For some, the decision to quit smoking is a turning point. They put down the pack, throw away the matches and deal with it as best they can. Others might need a little help. “Preloading” is a method some use, where the smoker uses nicotine patches for a while before going cold turkey. While the addictive part of smoking is about the nicotine and the body’s reliance on it, new research shows that nicotine patches that are used before a full attempt at quitting are not effective in curbing the habit for smokers.
Recently, a team of researchers from the UK Centre for Tobacco and Alcohol Studies investigated the use of a nicotine patch as a four-week run-up before patients quit entirely. Professor Paul Aveyard led the work at the University of Oxford. The study cohort was 1,792 nicotine dependent adults from four cities across England. On average, the participants smoked 19 cigarettes a day, which is slightly less than one pack. Most were middle-aged and were in lower educational brackets than the average UK citizen. Half of the subjects were male and one quarter were from minority groups.
A current strategy for some is to use the patches for a period before “Quit day” arrives. The nicotine delivery from the patches eases the cravings, but many smokers, after preloading with nicotine patches, then go on to use varenicline (brand name Chantix, a smoking cessation drug available by prescription) and this drug could be muddying the waters of whether or not the patches are genuinely effective.
The team at the Centre for Tobacco and Alcohol Studies said that if they could untangle the use of varenicline and nicotine patches, preloading with the patches “could lead to a worthwhile increase in long-term smoking abstinence.”
In the study, smokers were randomized into two groups. One half received smoking cessation medication, and behavioral therapy support and the other half received those same protocols as well as a four week trial of nicotine patches before quit day. After the initial four weeks, the preloading group could have kept using the patches or continued with the non-nicotine medication. After six months, 18% of the group that had used the patches in a preloading strategy had stopped smoking. The group that had gone without the patches had a rate of 14% of smokers who had quit.
When researchers checked in again at a year post-therapy, the two groups were almost at the same point, with the preloading group at 14% for smoking abstinence and the standard therapy group at 11%. Statistically, that’s nearly a tie. At 12 months, the differences between the two groups were modest with 14% of participants achieving abstinence in the nicotine preloading group compared with 11% who had received standard therapy. Subjects were assessed for abstinence with the use of a carbon monoxide breath test.
While the use of nicotine patches showed a small advantage, the study had a few drawbacks. Subjects knew which group they were in, so that could have impacted their motivation for success. In summary, the authors wrote, “Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect may have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect." Check out the video below to learn more about the study.