Are nicotine patches safe?

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Nicotine replacement therapy appears to be a safe option for smokers hospitalized for heart disease, even for critically ill patients on their first day, according to a new study.
Researchers hope the findings will encourage doctors to prescribe nicotine patches or other replacement therapies more often during a window when patients are most open to quitting the deadly habit.

Nicotine replacement therapy is predominantly used in outpatient settings to reduce cravings and treat other common smoking withdrawal symptoms such as irritability, anxiety, difficulty concentrating and depression.
But a study published Friday in the found that starting nicotine replacement therapy in the first two days of hospitalization did not affect a patient’s short-term outcome in death, length of stay, readmission or hospital expenses.

Only about 20 percent of heart attack patients get nicotine replacement prescriptions, researchers said.

“We said, ‘Let’s figure out if it’s hurting (patients) at all.’ And whether you add the nicotine patch or you don’t, we weren’t finding anything harmful. We couldn’t find anything,” said Dr. Quinn Pack, a preventive cardiologist and the study’s lead author.

“This included patients who were in the ICU, in the throes of a heart attack or right after bypass surgery. These were very sick patients, some of them getting life-supporting medicine for their blood pressure,” said Pack, a fellow at the Institute of Healthcare Delivery and Population Science at Baystate Medical Center in Springfield, Massachusetts.
The study evaluated data on 27,459 smokers admitted to 270 hospitals for one of three reasons: a heart attack, bypass surgery or the insertion of a cardiac stent. More than half of the patients were in the intensive care unit.

About 18 percent of the patients – 4,885 people – received some form of nicotine replacement therapy within the first two days of hospitalization for three days. Most patients selected the patch, with a daily nicotine dosage equivalent to one pack of cigarettes. A few patients instead used nicotine gum, inhaler or lozenges. The researchers did not follow up to see whether patients ultimately quit.

It is the first study to look at using nicotine replacement for heart patients within their first two days of hospitalization. Other research in the past decade, however, already suggested the therapy would be safe in the intensive care unit, during admission for acute coronary syndrome, or immediately upon hospital discharge.

“It seems counterintuitive, but we know that much of the risk from smoking doesn’t come from the nicotine itself, but other byproducts that come from the burning end of a cigarette,” said Dr. Kevin Woolf, a cardiologist who wasn’t involved in the new study but has researched the effects of nicotine replacement therapy on heart patients upon their hospital discharge.

Woolf, who works in private practice in Hillsboro, Oregon, said “there’s enough observational data” showing that nicotine replacement after a heart attack is safe. In fact, the benefits of getting patients immediately off tobacco products probably outweigh any risk from the replacement therapy.

“Getting a head start, right off the bat in the hospital and out the door, is going to be absolutely key in our ability to assist patients with quitting,” Woolf said. “Seizing these psychological moments, when somebody is nervous from their heart attack and may be more able to overcome their addiction, is important.”

The study stressed the same point, noting that a majority of smokers who try to quit relapse within two weeks after being discharged from the hospital.

“The ultimate goal is to show that (using nicotine replacement in the hospital) isn’t harmful, so if you think it’s going to help your patient quit smoking, absolutely go ahead and use it,” Pack said. “Studies suggest that most of the time these medicines are pretty good. These are no silver bullets, but they can help take the edge off the withdrawal and help reduce cravings at least a little.”

If you have questions or comments about this story, please email [email protected]

Brian Hitsman, PhD, assistant professor in Preventive Medicine and Psychiatry and Behavioral Sciences, is a senior author in a study that compared nicotine patch treatment lasting eight, 24 and 52 weeks.

Nicotine patch therapy is one of the most popular ways people try to quit smoking, but most who use it still relapse within a year. A new study from Northwestern Medicine and the University of Pennsylvania has found that extending patch treatment beyond the standard eight-week duration can lead to better smoking cessation rates – and established that a longer regimen is just as safe.

The study, published Feb. 23 in JAMA Internal Medicine, randomized 525 treatment-seeking smokers to patch treatment lasting eight, 24 or 52 weeks, and then compared their rate of smoking abstinence. Six months after treatment, 22 percent of participants in the eight-week group were abstinent, compared with 27 percent of those in the 24-week and 52-week groups.

Importantly, longer treatment was not associated with more negative side effects.

“Safety of long-term nicotine patch treatment has been a big unknown,” said senior author Brian Hitsman, PhD, assistant professor in Preventive Medicine and Psychiatry and Behavioral Sciences. “We found that adverse effects of using the patch for six months and even one year were the same as standard treatment.”

