Quitting smoking is very difficult, especially if you are doing it on your own without any aid. There is no doubt about it, more so if you have been a habitual smoker for years. The success rate varies between 3 to 5 percent.

And of those who succeed on their own, most start smoking within the first month after quitting due to the smoking withdrawal symptoms.

If you have failed to give up, there are effective aids that work and make it easier to stop smoking for good. One of the popular and medically approved effective processes for smoking cessation is nicotine replacement therapy (NRT). It is cost effective and boasts of a higher success rate.

The success rate of nicotine replacement therapy in smoking cessation is 25%. It is higher when NRT is combined with stop smoking programs.

However, according to onlinelibrary.wiley, NRT increases the chances of quitting by 50 to 70% regardless of the setting.

NRT deals with physical dependence while the programs help with psychological dependence. The combination of NRT with such programs significantly increases your chances of staying off tobacco permanently.

NRT is available in the form of nicotine skin patches, nicotine gums or lozenges, and nicotine inhalers.

You can use either the nicotine skin patches, or the gums, or the inhaler, which work effectively. And, you can start using them as soon as you have thrown away your last cigarette.

The nicotine in the cigarette smoke is the ingredient that makes you want to smoke again and again. It is what makes tobacco smoking addictive and you, physically dependent on it.

Are you severely dependent on nicotine?

The following signs indicate that you have become severely dependent on nicotine:

  • Smoking more than one pack a day
  • Smoking soon after waking up
  • A long interval of no smoking makes you physically uncomfortable
  • You smoke even when you are unwell

Nicotine patches and gums are designed to supply your body with nicotine, which helps you battle the withdrawal symptoms making it easier for you to stop smoking.

Results have shown these nicotine replacement therapy aids double and sometimes triple the chances that the smoker will succeed in quitting.

In certain cases, they also help to minimize the side effect of weight gain that comes after quitting.

NRT forms a very important option for smoking cessation. It helps smokers wean themselves off tobacco by providing nicotine without any of the other carcinogenic substances found in cigarette smoke. You get only the nicotine, which is what controls your withdrawal symptoms.

These products are most effective when used with stop smoking programs.

Nicotine gums, lozenges, and patches are available over-the-counter. But, nasal sprays and inhalers are available only on prescription.

Gums and lozenges are popular because they can be popped into the mouth when you feel the urge to smoke. Some people prefer inhalers because it mimics the inhalation of smoking.

However, inhalers are recommended mostly for heavy smokers (> 30-40 cigs/day) and for those where one NRT product has not worked.

All these forms are equally effective and you can even use them in combination. Such combined use of nicotine patches with gums, inhalers, or nasal sprays significantly increases chances of long-term smoking cessation rates. Quitting figures range from 19% to 26%.

However, though combinations work well, you cannot continue to smoke when on NRT.

How does nicotine replacement therapy work?

  • NRT products became available over the counter in the 1990s.
  • Since quitting smoking gives rise to nicotine withdrawal symptoms, it becomes that much more difficult for the smoker to quit. NRT consists of substituting the nicotine in the cigarette, which has been withdrawn, with another source of nicotine. This reduces or even stops the withdrawal symptoms and helps with smoking cessation.
  • Though it does help to get rid of the smoking habit, dependency on nicotine remains intact.
  • However, this is battled with nicotine then gradually being withdrawn and replaced.
  • All these products release nicotine in a gradual manner.
  • Different strengths are available for smokers according to the severity of their smoking habit.
  • If you suffer from withdrawal symptoms in the morning, the 24-hour patch provides a more protective effect.

Nicotine replacement therapy is available as

  • Nicotine skin patches in which route of absorption of nicotine is transdermal. (Nicoderm and Nicotrol). A nicotine patch is applied over the skin.
  • Nicotine gum and lozenges (Nicorette). The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth.
  • Nicotine nasal sprays and inhalers are also available as aids to quit smoking but by prescription only.

What happens when you smoke while wearing the patch?

Firstly, smoking when wearing the nicotine patch doesn’t cause any serious health issues because it will not give you that much nicotine to cause any damage.

Secondly, it reduces your chances of quitting smoking. Smoking with a patch on signifies that you lack the willpower and need more motivation.

If you have smoked with the patch on, you should see your smoking cessation specialist.

He will do two things:

  1. First, he will increase your nicotine dose given via NRT by using a product with higher nicotine. He may use a combination of the nicotine products: patch with gum or more preferably patch with the inhaler.
  2. Secondly, he will advise you to take the help of quit smoking programs and join the cessation support groups.

All this will significantly increase your chances of succeeding in your effort to quit.

Why some smokers find it difficult to quit even with NRT?

NRT products deliver nicotine more slowly than cigarette smoking and the nicotine blood levels, therefore, rise gradually as compared with the quick rise with smoking.

Even the nasal spray, the fastest NRT provider of nicotine, is slow and inefficient in providing nicotine as compared to smoking.

This is the reason why some smokers start smoking again to fight the physical addiction even when using NRT.

In such cases, a combination therapy may help, e.g., patch+gum, patch+inhaler. Higher doses and use of quit smoking programs and support groups will be of great help

Safety of NRT vis-à-vis heart and brain

According to a study published in the BMJ journals, “the use of NRT is not associated with an increase in the risk of myocardial infarction, stroke, or death”.

The study further adds that the risk is not increased even in people with existing cardiovascular disease.

However, yet, manufacturers recommend exercising caution against the use of NRT in patients with cardiovascular disease, such as, in those who have had a heart attack.

Price of NRT products

Below are the approximate costs a moderate smoker (1.5 packs per day) will incur towards treatment with nicotine replacement therapy in the first six weeks during which the full dose of the medications are used.

  • Nicotine Patch — $80 to $163
  • Nicotine Gum — $92 to $197
  • Nicotine Lozenge — $136 to $208
  • Nicotine Inhaler —  $302
  • Nicotine Nasal Spray — $165

Disadvantages of nicotine replacement therapy

Because nicotine, the main addictive in tobacco, is used in this therapy, there is a risk of readdiction. However, if weaning is properly done as per advice and instructions, this risk gets eliminated to a great extent.

Who should not use NRT? Contraindications

Any risks that may be associated with NRT substantially outweigh the well-known dangers of smoking. But, sometimes it is wise to be prudent.

  • The US Agency for Healthcare Research and Quality states that pregnant women and teens should not use nicotine replacement therapy products.
  • According to a study, women who used NRT during the first trimester (first 12 weeks) of pregnancy had a higher risk of having babies with birth defects.
  • Those with known hypersensitivity to the active ingredient or any component of an NRT product should not use NRT.
  • People with the temporomandibular disease should not use nicotine gum.
  • Gastric and duodenal ulcer patients should not use NRT nasal spray and gum.