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New developments in smoking cessation: What the future holds
John Hughes, Professor of Psychiatry, Psychology and Family Practice, University of Vermont, USA
Abstract
In recent years, truly innovative psychosocial treatments have been rare, in part due to the lack of new basic science information on the causes of lapses and relapses. One exception is demonstration that extended treatment occurring over several quit attempts can substantially increase quit rates. Motivational interventions and matching patients to treatments makes sense, but early work has not shown robust results. Recent studies suggest internet-based treatments have a small effect.
Physician-based interventions have recently focused on only asking them to refer, to using paraprofessionals and to developing systems changes. Offering free treatments or increasing coverage appears to increase quitting. In contrast, many pharmacological treatments have been tested. New NRTs likely to be approved include a faster-acting gum and a mouthspray. A true inhaler is being tested. A cannabanoid antagonist appears to both increase quitting and reduce weight gain which would be especially helpful with weight-conscious and cardiac rehab smokers; however, it has been associated with suicidal behaviours. Cytisine, a varenicline-like medication is being tested which could be a much less expensive alternative.
Three vaccines that block the uptake of nicotine into the brain are just now undergoing cessation trials. Whether vaccines can produce blockade for a sufficient time after just a few injections and whether smokers will persist in multiple injections is unclear. Other products likely to undergo development include MAOI inhibitors, opioid antagonists, GABA agonists and inhibitors, and Swedish snus.
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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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