The work replicates the results of a previous University of Pennsylvania study that showed 24-week patch treatment leads to a higher likelihood of smoking cessation than eight-week treatment. But the new study was the first to investigate 52-week treatment. While safe, 52 weeks on the patch did not lead to better quit rates.

“Extending patch treatment to 52 weeks did not provide an additional advantage over 24 weeks,” Hitsman said. “This may have been due to the difficulty of staying engaged in treatment between six and 12 months. It’s a problem that we also have with the treatment of other chronic diseases and conditions.”

Hitsman believes that further research focusing on these adherence challenges is needed.

“If adherence had remained high over 12 months, it’s possible that treatment would have been more effective,” he said. “Another next step is to see who benefits from 12 months of treatment or longer. It might be that people with a longer smoking history or who are more nicotine dependent may be the ones that should be continuing longer than six months, or at least should have the option to if they want it.”

In the meantime, the study suggests that the U.S. Food and Drug Administration should support longer-term patch therapy. Current guidelines FDA recommend that the patch be used for just eight to 12 weeks before consulting a healthcare provider.

“Provider monitoring of longer-term treatment isn’t needed,” Hitsman said. “We know that it’s safe and effective up to six months; people should be able to stay on it on their own.”

High smoking relapse rates point to another benefit of extended treatment.

“With 24-week or longer treatment, you can support people’s second and third attempts to quit,” said Hitsman, who is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “Once the standard eight-week treatment is over, you’re on your own.”

This study was supported by National Institute on Drug Abuse grants R01 DA025078 and R01 DA033681 and National Cancer Institute grant P50 CA143187.

Nicotine Patch

Generic Name: Nicotine Patch (nik oh TEEN)
Brand Name: Nicoderm CQ

Medically reviewed by Last updated on Jul 31, 2019.

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Uses of Nicotine Patch:

  • It is used to treat nicotine withdrawal.
  • It is used to curb the craving to smoke.

What do I need to tell my doctor BEFORE I take Nicotine Patch?

  • If you have an allergy to nicotine or any other part of nicotine patch.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Chest pain or pressure, a heartbeat that does not feel normal, or a recent heart attack.
  • If you still smoke, chew tobacco, or use other products that have nicotine while using nicotine patch.

This is not a list of all drugs or health problems that interact with nicotine patch.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take nicotine patch with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Nicotine Patch?

  • Tell all of your health care providers that you take nicotine patch. This includes your doctors, nurses, pharmacists, and dentists.
  • Get counseling to help you quit smoking.
  • Do not use more than told. Unsafe side effects may happen.
  • Tell your doctor if you are taking another drug to help you stop smoking.
  • Avoid driving and doing other tasks or actions that call for you to be alert until you see how nicotine patch affects you.
  • If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
  • When you stop smoking, other drugs may be affected. Talk with your doctor.
  • Tell your doctor if you have not been able to quit smoking after using nicotine patch for as long as it says to use it.
  • The patch may have metal. Take off the patch before an MRI.
  • If you have strange dreams or other trouble sleeping, take off the patch at bedtime.
  • This medicine may cause harm if chewed or swallowed. If nicotine patch has been put in the mouth, call a doctor or poison control center right away.
  • This medicine may cause harm or be deadly if used or swallowed by children or pets. If a child uses nicotine patch or if nicotine patch is swallowed by a child or pet, call a doctor or poison control center right away.
  • If you are 65 or older, use nicotine patch with care. You could have more side effects.
  • This medicine may cause harm to the unborn baby if you take it while you are pregnant. If you are pregnant or you get pregnant while taking nicotine patch, call your doctor right away.
  • Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

How is this medicine (Nicotine Patch) best taken?

Use nicotine patch as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • The patch comes in 3 doses. If you smoke 11 or more cigarettes a day start with the 21 mg patch (step 1). If you smoke 10 or less cigarettes a day start with the 14 mg patch (step 2).
  • Put patch on clean, dry, healthy skin on the chest, back, belly, or upper arm. Move the site with each new patch.
  • Put patch on a site without hair.
  • Wash your hands after use.
  • Each patch can stay on for 16 to 24 hours. If you crave cigarettes when you wake up, wear the patch for 24 hours.
  • Do not leave on the skin for more than 24 hours.
  • Do not put on more than 1 patch at a time.
  • Do not use patches that are cut or do not look right.

