Transdermal Nicotine for Smoking Cessation

Abstract

Objective.\p=m-\To evaluate the efficacy of a new transdermal nicotine system for smoking cessation. Design.\p=m-\Two 6-week, randomized, double-blind, placebo-controlled, parallel group trials were conducted. Successful abstainers from both trials enrolled in a third trial for blinded downtitration from medications (6 weeks) and subsequent off-drug follow-up (12 weeks). Setting.\p=m-\Nineoutpatient clinics specializing in the treatment of smoking cessation.Patients.\p=m-\Healthy volunteers who smoked one or more packs of cigarettes daily and wanted to participate in a smoking cessation program.Intervention.\p=m-\Patientswere randomly assigned to a transdermal nicotine system delivering nicotine at rates of 21,14, or 7 mg (in trial 1 only) over 24 hours or to placebo. Group counseling sessions were provided to all participants. Main Outcome Measure.\p=m-\Ratesof continuous smoking abstinence were determined during 6 weeks of full-dose treatment, a 6-week weaning period (through week 12), and a 3-month follow-up receiving no therapy (through week 24). Abstinence was defined by patient diary reports of no smoking during the designated periods, confirmed by expired-breath carbon monoxide levels of 8 ppm or lower.Results.\p=m-\Thecenters enrolled 935 patients. Cessation rates during the last 4 weeks of the two 6-week trials (pooled data) were 61%, 48%, and 27% for 21\ x=r eq-\ and 14-mg transdermal nicotine and placebo, respectively (P\m=le\.001 for each active treatment vs placebo). Six-month abstinence rates for 21-mg transdermal nicotine and placebo were 26% and 12%, respectively (P\m=le\.001). All transdermal nicotine doses significantly decreased the severity of nicotine withdrawal symptoms and significantly reduced cigarette use by patients who did not stop smoking. Compliance was excellent, and no serious systemic adverse effects were reported.Conclusions.\p=m-\Transdermal nicotine systems show considerable promise as an aid to smoking cessation. (JAMA. 1991;266:3133-3138) Reprint requests to Pulmonary and Critical Care NE 68198-2465 (Dr Rennard). SOME 50 million Americans regularly smoke cigarettes despite serious health consequences, declining social accept-ability, and numerous educational pro¬ grams and antismoking campaigns. While the prevalence of smoking in the United States is decreasing, current trends suggest that 22% of adults will still smoke in the year 2000. ' Cigarette smoking is a complex ad¬ diction, with both behavioral and phar¬ macologie components.

The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment

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Dental Education in the Prevention and Treatment of Substance use Disorders

“…The first Surgeon General's Report to address the systemic hazards of tobacco use was issued in 1964. 66 During the same year, the House of Delegates of the ADA 51 resolved that ...members be encouraged to inform their patients of the health hazards of the use of tobacco and, especially with young people, warn against acquiring the habit of cigarette smoking.…”

“…52 In the early 1980s, dentistry became involved in testing nicotine-containing gum as a smoking-cessation aid. 66 When patients began to inquire about obtaining nicotine-gum prescriptions, many dentists believed that it was illegal for them to prescribe this pharmaceutical agent. By the mid-1990s, however, these prescribing issues were resolved.…”

“…Since 1987, an eight-step, dental office-based tobacco-cessation plan has been regularly presented to Indiana University dental hygiene and undergraduate dental students. 66 A 51-page handbook, A Smoking Cessation Program for the Dental Office, now in its fourth edition, focuses on specific principles that are emphasized in the Mayo Clinic model. 51 Designed for dentists and dental auxiliaries, this approach utilizes the skills of hygienists and other office employees.…”