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Puff the Magic Patch
and Other Tales
(Nicotine Replacement Therapy)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 9 in the March 1-2, 2008 issue of The Mississauga News under the feature: Health & Wellness, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

There are dangerous devices found all over the world today that will kill over 500 million people in the next 50 years. They are not land mines or nuclear bombs. They are highly engineered drug delivery systems designed to addict the user. They are called cigarettes and they are legal. The Ontario Medical Association (OMA) considers tobacco dependence to be a progressive, chronic disorder. The OMA has developed a position paper to dispel some of the myths associated with trying to stop smoking. I provide for you a summary of some of the common myths. Keep in mind that the cigarettes are far more than rolled tobacco in paper.

1. Nicotine is the harmful substance in cigarettes. False. Nicotine is the addictive substance in cigarettes. Among the thousands of toxins produced in the combustion process at least 40 are known to cause cancer. Among them are bensopyrene, arsenic, nitrosamines and vinyl chloride. Nicotine does not cause cancer.

2. Nicotine addictive potential is the same, no matter how it is obtained. This is false. Cigarettes are far more addictive than nicotine patches. Inhaling nicotine smoke allows a quick and large hit to the receptors in the brain, while when using a patch, the delivery across the skin is slow and controlled. It is able to calm the craving without an addictive potential. Similarly, nicotine gum is chewed slowly and the transfer of drug occurs across the mucus membrane in your mouth. The newer inhaler device actually delivers a spray onto the oral membranes, again keeping delivery uniform. It reinforces and modifies the behavioral aspect of hand to mouth gestures common to smoking.

3. Nicotine replacement therapy (NRT) is safe for smokers. True. There are no toxins in patches, delivery is controlled and non-addictive, and side effects are extremely rare.

4. Smoking while using NRT causes heart attacks. Smokers are already at the high risk mark for heart attacks and strokes. These health hazards are the result of other toxins in cigarette smoke and not nicotine. This myth has been dispelled many years ago.

5. Patients with heart disease should not use NRT. Continuing to smoke is more dangerous than using NRT. Smoking promotes thickening of the blood which leads to clots. Nicotine is a stimulant that can aggravate things but is not the cause. Combining smoking cessation medication with NRT is a strategy worth trying by all smoking heart patients.

6. Pregnant women should never use NRT. Cigarettes increase the risk of abortion, prematurity and low birth weight. It is better to use NRT than to smoke during pregnancy. Second-hand smoke should also be avoided in pregnancy.

7. Teenagers should not use NRT. Also false. The under 18 crowd represents the largest group of new smokers. It is worth targeting a bad habit as soon as it is recognized.

Many people still feel that it is their "right" to share deadly toxins with those around them. It is a misguided inference that simply being able to legally purchase something implies that society has accepted that one can use it as one pleases. Apart from a cough, smokers don't see consequences of their actions for years. They too often assume that medical science can treat any symptom they develop and can start with a "fresh" bill of health any time that they choose. It is a frustrating part of many doctors' day to inform people that they are afflicted with a smoking associated disease. Please don't make my day! (Dr. Kujtan is a coroner as well as a family doctor). Help someone to stop smoking today.

Related resources:

Nicotine replacement therapy from Wikipedia, the free encyclopedia.

Smoking FDA 101: Smoking Cessation Products from U.S. Department of Health and Human Services.

Nicotine Replacement Products by Jane Thurnell-Read, HealthandGoodness.com. (Nicotine gum, Skin / Transdermal patches, Nasal sprays, Nicotine inhalers, Mecamylamine.)

Smoking Cessation Interventions: Pharmacological Aids by Dr. Mohammed H. AL-Doghether ABFM, SBFM, Saudi Arabia, from Middle East Journal of Family Medicine. Types of pharmacotherapy: Nicotine replacement therapies (nicotine gum and patches, aerosol inhalers, nasal sprays and lozenges), Anxiolytic medications, Some classes of anti-depressants, including bupropion (Zyban), A variety of other pharmaceutical therapies such as clonidine, nortriptyline, mecamylamine, naltrexone and silver acetate.

Nicotine Replacement Therapy (NRT) from Patient.co.uk. NRT increases your chance of quitting smoking. What is nicotine addiction? How does NRT work? How effective is NRT? Which form of NRT is best? Can different methods of NRT be combined?

Nicotine Substitutes / Nicotine Replacement Therapy from American Heart Association. Nicotine replacement therapy (NRT) has been shown to be safe and effective in helping people stop using cigarettes when used as part of a comprehensive smoking cessation program.

Nicotine Replacement Therapy from Centre for Addiction and Mental Health (CAMH), Ontario Ministry of Health. NRT Clean Delivery System.

Ontario Doctors Call on Province to Improve Access to Medication to Help Smokers Quit from Ontario Medical Association (OMA).

Rethinking Stop-Smoking Medications: myths and facts from Ontario Medical Association (OMA), June 1999. Position paper.

Smoke-Free Ontario from Government of Ontario. Tobacco use is the biggest preventable cause of death and disease in Ontario. It kills 13,000 Ontarians each year.

Smoke-Free Ontario Act. The Smoke-Free Ontario Act came into effect May 31, 2006. Three goals of the Act are to:

    ● prohibit smoking in all enclosed workplaces and public places;
    ● ensure that only those 19 years of age or older can purchase cigarettes;
    ● phase out the retail display of tobacco products, including a complete ban of all tobacco product displays, as of May 2008.

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