What do I do if I miss a dose?

  • Use a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not use 2 doses at the same time or extra doses.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
  • Mood changes.
  • Feeling confused.
  • Chest pain or pressure, a fast heartbeat, or an abnormal heartbeat.
  • A burning, numbness, or tingling feeling that is not normal.
  • Dizziness.
  • Upset stomach or throwing up.
  • Diarrhea.
  • Drooling.
  • Shakiness.
  • Feeling tired or weak.
  • Cold sweats.
  • Blurred eyesight.
  • Change in hearing.

What are some other side effects of Nicotine Patch?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

  • Trouble sleeping.
  • Bad dreams.
  • Feeling nervous and excitable.
  • Headache.
  • Joint pain.
  • Back pain.
  • Irritation where nicotine patch is used.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at

If OVERDOSE is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How do I store and/or throw out Nicotine Patch?

  • Store at room temperature.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
  • After you take off a skin patch, be sure to fold the sticky sides of the patch to each other. Throw away used patches where children and pets cannot get to them.

Consumer information use

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about nicotine patch, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Related questions

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More about nicotine

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Consumer resources

  • Nicotine Gum and Lozenges
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  • Nicotine transdermal
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  • Nicotine Inhaler
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Other brands: Nicorette, Nicoderm CQ, Nicotrol Inhaler, Leader Nicotine Polacrilex, … +4 more

Professional resources

  • Nicotine (AHFS Monograph)
  • … +6 more

Related treatment guides

  • Smoking Cessation

Smoking cigarettes contributes to almost 1 in 5 deaths. The top three smoking-related causes of death are cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD). In addition to these “top three,” smoking is also linked to a number of other cancers, an increased likelihood of getting more colds and infections, diabetes, osteoporosis and hip fractures, problems in pregnancy, difficulty with erections, stomach ulcers, gum disease, and the list goes on.

Quitting smoking can add years to your life. Though the earlier the better, it’s never too late to quit. The benefits of quitting are real, even at the age of 80!

So what’s the best way to quit?

Set a quit date

Pick a date in the next few weeks, share it with your friends and your family, and mark it on your calendar. Plan to completely stop smoking on that quit date. Think about what might make it challenging to stop. Be prepared for how you will handle any withdrawal symptoms. Identify what triggers your craving for a cigarette, and have a strategy to avoid or deal with these triggers. Start exercising before your quit date to minimize weight gain when you stop smoking. Find healthy distractions to keep your mind and hands busy. Have nicotine replacement products like nicotine gum and patches ready on hand if you plan to use them.

Going “cold turkey” might be better

You can choose to cut down on your cigarettes gradually before your quit date, or smoke as you normally do up until your quit date. Either is fine, but it seems that quitting abruptly, going “cold turkey,” might be better.

A recent study randomly assigned about 700 participants to either gradually cut back on smoking over two weeks or quit abruptly on a set quit date. Both groups were offered counseling support as well as nicotine patches and other forms of short-acting nicotine replacement. The group assigned to cold turkey was significantly more successful at quitting smoking, both at the 4-week follow-up (49% vs. 39%) and the 6-month follow-up (22% vs. 15%).

Many people need extra support

Though some people are successful on their own, many have a hard time—and it often takes multiple tries to quit for good. Ask for help. There are many ways to get support, from one-on-one in person, to telephone call support, to mobile phone aps. Many counseling programs are free, and will even provide nicotine patches without charge.

In addition to your doctor, here are some places to start:

  • 1-800-QUIT-NOW

Treatments available

Treatment with medications (nicotine replacement, varenicline, or bupropion) increases quit-rates, especially when combined with counseling. These medications may help with cravings, withdrawal symptoms, and other side effects of quitting smoking. All of these agents can be used even if a person has not completely stopped smoking. Varenicline and bupropion take some time to work, so they should be started a week to several weeks before the quit date, depending on the medication. Talk to your doctor about which treatment is suitable for you, especially if you have depression.

If these various treatments don’t work, they may also be tried in combination. In addition, there are other alternative treatments, like acupuncture and hypnosis, but success has been less clear with these.

