In a study of 96 smokers attempting to quit, 50 percent of those who wore the patch two weeks prior to quitting had stopped at four weeks. Only 23 percent of smokers who wore a placebo patch two weeks prior to quitting had stopped after four weeks. The same pattern appeared to continue for six months, although many of the study participants were no longer reachable to verify this trend, said the researchers.

If these findings are confirmed by a larger study currently underway, the researchers said the Food and Drug Administration may need to re-evaluate its current warning against smoking while wearing the nicotine patch. Moreover, said the researchers, such confirmation would lead them to advocate a change in clinical practice in smoking cessation programs, to include use of the patches before cessation.

Results of the study, funded by National Institute on Drug Abuse (NIDA), are published in the Feb. 1, 2006, issue of the journal Nicotine and Tobacco Research.

The Duke researchers said that wearing a nicotine patch before a smoker attempts to quit provides a steady, consistent source of nicotine that interrupts the rapid reward of inhaling nicotine via cigarettes.

Previously, it was believed that wearing the patch while smoking was either too toxic or could fuel the addiction by adding excess nicotine. Neither of these hypotheses was confirmed in the Duke study, nor in earlier studies of smoking cessation.

In fact, many smokers who wore the patch before their target quit date actually smoked less than usual during that two week period, had fewer cravings, or more easily switched to a low tar/low nicotine brand, the study found. The patch also reduced the severity of withdrawal symptoms, the study showed.

"Wearing the nicotine patch partially disconnects the reward of smoking," said Jed E. Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation and senior author of the study. "What reinforces the addiction to smoking is the connection between inhaling smoke and getting an immediate nicotine effect as it is absorbed by the lungs and brain."

In contrast, said Rose, smokers who wear the patch receive a steady level of nicotine. The steady influx attenuates or reduces the effect of the cigarette's dose of nicotine, because the brain is already receiving nicotine via the patch.

"When wearing a nicotine patch, the body and brain already have a certain level of nicotine, so the cigarette's delivery of nicotine is not as noticeable," said Rose. "An analogy is eating food when a person is not hungry. The pleasure is diminished and so the behavior is not as reinforcing."

Rose's team followed one pack-a-day smokers who were either given nicotine patches or placebo patches for two weeks before their targeted quit date. Smokers were told to either continue smoking their regular brand, switch to low-tar/low-nicotine cigarettes, or they were given denicotinized cigarettes.

On the target quit date, all smokers were given real nicotine patches plus a smoking cessation drug called mecamylamine, which blocks the rewarding effects of nicotine by binding to the same brain receptors that nicotine targets.

Four weeks later, half the smokers who wore the nicotine patch before quitting were abstaining. Only 23 percent of smokers who wore placebo patches were abstaining. The results held true regardless of which cigarettes they had smoked during the two weeks before quitting, the study showed.

In fact, wearing a nicotine patch may enable smokers to comply better because they don't go through nicotine withdrawal, said Rose. The most important predictor of successful smoking cessation was a decrease in nicotine dependence during the two weeks prior to the target quit date, the study found. Nicotine dependence was assessed with a standardized questionnaire used in smoking cessation programs.

"Nicotine replacement therapy helps separate the act of smoking from nicotine as a drug and thereby helps extinguish the smoking behavior," said Rose.

According to Rose, a larger follow-up study currently underway of 400 smokers is finding the same pattern of abstinence, although all the data are not complete. In addition, Rose plans to continue studies using mecamylamine and the nicotine patch prior to the target quit date. Previous studies suggest that the combination therapy may further aid smoking cessation efforts, he said.

"If further studies confirm our initial findings, our goal would be to have the FDA re-evaluate the current instructions on nicotine replacement therapies to advocate using them prior to attempting to quit, and ultimately to change clinical practice among smoking cessation programs."

© 2006 HealthNewsDigest.com