By Deborah Jeanne Sergeant
Quitting smoking or other tobacco products is difficult.
Of the approximately 67.7% of U.S. adults who smoked in 2022 and who tried to quit, only 8.8% were successful, according to the Centers for Disease Control and Prevention.
Nicotine and the habit of smoking are powerfully addictive.
The good news is that using prescription medication to help in the process of quitting can help.
“The first step is to be aware you want to do it,” said Francesco Trofita, pharmacist at Hilton Family Pharmacy in Hilton. “Smoking [obviously] has a lot of negative effects. If you’re not all in, it’s not going to work regardless of the medications. The motivation has to come from you and not a doctor. You are going to need to want to quit.”
The two main medications for quitting are
• Varenicline (generic; formerly brand name Chantix) and
• Bupropion SR (brand name Zyban).
The FDA is also studying Cytisinicline.
How these medications work varies, but it’s not just a matter of filling a script and seeing nicotine addiction evaporate with enough willpower.
“I encourage folks to understand that it’s not a matter of willpower,” said Rebecca Padilla, senior manager of nationwide health promotions with the American Lung Association. “It’s a chronic health condition. We would never advise someone with asthma if you tried harder, you could breathe better.”
Padilla encourages smokers who want to quit to discuss a plan with their primary care provider and find a therapist for their mental health since the FDA-approved medication alone does not change the behavior that fuels nicotine addiction.
“The more we’ve researched the mechanics of substance use disorder, the more we realize that nicotine use is a symptom of underlying mental issues,” Padilla said. “A lot of times, folks end up self-medicating with nicotine because they’re anxious, depressed or having a hard time focusing. It goes hand in hand with other substances. We encourage co treating with mental health issues because the efficacy of cotreatment is the standard we’d like to see healthcare providers uphold.”
Padilla also said that it can take six weeks minimum of working with counseling and supports such as the American Lung Association’s Freedom from Smoking program to acquire enough tools to manage quitting. This way, patients have coping mechanisms in place when they feel the urge to light up.
Prescription Varenicline (generic; formerly brand name Chantix) helps break the addiction by disrupting the uptake of nicotine to the brain. Even if the patient lights up, the cigarette won’t deliver the same effect as before.
“The older concerns about serious neuropsychiatric side effects have largely been addressed by large clinical trials, and the boxed warning was removed years ago,” Padilla said. “Providers still monitor patients appropriately, but Varenicline is considered safe and highly effective for most adults.”
Bupropion SR (brand name Zyban) works differently. Initially approved as an antidepressant, it reduces the effects of withdrawal and irritability.
“That’s one of the biggest complaints when people are attempting to quit,” Padilla said.
“You can take it long-term. It was originally developed as an antidepressant. People can stay on in it for years and have a lot of success. Because it doesn’t block the nicotine receptors, it can be combined with nicotine replacement therapy.”
Combination therapy protocol pairs a long-use prescription with a quick acting or short-acting relief medication like the nicotine replacement patch, gum or lozenge to help patients with both mood and cravings. Nicotine replacement involves gradually weaning the patient off dependence on nicotine in increments.
Bupropion SR can also compensate for additional weight gain. But Padilla said that typically, weight gain is negligible and often because as the smoker’s sense of smell and taste return, food is more appealing.
A new medication under research with the FDA, Cytisinicline, works similarly to Varenicline by stimulating nicotine receptors to reduce craving and withdrawal and reduce the reward from smoking.
“It’s also being studied in a separate FDA trial for vaping cessation,” Padilla said. “If approved, it would be the first new FDA medication approved for vaping. Similar medication has been successful in England and Europe. We are very much in support of it being studied. We’re very excited for that.”
Some people believe that e-cigarettes or “vapes” are helpful cessation products. However, Padilla said that they are not FDA-approved as safe or effective in cessation and they also have their own health risks. Many vape liquids come from China and other countries with few consumer safety laws and can contain heavy metals that are heated to high temperatures to achieve the water vapor that users inhale. Widespread reports of lung problems among vape users indicates the short-term dangers. The long-term dangers are yet unknown.
“Varenicline, bupropion and nicotine replacement therapies are all proven, evidence-based options,” Padilla said. “Promising new therapies like Cytisinicline may soon expand our treatment toolbox.”
She encourages people who want to quit to contact resources such as their primary care provider,
New York State Quitline (1-866-NY-QUITS) and The American Lung Association (www.Lung.org, www.FreedomFromSmoking.org or 1-800-LUNG-USA).