  1. Nicotine replacement. Using nicotine replacement doubles the quit-rate. It helps with withdrawal symptoms and cravings, and can be tapered off easily as withdrawal symptoms improve. There are many forms available over-the-counter or with prescription: patches, gum, lozenges, nasal spray, and inhaler. The highest dose patch (21mg) should be used if the smoker smokes more than 10 cigarettes a day. The patch delivers nicotine through the skin over 24 hours, but can also be removed at bedtime. The other short-acting forms of nicotine replacement can be used alone, or used with patches as needed for cravings or on a regular schedule at first (e.g. hourly while awake).
  2. Varenicline (Chantix). Varenicline works by binding to nicotine receptors in the body, partly turning them on to reduce withdrawal symptoms, but also blocking them from the nicotine in cigarettes and thus making smoking less pleasurable. So far, varenicline has shown the highest quit-rate in studies.
  3. Bupropion (Zyban, Wellbutrin SR). Bupropion is felt to work by working on the brain’s hormones. It has the added benefit of minimizing the initial weight gain with stopping smoking. Treatment for longer duration may help prevent relapse in those who have quit. It cannot be used in those who have a history of seizure disorders.

Most smokers who stop will feel better, and stopping will lower their risk of getting (and dying from) smoking-related illnesses. But quitting smoking can be very difficult. If you are a smoker and you want to stop, talk to your doctor about what the best options are for you to help you succeed.

A complete guide to the nicotine patches

The nicotine patch was developed in the 1980s after a small team of health care researchers in California discovered that nicotine could be absorbed through the skin, and that the effects of this could help to reduce cigarette cravings in smokers. In the absence of volunteers on whom to test these effects, the scientists reportedly experimented on themselves, by rubbing tobacco leaves onto their skin and measuring their bodies’ physiological reactions! They filed for US patent of the transdermal nicotine patch in 1988, and today it remains one of the most popular quit smoking aids available on the market.

Nicotine Replacement Therapy Explained

Nicotine replacement therapy (NRT) is a class of healthcare products that release low and controlled quantities of nicotine, without the other harmful substances found in tobacco such as tar and carbon monoxide. These harmful substances can increase the likelihood of conditions such as cancer and heart disease (heart attacks, high blood pressure and irregular heartbeats).

They’re used as stop smoking aids, as they can help to reduce the nicotine withdrawal symptoms that many people experience when they give up cigarette smoking. They can also limit weight gain after quitting smoking by reducing energy intake.

When people quit ‘cold turkey’ — without the use of any medication and without expert support — these withdrawal effects can be so difficult to overcome that many succumb to relapse. That’s why the cold turkey method is no longer recommended by health professionals, and instead, the use of NRTs is encouraged for those who feel that they would benefit from them, as part of a planned smoking cessation programme.

Nicotine replacement therapy is not intended as a long-term solution to a nicotine addiction, but rather it’s designed to help with the transition between cigarette smoking and being entirely nicotine-free.

In fact, a recent review of the current scientific evidence and clinical trials found that the use of NRTs can increase a person’s chance of successfully quitting smoking by a massive 50-60% — so you definitely shouldn’t overlook these products if you’re considering a quit attempt!

NRTs come in various forms (nicotine patches, nicotine gum, nicotine lozenges, habitrol and more), and it’s key to read all the important information so that you can find the one that works best for you. Here, we focus on nicotine patches, and cover everything you need to know about these products as you begin your smoke-free journey.

What are nicotine patches?

A nicotine patch is a form of nicotine replacement therapy (NRT), designed to help people quit smoking. It’s a transdermal patch, meaning it delivers a specific amount of nicotine through the skin and into the bloodstream, once applied.

Although all NRTs deliver nicotine to the brain at a slower rate than cigarettes, the release of nicotine from patches is the slowest of all NRT products. Rather than providing a ‘quick hit’ of nicotine in the way that some other products do, nicotine patches are designed to provide the body with a steady supply of nicotine throughout the day and in most cases, throughout the night too.

Nicotine patches are designed to provide the body with a steady supply of nicotine throughout the day.

Who should use them?

If you’re considering a quit smoking attempt, using NRTs could make things a whole lot easier. Though they only tackle the physical aspect of your smoking habit (you’ll still need to address the behavioural side of things), using NRTs can significantly reduce nicotine withdrawal symptoms and cigarette cravings, making it less likely that you’ll give in to temptation.

There is no evidence to say that one form of NRT is more effective than the other, however, so the product, or combination of products that you choose is entirely down to you.

