The pharmaceutical industry has a clear commercial interest in undermining smokers’ confidence in their ability to quit “cold turkey”.Some two decades of such promotion notwithstanding, the reality of smoking cessation is that between two-thirds and three-quarters of former smokers quit without using NRT or other drugs or attending any sort of smoking cessation service. As few as 1% to 7% even call a quitline.This situation has come to pass largely due the pharmaceutical industry’s aggressive promotion of its cessation treatments, often based on work by teams of researchers and consultants who report more favorable results than researchers not funded by industry.
Belief that smokers are unable to quit without using varenicline(Chantix), nicotine replacement therapy (NRT), buproprion (Wellbutrin) or some other form pharmacotherapy has become so entrenched that a 2010 article reporting that the great majority of ex-smokers had quit without recourse to assistance and suggesting smokers be made aware of this fact, was roundly criticised in peer-reviewed journals and on the leading international tobacco-control online forum.Criticism of the article was largely based on a clinical perspective of smoking cessation that’s preoccupied with rates of quitting associated with a particular treatment, as opposed to those who take a population-level perspective focusing on getting the greatest number of smokers to quit.
Not only do most smokers successfully quit by other methods, there is growing evidence that one such medication does more harm than good.Varenicline is a prescription-only treatment that works by binding to nicotinic receptors, providing some stimulation at the receptor but also blocking nicotine.The process may reduce withdrawal symptoms and nicotine cravings. Success rates among participants in varenicline clinical trials are reported to be around 22% continued abstinence after 12 months.
But clinical trials differ considerably from “real world” settings.Trials for varenicline enrolled healthy people:
with no pre-existing medical or psychiatric conditions;
who were motivated to quit;
with moderate levels of nicotine dependence, and;
who were also provided with regular cessation advice and support.
Smokers across the general population have a considerably less salubrious profile, and there are also substantial differences in motivation between trial participants and the broader community.Roughly half of participants stopped treatment within four weeks.
One potential explanation for the community drop-off rate is the range of associated side effects. Nausea, in up to one-third of those taking varenicline, insomnia, abnormal dreams, headache and constipation are commonly reported adverse effects.By May 2010, the TGA had received 1025 reports of suspected adverse reaction, 67% (691) related to psychiatric symptoms including “depression, agitation, anxiety, altered mood and aggression” and reports of “206 suicide-related events among people taking varenicline, including 15 completed suicides".Since 2009, the US Food and Drug Administration (FDA) has required that varenicline packaging display “boxed” warnings, the strongest of all FDA warnings, about a possible link between the drug and the onset of neuropsychiatric adverse effects.Despite such seemingly obvious concerns, varenicline is championed by many in a smoking cessation community increasingly committed to pharmaceutical approaches to quitting.
Before I am bombasted with criticism for opening this can of worms, I am not totally against NRTS or pharmaceutical interventions! If you are taking them under a Doctor's supervision and using them to successfully quit smoking - HOORAY!!!! The more EXers the better!!!! But if you choose to go cold turkey, you should know that you are not alone, and despite the propaganda in favor of pharmaceutical intervention, you CAN do this! Being highly motivated and getting regular advice and support (like coming here DAILY!) may be sufficient to create a SUCCESSFUL QUIT! Whatever it takes to be a 6%er!!!!!!
