The use of tobacco is growing greatly. It conquers men with a certain secret pleasure such that those who have once become accustomed thereto can hardly be restrained therefrom."
-Sir Francis Bacon, 1623 When Sir Francis Bacon described tobacco addiction 373 years ago, little did he know the significance of his observation. "It's 1996, and we're still supposedly arguing about whether tobacco is addicting or not," said Philip R. Diaz, Pharm.D., BCPS, a clinical pharmacist from North Carolina. Diaz, who used to run a smoking-cessation program in a family-practice setting, was speaking at an educational session at the American Pharmaceutical Association's annual meeting in Nashville, Tenn., last month. The program was supported by an unrestricted grant from McNeil Consumer Products.
According to Diaz, pharmacists can play an important role in helping the 54 million American adults who do smoke quit. He said that of the 17 million adults who attempt to quit every year, only 1.3 million succeed.
Pharmacists can assist patients in quitting by first determining whether the patient is ready to quit, he said. Diaz told the audience that patients who fill a prescription for a nicotine replacement therapy "because my doctor told me I have to quit" are setting themselves up for failure.
Once a patient is ready to stop, pharmacists can help them by providing selfhelp materials, setting a quit date within the next month, and having the patient sign a contract to stop smoking. The pharmacist can administer the Fagerstrom Tolerance test to determine the degree of nicotine addiction and can consider recommending nicotine replacement therapy.
Diaz pointed out that nicotine polacrilex gum (Nicorette, SmithKline Beecham) is a very useful tool for patients. He noted, however, that many patients use it incorrectly by chewing it continuously instead of the "park and chew" method recommended by the manufacturer. He also said that studies have shown that at least nine pieces of gum per day are needed for a patient who is moderately addicted to nicotine, and some patients may complain of having a sore jaw. "This is one mode of nicotine replacement that has a track record in helping people quit smoking," he said.
Diaz noted that nicotine replacement patches work well because they deliver constant levels of nicotine, avoiding the peaks and valleys in nicotine blood levels that occur with cigarettes. The constant nicotine levels provided by the patch also lower the nicotine levels above which patients experience pleasure and arousal and lower the nicotine level below which patients experience abstinence and withdrawal symptoms.
Diaz told the audience that of the four nicotine replacement patches on the market-Habitrol (Ciba-Geigy), Nicoderm (Hoechst Marion Roussel), Nicotrol (McNeil), and Prostep (Lederle)--no two have been compared head to head, so none has been proven to be superior to another. …