Nicotine patches may be beneficial for those who prefer to tackle withdrawal symptoms in a more discreet way, since the patches (which are now available to match different skin tones) can be applied to an area that’s hidden beneath your clothes, and can be left in place for the entire day. Some people also find that nicotine patches are less hassle, since you simply have to apply them in the morning and don’t have to worry about carrying anything around with you, or remembering to actively use the product throughout the day, as would be the case with nicotine gums, lozenges or nasal sprays.

You can also be confident that your body is receiving a steady supply of nicotine, and this may help with the psychological aspect of your cravings, as well as the physical. Lastly, not everyone like the taste of oral NRTs, so if that’s the case, a nicotine patch could be a better alternative.


Though a great deal safer than cigarettes, NRTs still contain nicotine, so are not entirely risk-free. However, most experts agree that they are a far better alternative to smoking, and that the benefits therefore outweigh the risks. Nevertheless, certain individuals should take extra caution before using these products, in order to minimise any adverse effects.

If you’re pregnant or breastfeeding, you should visit your GP before continuing use of these products. That’s not to say that you won’t be able to use them, but it’s best to seek expert advice first, to ensure your baby isn’t put at risk.

Similarly, if you have a long-term health condition, it’s worth informing your GP of your plans to quit smoking in order to minimise any drug interactions or worsening of symptoms. Your GP will then be able to offer you personalised advice with regards to quit smoking aids.

Due to the application of nicotine patches, those with skin conditions such as eczema may find that these products exacerbate symptoms. Equally, those who are allergic to adhesive tape should steer away from nicotine patches and instead choose another form of NRT.

How to use nicotine patches

Step 1: Choosing the strength

Nicotine patches come in three strengths, and are labelled according to how much nicotine they supply over a 24-hour period:

  • 7mg/24 hour (low strength)
  • 4mg/24 hour (medium strength)
  • 1mg/24 hour (high strength)

The strength that’s right for you will depend on the amount of cigarettes you would usually smoke. If you’re a heavy smoker, or usually smoke more than 10 cigarettes each day, you should start with a high strength nicotine patch, whereas the medium strength will usually be sufficient for a lighter smoker.

Regardless of the strength you start with, it’s important to remember that nicotine patches — like other forms of NRT — are not intended as a long-term solution to your smoking habit, and therefore use of these products should be reduced over time. Generally, patches are recommended for 8-10 weeks, though towards the end of the usage period you should switch to a lower dose in order to gradually wean yourself off nicotine.

The product you purchase will come with a set of directions, however if you are confused or wish to clarify the strength that you should be using or the correct timescale of use, you can visit your local GP or stop smoking service, or alternatively speak to a pharmacist.

Step 2: Applying the patch

A nicotine patch effectively looks like a large plaster, or bandage. The outer part of the patch contains an adhesive, so it’s this part that sticks to your skin and holds the patch in place. The inner part of the patch contains the nicotine, and is pressed close to the skin in order to enable the effective release and delivery of nicotine.

You should apply the patch to an area of skin that has a minimal amount of hair, such as your upper arm, hip or upper chest. The area of skin you choose should also be clean and dry before application. After removing the protective seal, apply the patch straight away, avoiding touching the adhesive as much as possible. Once stuck to your skin, press down firmly on the patch for around 10 seconds to ensure it is flat and secure, before washing your hands once you’re finished. If the patch becomes loose or falls off, simply replace it with another.

When it’s time to change the patch, peel it away from your skin, fold it in half and dispose of it immediately. You should apply the new patch to a different area of skin, though a skin site can be reused after a period of one week.

Step 3: Use in conjunction with behavioural therapy.

Nicotine patches only address the physical side of addiction. A behavioural therapy app, like Quit Genius, works in conjunction with the patches to deal with the psychological part of addiction!

Side effects

As with any medication, some people experience side effects while using nicotine patches. Possible side effects include:

  • Itching or skin irritation (skin redness)
  • Headaches
  • Increased heart rate and blood pressure
  • Dizziness
  • Nausea
  • Vivid dreams (rare)

These symptoms are usually mild, serious reactions are exceedingly rare. If they appear to be worsening after your start date, or if they’re impacting your ability to use the products as intended, seek advice and health information from a health care professional such as your GP or pharmacist.

If you experience any signs of an allergy, such as a rash, swelling, hives or difficulty breathing, discontinue use of the patch immediately and seek medical attention as soon as possible.

Where to buy

In most countries, nicotine patches are available over the counter, meaning you don’t need a prescription to purchase them.

You can buy them from your local pharmacy or drugstore, as well as many supermarkets and online retailers.

