Nicotine replacement therapy

Nicotine replacement therapy (NRT) is the use of various forms of nicotine delivery methods intended to replace nicotine obtained from smoking or other tobacco usage. These products are intended for use in smoking cessation efforts to help deal with withdrawal symptoms and cravings caused by the loss of nicotine from cigarettes. Several forms of NRT have been marketed, including the nicotine patch, inhaler, nasal spray, gum, sublingual tablet, and lozenge. NRT is thought to be useful and beneficial for tobacco users who want to quit their addiction and is for most people perfectly safe. Cigarettes on the other hand cause the early deaths of about 5 million people each year. These people are not killed by the nicotine in the cigarette, but by other constituents of tobacco smoke such as Carbon Monoxide and tars. It is the nicotine that keeps the smoker addicted. Cigarettes can be viewed as a "dirty" and dangerous method of delivering nicotine, while NRT is a "clean" and safe method.

NRT delivers nicotine to the smokers brain in a much slower way than cigarettes do. It helps to damp down the urges to smoke that most smokers have in the early days and weeks after quitting, rather than remove them totally. It gives the smoker the chance to break smoking cues in their daily lives, and might provide a more comfortable exit from the smoking habit. NRT however is best used with some form of support, ideally from someone who knows something about smoking cessation.

In 2005 the Committee on the Safety of Medicines recommended that NRT be given to pregnant smokers and also to adolescent smokers. However, in the opinion of many independent nicotine researchers, the Committee on the Safety of Medicines has got its new advice on NRT dramatically wrong. Tobacco researchers who have received funding from the pharmaceutical industry have acted as consultants to the Committee.

Ginzel et al. (2007) reviewed the dangers of nicotine for the developing brain (Journal of Health Psychology 12, 215). Recent diversification of nicotine products and their placement on the free market are solely in the interest of industry and will not help to reduce youth smoking, but could serve as a gateway drug for nonsmokers. The recommendation of ASH to use NRT even without stopping smoking will create dependencies on both cigarettes and NRT (used simultaneously or alternating), again in the interest of industry only. Family doctors will be appropriately cautious about prescribing a drug that is a poison and carries many potential dangers to the foetus and adolescent smokers and indeed to all smokers who use NRT and yet continue to smoke tobacco.

A small number of people who use NRT, especially Nasal Spray and Nicotine Gum, will go on to use it on a longer term basis. These are usually highly nicotine dependent smokers who would not have been able to quit without the help of such medication. There is currently no evidence that such long term usage is harmful to health, especially when compared to smoking.

Findings from a recent Cochrane review of controlled trials testing NRT products (REFERENCE NEEDED) indicated that smokers using NRT were 1.5 to 2 times more likely to be abstinent from smoking at followup than those in the placebo or control treatment condition. However, this statement is controversial, and critics have pointed out that real-world trials rather than artificial ones yield results for NRT that are hardly better than those obtained for non-NRT controls.

Types

 * Nicotine patch
 * Nicotine gum
 * Nicotine inhaler
 * Nicotine lozenge
 * Nicotine spray
 * Nicotine sublingual tablet

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Tobacco cessation clinic