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Making best use of NRT
John Hughes, Professor of Psychiatry, Psychology and Family Practice, University of Vermont, USA
Abstract
Many recent studies have empirically verified that NRT efficacy can be substantially improved over use according to package labeling or regulatory agency guidelines. Combination of patch and acute NRT increases quit rates by a factor of 1.4. Using NRT for several weeks prior to the quit date increases quit rates by a factor of 2.2. A major therapeutic effect of NRT is to prevent lapses from becoming relapses (OR = 7.1) plus use of NRT while smoking is safe; thus, smokers should continue, not stop, NRT upon a lapse. In smokers who are not currently planning on quitting, reduction aided by NRT increases the probability of later quitting typically by a factor of 1.5–3.0. NRT can be used more aggressively in smokers with cardiovascular disease as recent studies indicate it is safe in this group. Other new uses of NRT have yet to be verified. Longer-term use of NRT has not consistently been better than short term use; however, long-term use does appear to be safe. Whether reducing prior to quitting increases or decreases quit rates compared to abrupt cessation is debatable. Whether NRT is likely to be helpful in adolescents is unclear. Whether NRT should be used in pregnant smokers when they fail non-medication treatment is still unclear. Whether using NRT to reduce craving and withdrawal in smokers not trying to quit during smoking restrictions would help or undermine the effects of smoking restrictions on quitting is unclear.
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About the presenter
John R. Hughes, M.D. is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 350 publications on nicotine and other drug dependencies and is one of the top 25 most cited tobacco scientists. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the US Food and Drug Administration, and the White House. His current research is on tobacco and marijuana cessation and is supported by grants from the US National Institute of Health and pharmaceutical companies. He has received fees from almost all of the companies who develop smoking cessation services, medications and devices and from various public and private organizations who promote tobacco control.
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