Keep the patch on and the smoke clouds away

Quitting smokers who prolong their use of nicotine patches may find it easier to abstain from cigarette use in the future, according to a recent study by Penn researchers.

“The moral of the story seems to be that continuous [patch] use is needed in order to have a significant long-term impact on smoking behavior,” according to Samuel Preston, a Penn professor of sociology who works with smoking and population health.

The study — conducted through the University of Pennsylvania School of Medicine’s Center for Interdisciplinary Research on Nicotine Addiction — found that smokers who used nicotine patches for six months were 1.8 times less likely to relapse than a group that used patches for manufacturer’s standard recommendation of two months.

After 24 weeks, 31.6 percent of extended nicotine patch therapy participants had not smoked in the last week, compared to 20.3 percent of participants given a placebo patch after the first eight weeks.

Extended therapy participants who relapsed abstained from cigarettes for longer than the control group and were more likely to abstain again after relapse.

“Our data re-conceptualizes what the appropriate duration of therapy is,” said Caryn Lerman, senior author of the study and director of Penn Med’s Tobacco Use Research Center.

However, the study showed that the benefits of extended therapy only lasted as long as the patch was being used. In a follow up with study participants a year later, there was little difference between the two groups in their smoking abstinence.

Lerman suggested that some smokers “should continue staying on nicotine replacement therapy as a long-term replacement to smoking.”

But one issue with extending nicotine patch therapy is the cost per patient, which was estimated to be $2,482. Lerman said this is “well within the bounds of what is considered cost-effective.”

According to the study’s lead author Robert Schnoll, “from a policy perspective, it’s worth the investment.” Yet, the study also mentioned that only 8.6 percent of U.S. health insurers and 33 state Medicaid programs cover nicotine patch costs.

Preston said the increased treatment would be worth the investment, since nonsmokers have a seven to ten year life expectancy advantage over smokers.

The authors of this study also emphasize that treatment effectiveness by duration would vary among individual users.

“Our center has shown that treatment effectiveness depends on the background of the smoker,” Lerman said. “We want to identify smokers for whom extended therapy is needed.”

This is the first well-controlled major study on extended nicotine replacement therapy, Scholl said. He suggested that further extended studies would be needed in order to encourage healthcare providers to change their policies on the duration of nicotine replacement therapy.

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