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Although it may seem unbelievable, the first pharmacological
agent approved by the Food and Drug Administration (FDA) for
use in smoking cessation therapy was nicotine. This is a case
of the benefit of fighting fire with fire. Nicotine replacement
therapies, such as nicotine gum, patches, nasal sprays, and
inhalers, have been approved for use in the United States. They
are all designed to relieve withdrawal symptoms. Using them
produces less severe physiological alterations than tobacco-based
systems, and they generally provide users with lower overall
nicotine levels than tobacco. An added benefit is that these
forms of nicotine have little abuse potential since they do
not produce the pleasurable effects of tobacco products. Nor
do they contain the carcinogens and gases associated with tobacco
smoke.
The FDA’s approval of nicotine gum in 1984 marked the
availability (by prescription) of the first nicotine replacement
therapy in the United States. In 1996 the FDA approved chewing
gum containing nicotine for over-the-counter sales. Chewing
nicotine gum interrupts smoking behavior while maintaining
nicotine levels in the blood to minimize the effects of withdrawal.
Three-month success rates of 76 percent and one-year success
rates of 50 percent have been reported.
This approach is most effective when it is accompanied by
psychological therapy. Still, it has been found that there
is considerable incidence of relapse after gum use is completed.
While nicotine gum provides some smokers with control over
dose and the ability to relieve cravings, others are unable
to tolerate the taste or simply dislike chewing gum. In 1991
and 1992 the FDA approved four transdermal (allowing medication
to be absorbed through the skin and into the bloodstream)
nicotine patches, two of which became over-the-counter products
in 1996. By transferring nicotine through the skin, these
patches meet the needs of many tobacco users.
Data from the FDA and the pharmaceutical industry indicate
that more than one million individuals have been successfully
treated for nicotine addiction using nicotine gum or the transdermal
patch. A nicotine nasal spray became available by prescription
in 1996, and a nicotine inhaler was introduced in 1998. All
of the nicotine replacement products appear to be equally
effective. In fact, the combination of over-the-counter availability
of these medications and intense media campaigns urging people
to quit smoking have produced about a 20 percent increase
in the number of people who successfully quit each year.
While doctors await the approval of a nicotine tablet that
is dissolved under the tongue, researchers are voicing concern
about the long-term physical effects of nicotine replacement
therapies. Some smokers use nicotine replacement products
for longer periods than is intended for these products. Now
that these products have become readily available without
a doctor’s prescription, there is evidence of undesirable
side effects from their long-term use.
Your First Day
of Quitting Smoking
1. Breathe deeply. Practice lying down with your hands on
your abdomen so you will know if the breath is going to the
farthest reaches of your lungs. Breathe deeply and observe
your hands rising and falling. As a smoker, you have not been
able to take a truly deep breath for some time. Practice the
refreshment and satisfaction that comes from filling the lungs
with a full dose of oxygen.
2. Drink copious amounts of water. Keep a water bottle with
you at all times; every time you think you want a cigarette,
take a sip. You may want to buy a bottle holster to make this
more convenient. | 
