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Research has shown that 70% of people who smoke want to quit, but only 7.5% are successful (1). This is likely because people who smoke try to quit without adequate help. With cessation treatment and therapeutic support, the chances of successfully quitting smoking are 2-3 times greater (2). There are several strategies to stop smoking for good. People who smoke who can get help and advice from a medical expert or a specialist educated in stopping smoking have a considerably better probability of success. In certain circumstances, using nicotine replacement therapy together with or instead of prescription medicine to stop smoking more than doubles the likelihood of long-term success.

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Transdermal Nicotine Patch

A Long-Acting Nicotine Replacement

Nicotine replacement can be administered through a patch that delivers a steady amount of nicotine over a 24-hour span through the skin (4). The dosing should be scaled depending on the number of cigarettes smoked in a day, to ensure that withdrawal symptoms are minimized. People smoking more than 10 cigarettes should start with a 21 mg patch, and those smoking less than 10 cigarettes a day should start with a 14 mg patch. It is recommended to start with the patch dose for an entire month and then reduce the dose every 2-4 weeks until the lowest dose is reached (3, 5-6).

Nicotine Lozenge
A Short-Acting Nicotine Replacement

Nicotine lozenges are available in both 2 and 4 mg doses and need to be placed between the gums and the cheek for optimal absorption. This product is available over the counter and is covered by many insurance plans (3, 5-6). Nicotine lozenges come in all different shapes and sizes, ranging from “tic-tac” sized lozenges that deliver nicotine faster to bulkier lozenges that take longer to deliver nicotine.

Nicotine Gum

A Short-Acting Nicotine Replacement

Nicotine gum is available in both 2 and 4 mg doses and must be used in contact with mucosal lining of the mouth. The most effective way to use this gum is to begin with a lower dose and chew it until it is “spicy” or tingly. Once this is completed, the gum should be held between the persons gums and cheeks for abut 5 minutes. This should be repeated for about 5 cycles, to utilize the full dosage of the gum. Chewing up to 20 pieces of nicotine gum to reduce cravings and withdrawal symptoms is safe (3, 5-6). This product is available over the counter and is covered by many insurance companies.

Nicotine Inhaler

A Short-Acting Nicotine Replacement

Nicotine inhalers are popular amongst those who are strongly attached to the sentiment of holding a cigarette. Contrary to the name, this method needs a short puffing into the inhaler rather than long inhalation. Since nicotine is absorbed through the mucosa in the mouth, a puff is a necessity to ensure maximum absorption. This device is not to be confused with e-cigarettes/vaping, which have been shown to be more addictive to younger people than cigarettes (14). Nicotine inhalers are only available through prescription (3, 5-6).

Bupropion Sustained Release

A Non-Nicotine Medication Therapy

Bupropion Sustained Release (SR), or Zyban/Wellbutrin, is a prescription medication used to reduce smoking addiction, and has been shown to increase smoking cessation by 52-77% (8). This medication works well when paired with nicotine replacement therapies. This medication allows more neurotransmitters like dopamine to circulate in the brain, reducing cravings and anxiety associated with quitting smoking (3, 9-11).

Varenicline

A Non-Nicotine Medication Therapy

Varenicline, or Chantix, is another common smoking cessation medication. It has been shown to increase the success rate of quitting fourfold (10). This medication functions by mimicking nicotine in the brain, and essentially “tricking” you into thinking you have had nicotine, reducing cravings and withdrawal. This medication is not meant to be used alongside nicotine replacement therapies.

Support Groups

Many organizations have smoking support groups that are run by someone trained in tobacco cessation counseling. These groups are an amazing way to connect with others with similar goals of quitting and provide you with support in the process. Support groups have been shown to increase smoking cessation rates by 10-20% (12).

Web-based/Online support

American Lung Association/Freedom from Smoking

https://www.freedomfromsmoking.org/

U.S. Department of Health and Human Services

www.smokefree.gov

Become An EX

www.becomeanex.org

Quitlines

Many states have quitlines that provide phone-based counseling from trained quit coaches. These counselors can also help people make a personalized plan going forward. Oftentimes reaching out to these quitlines can provide you with educational resources, and free nicotine replacement therapies. Additionally, with prescription, non-nicotine medications can be provided at a reduced cost through these quitlines.

The North American Quitline Consortium can be contacted at 1-800-QUIT-NOW or through their website at www.naquitline.org, for information about local quitlines.

References

Creamer MR, Wang TW, Babb S, et al. Tobacco product use and cessation indicators among adults – United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(45):1013-1019. Hughes JR, Stead, L.F., Hartmann-Boyce, J., Cahil, K., Lancaster, T. Antidepressants for smoking cessation. Cochrane Library. 2014. S. Department of Health & Human Services. Treating Tobacco Use and Dependence: 2008 Update. Public Health Service; 2008. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Library. 2018;5:Cd000146. Rigotti N. Pharmacotherapy for smoking cessation in adults. Up To Date. 2021. Burke MV, Ebbert JO, Hays JT. Treatment of tobacco dependence. Mayo Clin Proc. 2008;83(4):479-483. Jankowski M, Krzystanek M, Zejda JE, et al. E-Cigarettes are More Addictive than Traditional Cigarettes-A Study in Highly Educated Young People. Int J Environ Res Public Health. 2019;16(13). Howes S, Hartmann-Boyce, J., Livingstone-Banks, J., Hong, B., Lindson, N.et al. Antidepressants for smoking cessation. Cochrane Library. 2020. McEwen A. Manual of smoking cessation : a guide for counsellors and practitioners. Oxford; Malden, MA: Blackwell Pub.; 2006. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Library. 2013;5:CD009329. Burke MV, Ebbert JO, Hays JT. Treatment of tobacco dependence. Mayo Clin Proc. 2008;83(4):479-483. Hartmann-Boyce J, Hong, B., Livingstone-Banks, J., Wheat, H., Fanshawe, T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Library. 2019.

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