If you analyzed hundreds of studies examining what it takes to quit smoking, what do you think are the most effective tools?
1) Nicotine patch?
2) Is this drug widely prescribed for depression as well?
3) Is it a natural health product sold over the counter in Canada?
4) Nicotine-free electronic cigarettes?
5) A drug made to imitate a shrub some soldiers smoked during World War II?
If you select 3 and 5, you are successful.according to the study published last Month In the major medical journal “Cytisine”, compound found Varenicline, found in some seeds and a synthetic compound designed to work similarly, is much more effective than most other methods of quitting smoking. Sadly, neither of these medications are readily available to the millions of smokers in the United States who try to quit each year. Although cytisine has been popular for a long time, in eastern europe now available in Canada in 2017, not sold in the United States Although varenicline is technically available, doctors often discourage smokers from trying it. Why is this? The answer, in part, has to do with the economics of drug development.
One of the researchers hopes the discovery will help reignite interest in expanding access to cytisine in particular. “We have all the evidence that it works. Shouldn’t we give it our all?” Jamie Hartman Boyce, now a professor in the School of Public Health and Health Sciences and the University of Massachusetts at Amherst, told me. told.
Of course, “going well” in the world of addiction is never anything close to 100% as we all want it to be. Her meta-analysis found that across hundreds of studies, an average of 14 percent of cytisine users remained smoke-free for more than six months. However, this is much higher than many other methods.
To find out which smoking interventions are most effective, Hartman-Boyce, then at the University of Oxford, and colleagues reviewed hundreds of randomized controlled trials from the 1990s to 2022. This included non-nicotine-containing medications such as bupropion (also known as Wellbutrin), nicotine-cessation tools such as patches, and e-cigarettes with or without nicotine. After narrowing down the research results to 320 that met the criteria, the researchers found about 157,000 smokers to analyze.
researchers plotted The probability of being able to quit smoking for at least 6 months while using a specific intervention versus the probability of being able to quit for the same amount of time without using any. Just his three interventions – nicotine e-cigarettes, cytisine, and varenicline – more than double his odds, and about 14 out of every 100 people he tries to quit using these methods are likely to succeed. It means that. (Fourth place went to nicotine patches combined with something containing nicotine, such as lozenges or gum.)
Should you really quit smoking and start using nicotine e-cigarettes? count It is the smoker’s responsibility to quit smoking. (The same is true if you replace a pack of cigarettes with a $40 bag of nicotine mints and munch on them while wearing the patch.) Experts in the field consider e-cigarettes to be mild stimulants. Opinions differ as to whether it is wise to introduce it as such. Some warn that it encourages switching from one unhealthy addiction to another, while others argue it is the most practical way to save smokers’ lives. I’m not going to participate in this discussion for now. Key takeaways from this study include: He says there are two nicotine-free drugs that help people quit smoking at a similar rate to e-cigarettes, but unlike e-cigarettes, no one who has tried them may know about them.
Why not? It’s more than a name you can’t remember. Let’s start with cytisine. Plant compounds found in the seeds of various trees have been used for decades in Poland and other Eastern European countries. Ultimately, it mimics some of the effects of nicotine, thereby reducing withdrawal symptoms and making smoking less enjoyable. This is especially helpful in his first four weeks after vowing to make a final effort. Some people have reported side effects such as nausea and unusual dreams, but overall, the drug has performed impressively in studies.
“It should also be available to patients in the United States.” Dr. Maher Kalam Hagea behavioral science professor at the University of Texas MD Anderson Cancer Center told me. Lisa FucitoThe director of tobacco treatment services at Yale School of Medicine agrees. “The challenge in the United States is that we need pharmaceutical companies behind our medicines,” she says.
Because cytisine is a natural compound, it cannot be patented as easily as oregano. This reduces the incentive for big drug companies to push their drugs through the costly FDA approval process. In recent years, several companies have attempted to develop this drug as a prescription and over-the-counter drug. But no one in the U.S. has reached the pharmacy placement finish line.
In Canada, it’s a different story. In 2017, the country’s FDA approved the compound as a natural health product, meaning it is available over-the-counter. “It was almost immediate. The first day I took CRAVV I didn’t have any cravings for cigarettes.” reviewer I have written. (Cravv is the brand under which Cytisine is sold.) “I don’t understand why they don’t promote this product more,” wrote one. another.
So should smokers start? Growing wood Does it contain cytisine? Probably not.Drinking the leaves as a tea seems to at least kill you. one young man.And that species can be dangerous livestock.
The story of varenicline, a synthetic compound designed to act like cytisine, is even more troubling.Big Pharma is already doing it hard work The idea is to get FDA approval to change the drug to a more memorable name: Chantix.But soon it became associated with serious side effects This includes depression and suicidal tendencies. Experts I spoke to pointed out that subsequent studies showed no significant risks, which ultimately prompted the FDA to take the unusual step. lift Black box warning. As with cytisine, vivid dreams and nausea are not uncommon, but subsequent studies have shown that the drug is safe for patients who are in a mentally sound place.
“I think previous concerns about neuropsychiatric side effects were overstated.” Jonathan FallsTobacco addiction researchers at the Penn State Cancer Institute told me. (Mr. Foles worked as a consultant for Pfizer, but others with no connection made similar comments.)
Nevertheless, the damage was done, and the drug’s reputation it just got worse Early in the pandemic, the FDA captured impurities in bulk; recall. Several researchers told me that the impurities weren’t hurting anyone and shouldn’t have been enough to stop the drug in its tracks. After all, it is one of the most effective tools for ending life-sapping habits. hundreds of thousands of people Number of Americans per year.
“Varenicline is better than any other drug, and all the studies to date support that,” Karam Hage told me. He pointed to one major study in which the smoking cessation rate was 38% after 12 weeks, almost three times higher than a placebo.
But by the time Pfizer was no longer busy managing its coronavirus vaccine, the FDA had approved it. Generic version of smoking cessation treatment. Generic drugs are beneficial to consumers and reduce drug prices. But instead, their presence may remove the incentive for the original patent holder to defend the drug.
Yale’s Fusito warns patients about varenicline, alarmed that even many enlightened colleagues have misconceptions about it. “If someone tells you not to do that, I want to know why and get a second opinion,” she said.
Ultimately, Fucito et al. pointed out that using pharmacotherapy to quit smoking may not be the best approach for everyone. And even those who accept it must combine the pill with: counseling To minimize the risk of recurrence. Once you find friends and family who are willing to help, you might consider applying the lessons from school. previous research Written by Hartman Boyce. In her analysis, her team investigated the effectiveness of financial incentives for smoking cessation. Participants who received rewards quit more effectively than those who did not. In fact, it didn’t matter whether the person received $100 or $700.All that mattered was money. Involved.
This fall, I will be writing regularly about drugs and mental health for Slate.Have a tip, complaint, idea, or question? Let us know heather.murphy@slate.com.