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Study: Safe, effective to use multiple nicotine replacements

Published 11:06 am, Saturday, June 14, 2014
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Fast facts on smoking
About 18 percent of adults -- 42.1 million people -- were smokers in 2012
Each day, more than 3,200 people young than 18 smoke their first cigarette
Each day, an estimated 2,100 youth and young adults who have been occasional smokers become daily cigarette smokers
As of 2011, 68.9 percent of adult smokers said they wanted to quit smoking and 42.7 had made an unsuccessful attempt to quit in the past year
Source: Centers for Disease Control and Prevention
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Julia Kelly smoked for 30 years and didn't think she'd ever quit.

Earlier this year, the 61-year-old kicked the habit by doing something slightly unorthodox -- combining the use of nicotine patches and nicotine gum. Though nicotine replacement therapies like patches and gums are often seen as helpful tools, the Food and Drug Administration recommend using only one method, not combining them.

Yet Kelly, a breast cancer survivor, said one of her doctors, Dr. Benjamin Toll, program director of smoking cessation services at Smilow Cancer Hospital at Yale-New Haven, recommended using the patch and gum together. That, along with counseling and keeping a diary of her smoking behavior, helped Kelly reach a goal she never thought she'd attain.

"It was easier than I thought to quit smoking," said Kelly, who lives in New Haven.

Toll, along with Yale colleague Lisa M. Fucito and a team of other researchers, recently wrote a paper, published this week in the journal Nicotine & Tobacco Research, stating that changing the way nicotine replacement therapies were used could help people quit sooner. For a long time, the FDA advised against patients using these products while still smoking, discouraged them from combining therapies and advised stopping use of the products after three months.

The FDA recently announced it was changing guidelines for nicotine replacement products, including deleting a warning on the label telling patients not to use the products if they were still smoking, chewing tobacco or using other nicotine-containing items. The FDA also stated it would allow for a longer use of nicotine replacement products, but only under the guidance of a health care provider.

Though these changes are a step in the right direction the guidelines "are still too narrow," said Fucito, assistant professor of psychiatry at the Yale University School of Medicine. One change that needs to be made, she said, allowing patients to use multiple therapies at once, the way Kelly used both a patch and the gum. She said there's evidence that, not only is it safe to use multiple products at once, it's a more effective form of treatment.

In the article, she and the other researchers site multiple studies showing that combining nicotine replacement products led people to quit fast. One study, of 300 smokers showed that nearly 40 percent of those who used nicotine gum and a nicotine patch together quit within three months of trying. Of those who used nicotine gum with a placebo patch, only about 30 percent quit in three months. Fucito said using multiple therapies helps curb cravings for many patients in a way a single treatment doesn't.

"You're probably not going to do very well if you just use the patch," she said. "You probably need to use the patch and something else."

Fucito said the researchers plan to reach out to the FDA soon and tell them about the paper and their findings on nicotine therapies. "We need to bring the guidelines in line with what the research shows," she said.

Fucito said some patients who might benefit from multiple therapies are afraid to try them because they worry about safety. Changing the guidelines could help adjust that.

Kelly, meanwhile, said using multiple methods was helpful. Still, she attributes most of her success to the counseling she received, particularly the smoking diary.

"You don't realize how much you smoke until you see it on paper," she said.