Quit the Habit – For Good: Nicotine Replacement Therapy

Excela Health Smoking Cessation Program
Presented by Dr. Jesse Milliken

After deciding to quit smoking, a large hurdle that people dread is the withdrawal. That urge to smoke and the feeling when that person has not smoked for some time can feel insurmountable. However, there are many ways that a person wishing to quit smoking can help to alleviate that feeling. Nicotine replacement therapy is an easy way to curb that urge and that need to smoke. Nicotine is highly addictive, and while the end goal is to stop being dependent on nicotine, the larger goal is decreasing and hopefully stopping the amount of toxic smoke from cigarettes that is inhaled. A way we can do that is by giving our body lower amounts of nicotine over time to curb that urge without putting the harmful effects of toxins in cigarettes into our bodies. There are many different methods of nicotine replacement therapy including a nicotine patch, gum, lozenges, nasal spray, and inhalers. All of these options can have advantages and disadvantages, so let’s go over some common options. Let’s first start with a method that a lot you probably have heard of. Nicotine gum. Nicotine Gum works by releasing nicotine from the gum that is absorbed through the oral mucosa. A benefit for nicotine gum is that it can be used when having those large urges to smoke due to its quicker onset. The peak of its effect usually occurs after 20 minutes and as a bonus it also helps with that oral fixation that some people can have when attempting to quit. The gum is usually only good for about 30 minutes before having to throw it away. A common misconception about nicotine gum is on its use. Although it is called gum, you actually do not constantly chew it. Chewing it too much too fast can lead to the release of too much nicotine too quickly and cause an irritated stomach. The optimal way to use the gum is a technique called chew and park. What you do is chew the gum until it has a flavor and then tuck it against the side of your mouth until that flavor disappears. You then repeat this for the 30-minute duration and ultimately fulfilling that urge for nicotine. Similar to nicotine gum is a nicotine lozenge. The lozenge is used in a similar fashion without having really having to chew. The lozenge then dissolves over a 30-minute span. This can be beneficial for people with poor dentition or jaw pain. It is less likely to expel too much nicotine at once and cause an upset stomach although upset stomach as well as mouth irritation can occur. Less used are the options of nicotine inhalers and spray. The nicotine is delivered via a vapor inhaled either through the nose (the spray) or through the mouth (with the inhaler). The onset is quickest with these options, however it does come with side effects of heavy nasal irritation and possible bronchospasm. It is not generally recommended to people with a history of breathing concerns.Another very commonly used method for nicotine replacement therapy is a nicotine patch. The nicotine patch is used by placing a patch on a hairless area of the skin and then is simply left on for the rest of the day. It is then removed at a later time, usually 24 hours later but can be removed at night, and replaced by another patch, usually on another spot of the body to mitigate any irritation. The patch is a long-acting and slow-onset method of delivering nicotine to the body, which produces relatively constant relief from withdrawal over a 24-hour period. However, the disadvantage is the user cannot adjust the dose of nicotine being released. This means you cannot increase your dose when having cravings. But not to worry, we can still treat those breakthrough cravings as well. As we have discussed, there are many options for nicotine replacement therapy, such nicotine patches and nicotine gum, but did you know that you can take both at the same time? This is because the concentration of nicotine in each individual treatment is lower than smoking a pack of cigarettes per day. Using a long-term patch to have a slow feed of nicotine, and then using gum, lozenges, or spray for those times when cravings get a little more intense can go a long way in limiting nicotine urge or withdrawal. Another question is, how long can you use these for? Most people will use these anywhere from a couple weeks to a couple months, and sometimes even longer. The goal is to decrease the amount of nicotine used at the user’s comfort level. Remember, nicotine replacement is much safer and healthier for your body than smoking. And if needed, and a relapse occurs while having a patch on, do not worry, they can be used while smoking as well. Also, it is important to keep in mind that all of these methods have different dosages which can be adjusted due to how many cigarettes a person smokes and even for when they smoke. Discussing the optimal dose of Nicotine replacement therapy with your doctor can help get the best results.