicating that they were effective measurement systems.
The Problem With Random Trials:
Normal randomized trials have been criticized for having many features that set them far apart from how drugs are used in the real world.
Often they are filled with participants with histories of mental illness, or no fixed address who sign up in exchange for money, or the promise of potentially receiving free treatment for an issue during the trial itself.
Out in the actual world though, people are not given incentives or paid to continue to keep using drugs so they can complete the full period of a trial, so the likelihood of people taking the drugs correctly in the real world is generally always far lower.
Real-world people also miss out on getting text messages and calls reminding them to take their drugs, or pop-in visits from researchers who are paid to ensure a low drop off rate during a trial.
Another obvious problem is that participants hooked on nicotine typically realize quite quickly if they’ve been given a placebo.
They inevitably feel like smoking more and more as time goes on, and realizing they have been given the placebo can increase their chance of giving in and lighting up. If this happens, which it almost always does, then the drug will seem more effective than the placebo if the drug works at all.
In the case of this recent study, the nicotine replacement therapy (patches, gums etc.) and the prescription drugs were found to be similarly as ineffective as the placebo, so what does that say for the drugs and patches?
Were people craving a cigarette so badly that they thought they were given the placebo and gave in, or did they just not work at all? Either way, the revelation is pretty damning for patches and drugs.
As for the evidence on e-cigarettes in stopping smoking:
A study by the American Journal of Preventative Medicine found that users of e-cigarettes who used their devices regularly throughout the day (20 times or more per day) had a successful quit rate of 70.0%.
So, while the effectiveness of e-cigarettes seems to be linked quite strongly to using them consistently, they are a hell of a lot more effective than the alternative, which don’t show any signs of working over a useless placebo.