To NRT or Not to NRT – That is the Question

Blog Post created by dr_hays on Jul 13, 2016

When I first meet with patients, a concern I often hear is whether it is okay to use nicotine replacement therapy (NRT).  They ask, “Doc, why should I use nicotine if I’m trying to get off the nicotine?  This is a great question!


First it is important to note that nicotine is NOT the harmful substance in cigarettes.  Rather it is all the other compounds and chemicals in cigarettes and smoke that cause the damage.  Secondly, nicotine in its medicinal form has a very low addictive potential, especially when we compare it to the free-based nicotine in tobacco.  You can learn about the neurobiology of tobacco addiction from my past blogs (Part I; Part II).  When we use NRT to assist with quitting smoking, we are satisfying the brain’s desire for nicotine without maintaining the addiction and without exposing our body to the other harmful substances in cigarettes such as carbon monoxide, hydrogen cyanide, benzene, and formaldehyde.


In order for NRT to be the most effective, we find it is critically important to do two things: accurately match the NRT dose to the amount of nicotine your brain is accustomed to receiving from cigarettes and ensuring the medication is used for the recommended amount of time – which can be several months for some individuals.  There are currently five NRT products available in the United States including the long-acting patch and the faster acting nicotine gum, lozenge, inhaler, and nasal spray.  Research shows that using a combination of smoking cessation medications – using a fast acting product during triggers while wearing the patch throughout the day - can greatly improve quit rates.  


While there is strong evidence to support the use of NRT during the quit process, it is a personal decision.  Your healthcare provider can be a great resource to help you find a dose and combination that will not only be effective in controlling cravings, but also be a plan with which you are comfortable.  You will find many different philosophies and experiences within the Ex Community and I encourage you to explore them all.  Most importantly, consider your own thoughts and feelings when deciding to use medicinal nicotine on your smoke-free journey.