From Our 2009 Archives

Nicotine Gum OK for Gradual Quitters

Study Shows Nicotine-Replacement Gum Works Even If You Don't Quit Smoking Cold Turkey

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 8, 2009 -- Cigarette smokers who try to quit gradually rather than giving up smoking all at once can safely use nicotine-replacement gum, a new study shows.

Heavy smokers in the study who chewed the highest doses of nicotine-replacement gum as they tried to cut down on their smoking reported no more side effects than lighter smokers who chewed less nicotine gum.

The research was funded by GlaxoSmithKline, which markets Nicorette -- the nicotine-replacement gum used in the study. The study appears in the February issue of the American Journal of Preventive Medicine.

For the first two months of the study, the smokers were told to gradually reduce their smoking while increasing their nicotine gum use, with the goal of giving up cigarettes altogether.

Compared to smokers randomly assigned to a group using a placebo instead of nicotine gum, use of nicotine gum appeared to triple the odds of being a nonsmoker at six months.

Just 2% of placebo-gum users achieving this goal, compared to 6% of nicotine-gum users.

"Nicotine-replacement therapies like gums and patches are approved for abrupt quitting, but many people prefer to try and quit gradually by cutting down cigarettes rather than giving them up all at once," study researcher Saul Shiffman, PhD, tells WebMD. "Our finding is very reassuring because it shows this to be a safe way to use these products."

Smokers Who Quit Gradually

Studies suggest that only about 3% of attempts to stop smoking without the aid of nicotine replacement, other medications, behavioral therapy, or some other type of treatment are successful.

Shiffman, who is a long-time smoking-cessation researcher as well as a consultant for GlaxoSmithKline, says many smokers who want to quit express a preference for quitting gradually.

But it has not been known if they could safely do so using nicotine-replacement products at the same time.

In an effort to study this, the University of Pittsburgh professor of psychology and colleagues recruited almost 3,300 smokers from across the country. All had expressed an interest in quitting smoking gradually instead of stopping "cold turkey."

The smokers were allowed to choose either 2-milligram or 4-milligram doses of nicotine gum, but some of the participants in both groups unknowingly got a placebo rather than active-nicotine gum.

The 4-milligram dosage is generally recommended for heavy smokers -- those who typically smoke 25 or more cigarettes a day.

Participants were instructed to cut down on cigarettes while increasing their use of the gum over a two-month period, but they were not given explicit instructions on how to do this, Shiffman says. Participants reviewed FDA-approved labeling for the gum products.

Those who reported giving up cigarettes at the end of two months were followed for an additional four months, during which time they were allowed, but not required, to continue using the nicotine-replacement gum or a placebo.

During the first four weeks of the study, the researchers evaluated the impact of simultaneous use of cigarettes and nicotine-replacement gum.

They found no difference in adverse outcomes among the heaviest nicotine users (who averaged 22 cigarettes a day and nine pieces of 4-milligram gum) compared to people who used less nicotine.

At the end of six months, smokers on active nicotine-replacement therapy were more likely to have stopped smoking than those who chewed the placebo gum.

Shiffman acknowledges that the success rate for all the study participants was low. But the 6% quit rate for the smokers who chewed the 4-milligram nicotine-replacement gum was roughly double that typically reported in studies evaluating smokers who try to quit without help.

Nicotine Gum 'Better Than Smoking'

The study did not examine nicotine gum use for longer than six months, but it is clear that many people stay on the gum or other forms of nicotine-replacement therapy for much longer.

New York University professor of medicine and smoking-cessation researcher Scott Sherman, MD, tells WebMD that the evidence suggests that long-term use of nicotine-replacement treatments is safe and "a whole lot better for you than smoking."

While nicotine is the agent that gets people hooked on cigarettes, other chemical toxins in cigarette smoke are the cause of lung cancer and other health effects.

But while long-term use of nicotine-replacement products appears safe, Sherman says there is less evidence that it is effective.

"It is not really clear if using nicotine gum or patches or even other forms of medication for a year instead of three months improves your chances of quitting smoking," he says. "We can't really tell people that they will be more likely to be a nonsmoker 10 years down the road if they chew nicotine gum for an extra year."

Sherman says that people who are trying to quit smoking typically use too little medication rather than too much. "A common mistake people make with gums and lozenges is that they wait until they feel symptoms, and that's too late."

Sherman and Shiffman offered other tips for stopping smoking:

  • Use medication. People who use nicotine-replacement therapies or other types of drugs approved for smoking cessation are twice as likely to quit successfully, Sherman says.
  • Get some support. Most states have smoking-cessation hotlines that can provide counseling and information for people trying to quit.
  • Recognize your smoking triggers and have a plan for dealing with them.

If your first attempt to quit smoking doesn't work, you're not alone. The average person who successfully gives up cigarettes had tried to quit unsuccessfully at least half a dozen times, Sherman says. "Rather than beat yourself up and feel defeated, these unsuccessful attempts should be viewed as learning opportunities."

SOURCES: Shiffman, S. American Journal of Preventive Medicine, February 2009; vol 36: online edition. Saul Shiffman, PhD, clinical psychologist and professor of psychology, University of Pittsburgh. Scott Sherman, MD, MPH, associate professor of medicine and psychiatry, New York University School of Medicine.

©2009 WebMD, LLC. All Rights Reserved.