Take home message

If you’ve made the decision to tackle your smoking habit, now is a great time to consider how nicotine replacement therapy can help you on your way. Nicotine patches, in particular, offer a discreet and hassle-free way of combating cigarette cravings, by providing your body with a steady dose of nicotine throughout the day.

However, the type of quit smoking aid you choose is dependent on your preferences, and it’s important to choose a product that you feel comfortable using. Take your time and do your research, but try to decide on a method prior to your quit date, so that you can have everything in order and be completely prepared as you set out to enjoy the benefits of a healthier, happier, smoke-free life!

Does nicotine replacement really help smokers quit?

Alpert, Connolly and Biener’s new population level study found that within the first six months of quitting that the odds of smoking relapse among heavily dependent quitters using nicotine replacement threapy (NRT) were 3.53 that of those quitting without NRT or professional help. That ratio declined to 2.62 within the first year of quitting, and held steady at 2.68 by two years.1 Heavily dependent was defined as having smoked within 30 minutes of waking + smoking at least 20 cigarettes per day.

Douglas Kamerow’s January 18, 2012 BMJ editorial is entitled “Does nicotine replacement really help smokers quit?”2 Kamerow suggests that the Alpert study was not “well done” because “most importantly, we have known for a long time that people who quit on their own (‘cold turkey’) are different from those who need and seek help through counselling or drugs.” “They may be less addicted, or have more willpower, or something else…”

It’s ironic that Kamerow invokes NRT’s current most favored failure explanation, the selection bias theory, when the above unmentioned Alpert findings contrast heavily dependent NRT quitters to heavily dependent non-NRT quitters.

It’s also strange to at last read in print that cold turkey quitters truly are different from clinical trial placebo quitters, who joined seeking “medication.” It’s why quitting product marketing assertions that “your chances” are the same as a clinical trial placebo user’s are both false and deceptive.

But Alpert’s negative real-world NRT findings are far from alone. Nearly all population level studies since 2000 have found NRT no more effective than quitting without it.

Responding to my Freedom of Information Act Requests, the only population level quitting method study acknowledged as having been conducted by the USDHHS was the 2006 National Cancer Institute analysis by Hartman.3 Hartman found 9 month quitting rates among 8,200 quitters to be 14 percent among 1,766 NRT users, 12 percent among 311 using more than one type of NRT, and 16 percent among 5,428 non-NRT quitters.

A 2006 Australian study followed smoking patients of 1,000 family practice physicians.4 Among 2,207 former smokers, 88 percent had quit cold turkey, with cold turkey’s success rate roughly double that of the nicotine patch, gum and inhaler, or Zyban.

Clearly, the world’s most medication dependent cessation program is UK NHS Stop Smoking Services (SSS). Review of the program’s facilitator training guide, the NCSCT Standard Treatment Programme suggests that medication use is all but forced upon participants. Medication use is urged while teaching the “not a puff rule,” during discussion of withdrawal symptoms, during review of medication options, and in discussing quitting preparations.

What’s missing from NHS facilitator training is any mention as to how most real-world quitters succeed, how SSS counselling or support can substantially enhance cold turkey success rates, or how even by week four of treatment, that UK NHS SSS program data consistently shows non-medication quitters doing as well as or better than NRT quitters, who still have another 4 to 8 weeks of treatment before attempting to adjust to natural brain dopamine pathway stimulation.6

Although long-term NHS quitting method data is treated as though top secret, there was one long-term study. Ferguson et al 2005 examined one-year SSS rates in Nottingham and North Cumbria. The sample shows just how forced medication use is within SSS. Among 47 non-medication quitters, 25.5 percent quit for one year versus 15.2 percent among 1,568 NRT quitters.

So, how do we explain 88 percent of Australian smokers quitting cold turkey while 93 percent of 2011 UK NHS quitters used medication? And at what price? If population level use of NRT is less effective than quitting without it, are quitters world-wide paying with their lives?

It’s a question that begs investigation by non-conflicted researchers. When doing so, I recommend focus upon subgroups within non-medication and unassisted populations. Which subgroup method was superior? And what was the common thread among the method’s successful quitters?

John R. Polito, JD – Nicotine Cessation Educator

1. Alpert, HR, Connolly GN, Biener, L, A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation, TC Online First (TC abstract), January 10, 2012

2. Kamerow, D, Does nicotine replacement really help smokers quit? BMJ 2012;344:e450

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