Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample

Abstract

Background: In 1996, the US Food and Drug Administration (FDA) approved switching nicotine gum and patch from prescription to over-the-counter (OTC) status. Some expressed concerns that broader availability and lack of physician control might increase persistent use of nicotine replacement therapy (NRT)-that is, use beyond the period specified by the FDA approved label. Objective: To estimate the incidence of persistent use of OTC nicotine gum and patch for periods of > 3 months, > 6 months, > 12 months, and > 24 months. Design: Analysis of NRT purchase patterns in data from a population based panel of US households that electronically scanned all household purchases between January 1997 and March 2000. Subjects: In a national panel of 40 000 US households, 2690 recorded NRT purchases. Results: Among 805 households that purchased nicotine gum, 2.3% of new purchase incidents led to continuous monthly purchase of gum for > 6 months. For nicotine patches (2050 households) the percentage was 0.9%. For both gum and patch, the incidence of persistent purchase dropped below 0.4% by 24 months. Allowing one month gaps within a "continuous" purchase run resulted in increased estimates (for gum: 6.7% for > 6 months and 1.0% for > 24 months; for patch: 1.7% for > 6 months and 0.05% for > 24 months). Conclusion: Persistent use of nicotine gum and patch is very rare and has not increased with the transition to OTC use, despite removal of physician oversight.

Dependence on Tobacco and Nicotine Products: A Case for Product-Specific Assessment

“…It is of interest to note that the authors excluded long -term patch users since it would have been unlikely to see a difference between active and placebo treatment due to the ease by which they normally can stop. Moreover , it is much more infrequent to observe long -term patch use ( Shiffman, Hughes, Pillitteri, & Burton, 2003 ). It seems as a patch is not very likely to be able to support a compulsive use pattern due to its little behavioral involvement and or pharmacokinetic nicotine uptake pattern.…”

“…This is most likely the reason why it is very unusual to see longterm use of patch. However , cases exist ( Shiffman et al, 2003 ) in which nicotine patch use persists. If that can be taken as an indicator of dependence , one can speculate that the type of dependence might be of a different sort than the one to cigarettes.…”

Effect of deregulation on the prices of nicotine replacement therapy products in Finland

“…One of the arguments against deregulation was that the easier access to NRT products could lead to misuse and dependence on these products. However, Shiffman et al [21] reported that persistent use of NRT products is very rare and did not increase with the transition to OTC use in the USA. In fact NRT products were more often used for shorter lengths of time than recommended.…”

Nicotine replacement therapy practices in Finland one year after deregulation of the product sales—Has anything changed from the community pharmacy perspective?

“…Among the most important barriers are scepticism towards NRT effectiveness; fear of addiction [20,21]; health care providers' reluctance to get involved and support SC [22,23]; and the price of the NRT products [24]. Also several other problems related to the use of NRT exist, which underline the importance of the guidance and support given by health care professionals [3,5,6,10,20,[25][26][27][28][29][30][31][32][33][34][35][36].…”