Nicotine Replacement Therapy

by Mark Elliot

Have you heard about Nicotine Replacement Therapy? *(See Below)

The words “quitting smoking” have a negative meaning in the ears of a smoker. The idea of Nicotine Replacement Therapy is to change the way you get your nicotine. This particular therapy has more hope of success with long-term smokers than any other.

I first heard about it from Ken Osean, a therapist with the Hazelden Treatment Center in Dallas, TX. We were attending a conference of recovering people and talking about new therapies designed to help addicts to quit smoking. While I voiced my usual complaint about wanting to quit smoking more than anything else Ken started explaining that while roughly 20 – 25% of the general population smokes cigarettes. 80 – 95% of all addicted and recovering people smoke. The most common cause of death for a person who’s given up drinking or drugs is smoking related illness: Heart disease, emphysema, or cancer.

Harm reduction is the goal of Nicotine Replacement Therapy. Cigarettes are a device for delivering nicotine and the key to the therapy is to change the delivery system. Changing the way you get your nicotine means giving up cigarettes, but still getting the nicotine fix that you’ve come to depend on. This way you’re getting just the hit of nicotine, without the tar, carbon monoxide and 5000 other toxic gases that come from cigarette smoking. However, the cost of nicotine replacement products is a formidable obstacle to those who smoke the most: The poor. A recent survey of prices for nicotine patches shows the cost to be close to the cost of a carton of cigarettes. Not a big incentive for a low-income smoker to try quitting.

Any doctor would agree that getting pure nicotine from anything other than a cigarette is far better healthwise than smoking. It’s a different strategy for dealing with the age old problem of quitting smoking that was developed to help to most chronic smokers of all: Alcoholics and drug addicts like me.

In Britain the patches are free for the poor...

The British National Health Service (NHS) has recognized the effectiveness of nicotine patches and gums in reducing long-term healthcare expenses. For that reason they recently decided to provide them free of charge to low income smokers.

It only makes sense.

Regardless of that enlightened attitude in the U.K. there are ways to make using the patch less costly. Not manufacturer recommended, but I found the uniform pricing of 21 mg, 14 mg, and 7 mg patches to be a rip-off! You can get around it by using the Nicoderm 21 mg patches exclusively and slicing them into pieces. (Don’t try this with Habitrol patches; they use a different construction which doesn’t allow you to slice them)

You get your nicotine from other sources and break the habit of smoking.

OKAY, I’M QUITTING. ATTEMPT #1

Nicotine patches take some getting used to. The first time I tried them I felt at ease, surprised at how I felt comfortable without a cigarette. The hunger for a cigarette was controllable for the first time in the 35 years since I began smoking. It was a good sensation to experience, but short-lived.

First came a druggy feeling which I assumed was just part of getting used to the nicotine patch. Worrisome, because I didn’t like feeling druggy at all. I didn’t want a cigarette, but my friends noticed my new red complexion and buggy eyes. A friend took me in hand to the blood pressure machine at the local drugstore where we discovered my blood pressure had soared to heart attack level! Pure nicotine has an immediate effect on your metabolism. I was tearing the patch off before I even got out the front door! This wouldn’t work, I said to myself as I hastily ducked into a corner store to buy another pack of cigarettes.

I explained to friends that I’d gone back to smoking again for my health. It wasn’t the same though. My blood pressure which had risen so disastrously high now wasn’t coming falling in spite of giving up the patch. A visit to my doctor explained why: I was overweight by about 30 pounds and my blood cholesterol level was the same reading as oil pan sludge. Not only the smoking had to go: I had to crash diet to lose weight and exercise to get in some kind of shape before my next try at using the patch.

Three months later (and 30 pounds lighter), I was ready to try again.

TRY, TRY AGAIN. ATTEMPT #2

That first experience of feeling comfortable without cigarettes had a profound effect on my next attempt. Being able to recall a comfortable feeling associated with using the nicotine patch was at least a hopeful sign. I found out quickly that the 21 mg patches were too strong and gave me a woozy feeling along with a headache. It takes some adjustment to figure out the exact dose of patch to use. 21 mg was too strong. 14 mg wasn’t strong enough. I was using 14 mg but chewing a couple of 2 mg pieces of nicotine gum to keep in my comfort zone.

This went right against the advice on the packages. (You’re not supposed to use gum or smoke with the patch on) But, by the third day I was using the patch alone and feeling fairly good. I’ve known of one guy who started with two 21 mg patches because he was such a heavy smoker. He was also in a hospital ward and under close supervision mostly to keep him from slipping out for a cigarette.

Have you ever noticed that up until recently you needed a doctor’s prescription for patches or nicotine gum, yet at the same time cigarettes were available over the counter...? Ain't it ironic?

You sweat a lot while using the patch. Finding my comfort level was an involved process because the nicotine affected me in so many ways. I was monitoring my blood pressure constantly in fear of it going through the roof again! But, it didn’t.

Something else was that I had incredibly vivid dreams if I left the patch on while I slept. At first it was kind of cool…almost hallucinogenic. But, it became more uncomfortable as the days went by and I started getting in the habit of taking the patch off an hour before bedtime. This is a routine that has to be learned as you also have to develop a habit of taking the patch off an hour before you do any rigorous exercise. My blood pressure was still running around “high normal” and a sudden burst of exercise could easily push it into the danger zone.

I was also seeing my doctor weekly to make sure everything was working right. After all the scares I wasn’t taking any chances. Some of the strangest sensations were the old habits that now were passé like running outside for a cigarette on every coffee break. (Smokers always have the rosiest cheeks in winter. They’re outside freezing every chance they can break for a cigarette) It was even a bit disconcerting not to need to jump for a cigarette anymore. Change hung around in my pockets without being spent. My desk at home didn’t need to be cleaned all the time. All the ashtrays in the house disappeared. Strange.

Getting nicotine in other ways than smoking makes sense.

Restrictions on where and when people can smoke mean many people are smoking fewer cigarettes, but they are inhaling harder, so their nicotine dependence is still high.

If you need a cigarette within 30 minutes of getting up, you’re a heavy smoker. Anything you can do to break the habit is going to be less harmful than continuing smoking. Most people are concerned about weight gain when they quit smoking, but all the studies of the subject show the health risks of gaining a few pounds are offset any other problems.

More to Come...

* For more information on side effects and possible dangers or Nicotine Replacement Therapy visit the Drug Resource Center

For more books and information about quitting smoking visit the Smoking Resources Page

NHS boost for nicotine patches (BBC News Wednesday, 14 March, 2001, 00:23 GMT)

Habits: Focus on Health, One Problem at a Time By JOHN O'NEIL (New York Times November 6, 2001)

Nicotine patch rules condemned (BBC News Wednesday, 12 December, 2001, 23:54 GMT)