There were many comments concerning my recent posting about nicotine medications. Many of the writers spoke about people that they know who have used nicotine medications longer and find this objectionable. Certainly what we have learned from our experiences is that all smokers are not alike and that each requires an individual approach to their medications. As pointed out by some of the readers, some people can stop smoking with a very short period of nicotine replacement medications while others require none at all. This all goes back to the neurobiology and that all smokers are not alike. To refresh memories, I would encourage people to watch the video, “Why Is This So Hard”, http://www.youtube.com/watch?v=ISe0-MvVFyo.
What we know about nicotine replacement therapy is that it is safe even if used for protracted periods of time and if the new ex-smoker is concerned about relapse to smoking we continue using nicotine replacement therapy until the person is very comfortable of being able to get through circumstances of relapse comfortably and confident about being able to avoid relapse before stopping the medication. It is true that some abstinent smokers continue to use nicotine gum for protracted periods and for these we recommend to eventually taper off, but if there is concern about relapse to smoking we continue the nicotine gum.
The other point to make is that these FDA approved medications have shown to be safe and effective in randomized clinical trials compared to placebo. The levels of nicotine in the blood of smokers is much higher than achieved with the nicotine medications thus the medications are safe even in higher than usual doses. Some smokers may require higher than usual doses and this is no different than the treatment of any other medical condition where some people require different medications or higher doses compared to others. For example, insulin dependent diabetics are not all prescribed the same dose of insulin.
Regardless of the method the person uses to stop smoking, if they are successful I think that is great. We encourage the use of evidence-based techniques including counseling and medications but realize treatment will be different from one smoker to the next.