What are the 6 effective treatments to quit tobacco smoking

Those who stop using tobacco always win. Within 20 minutes, the heart rate decreases and blood pressure drops. After a year, the risk of having a heart attack drops by half. Quitting smoking is known to have enormous health benefits, including improved well-being, but controlling addiction is not easy. Therefore, it is recommended to seek help from health professionals, and - if appropriate - to access pharmacological treatments that have proven effective.

For people over the age of 18 who consume between 10 and 20 cigarettes a day, there are 6 effective pharmacological treatments, according to a consensus panel with twenty-five experts from different scientific societies, institutions and jurisdictions in Argentina. With its recommendations based on scientific studies, the Ministry of Health of the Nation published the new clinical practice guideline “Treatment of tobacco addiction”.

In addition to giving recommendations in favor of such pharmacological treatments, experts warned that there are 20 products that are sold or indicated with the promise that they “help” to quit smoking, but they have no use, as is the case with the popular electronic cigarette. In some cases, ineffective products are even suggested by some health professionals.

“Tobacco addiction involves compulsive use. It is a mental or emotional dependence on nicotine, which is the addictive substance contained in tobacco products. As it is part of complex behavior, quitting smoking is sometimes not easy, but there are millions of people who have succeeded,” Alejandro Videla, president of the Argentine Association of Respiratory Medicine, told Infobae, who was one of the experts who prepared the guide under the general coordination of doctor Brunilda Casetta and the general review of Mario Virgolini and Graciela Abriata of the Ministry of Health and Dolores Breit, of the Pedro de Elizalde Children's Hospital.

“You often hear offers of miracle cures to quit tobacco smoking, and sometimes they capture the attention of people looking for change to be quick and with as little effort as possible,” he added. But the truth is that products without evidence of effectiveness are a waste of time and money, and can lead consumers to become frustrated and believe that there is no remedy for their addiction. However, there is.

It has been shown that the pharmacological treatments endorsed increase the success rate when combined with practical counseling by a trained professional because it promotes the smokers change their behavior.

“Asking for help from professionals who are trained in smoking cessation is key,” said Sandra Mariela Galarza, physician and director of the tobacco control program at the Ministry of Health of the City of Buenos Aires, who also participated as a reviewer of the guide.

With counseling, smokers can be trained to identify and cope with events and problems related to smoking or relapse risks. For example, they can anticipate stressful situations and learn relaxation strategies. “It is recommended that people who smoke have access to intensive interventions both individually and in groups as both increase the cessation rate,” the experts said in the guide.

Four of the 6 effective treatments for smoking cessation fall within the group of nicotine replacement therapies. They consist of providing nicotine in the form of chewing gum (chewing gum), patches, nasal sprays, and dragees (or nicotine dispersible tablets). Many scientific studies have shown that using nicotine replacement therapy can almost double the chances of successfully quitting smoking.

In the case of nicotine patch, it is recommended to use it for 8 to 12 weeks from the date to quit smoking, that is, the “D-Day”, as it increases the rate of cessation. It's over-the-counter. It can be applied to the arm, abdomen or leg, said Dr. Galarza. Meanwhile, nicotine gum is a dose of 2 milligrams that can be used for 8 to 12 weeks and is over-the-counter. Before using it, they recommend checking the dental condition and whether there are contraindications to chewing gum.

As for the nicotine dispersible tablet or dragee, the dose is 1 milligram and over-the-counter, and it can be given as a treatment for 8 to 12 weeks from “D-Day”. They are used by letting them dissolve in the mouth.

In people who smoke and have a high dependence, the use of nicotine nasal spray is suggested in 12-week treatments as it is effective in increasing the cessation rate. It is sold only with a doctor's prescription. It is considered “high dependence” when people smoke more than 20 cigarettes a day or when smoking is needed within the first 30 minutes of waking up in the morning. But experts also noted that the spray should be used with caution because of the risk of development of dependence.

In addition to nicotine replacement therapies, there are two other drugs that are effective in adults who smoke more than 10 cigarettes per day. One of them is the antidepressant bupropion, which should be used in doses of 150 or 300 milligrams per day in treatments of 8 to 12 weeks. In this case, treatment should be started at least one week before the “D-Day” on which smoking is stopped.

The sixth treatment with validity of effectiveness - which has the consensus of experts - is varenicline, which is consumed in doses of 1 to 2 milligrams per day for 12 weeks of treatment. But currently that drug is not available on the market due to a problem of batch contamination of the products in the United States, which led to changes in production processes globally. It is estimated that the supply of varenicline will normalize over the next few months.

And what are the 20 products that are offered or promoted to quit smoking but have no evidence of effectiveness? One of them is the electronic cigarette, which is not an endorsed treatment for smoking cessation. “It is not recommended to use e-cigarettes to quit smoking because it involves the risk of developing severe lung disease. It is not effective for smoking cessation,” emphasized Dr. Videla, who is head of the Pneumonology and Sleep Clinic Service.

On the one hand, if they practice vaping, the person persists in nicotine dependence through a product other than cigarettes, the expert remarked. On the other hand, “even if they use electronic cigarettes without nicotine, there are studies that show that manufacturers do include nicotine and maintain dependence on smoking behavior. 80% of users of electronic cigarettes are also consumers of conventional cigarettes,” he said.

In the guide, experts consider that the use of electronic cigarettes has been proposed as a harm-reduction strategy compared to ordinary cigarettes. But they warned: “This strategy is highly questionable given the existence of potentially fatal adverse effects in young people, with the alternative of total cessation and effective and safe pharmacological treatments.”

In addition, these products are not supported by scientific research to quit tobacco smoking: benzodiazepines and other anxiolytics, such as diazepam and buspirone, beta-blockers, silver acetate, and cannabinoids. Nor are antidepressants called selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), venlafaxine, naltrexone and mecamylamine useful for smoking cessation.

In addition, these 8 interventions have not been shown to be effective or safe in saying goodbye to tobacco. “It is recommended not to use the following proposals for smoking cessation: glucose, traditional acupuncture, electrostimulation, bioinformation/biofeedback, sensory deprivation, aversive therapies, laser and hypnosis because of the uncertainty of their effect on the cessation rate,” wrote the experts who are part of the Association Argentine Tobacology Association, Argentine Toxicology Association, Argentine Federation of Cardiology, Argentine Federation of Nursing, Argentine Federation of Family and General Medicine, Inter-American Foundation of the Argentine Heart (FIC Argentina), Argentine Society of Cardiology, Argentine Society of Medicine and the Argentine Anti-Tobacco Union (UATA), among other organizations.

These unsupported proposals “propose a magical solution to the problem of addiction, rather than generating behavior change,” they explained. In the case of so-called “aversive therapies”, the person switches to high doses of tobacco, and is even more at risk of exposure to toxic substances.

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