The biggest struggle in preparing this topic was to decide on how much information I should provide on the importance of quitting. I do think there has been a great job done by organizations like Truth by educating people on the dangers smoking and of the importance of quitting. So I’ve chosen to do just one sentence on it. Smoking causes multiple cancers, heart disease, stroke, complications of pregnancy, chronic obstructive pulmonary disease, and many other diseases that, on average, shorten a smoker’s lifespan by 14 years. Oh…one more thing. Sorry, it has turned into 2 sentences. But, smoking can increase risk for stroke and heart attack in women taking birth control! So be careful ladies!

I’m mainly going to talk about the different ways to quit and what products to use. Your options for quitting are trying it cold turkey, acupuncture, hypnotherapy, behavioral therapy, medications, and counseling. I usually only recommend medications and counseling as studies have been proven that these are the most effective. And in combination, counseling with a healthcare provider and medications have been proven to be the superior of all the different ways to quit. Quitting is hard. A lot of people are not successful, especially if they’ve tried cold turkey. And sometimes it takes multiple attempts. But stick with it! And hopefully this article will help.

Where to start?

The first thing you should do is pick a quit day. That’s right, name the exact day you plan to start and write it down somewhere or make a note of it on your phone’s notes app or calendar. Then, you should start trying to figure out what your triggers are. What is likely to cause a craving? Or maybe there are no triggers and you just have to wake up in the morning and feel the need to smoke. What ever the case may be, you need to understand your triggers and what your smoking patterns are. Common triggers for cravings can be:

• stress,
• food,
• certain social situations,
• coffee, drinking alcohol, meal breaks at work,
• driving, walking, or even talking on the phone.

Triggers can also be physical possessions like matches, lighters, and ash trays. Throw our these things or anything else that may remind you of smoking.

Write down a list of all of your possible triggers and make it a point to avoid these. Triggers also help in knowing when or how you may use a particular treatment.

Now what?

Ok, but how?! How do I quit? Glad you asked. I recommend that every person who is trying to quit, use nicotine replacement therapy, or NRT for short. I recommend NRT to everyone, unless medically contraindicated. NRT provides controlled amount of nicotine to help with cravings and withdrawal symptoms of smoking cessation. But before you start any medications to quit smoking, speak to your pharmacist or health care provider as changes to the way you smoke can affect other medications you take and other ailments you may have.

There are 5 different types of NRT:

1. Patches
2. Lozenge
3. Gum
4. Nasal Spray
5. Inhaler
6. Bonus: E-cigarettes

Ok that’s 6 sorry.

There are also prescription medications available for smoking cessation that do not contain nicotine. But, most of them have bad side effects, and should be used only after nicotine replacement has not worked. These mediations are used to prevent cravings and reduce withdrawal symptoms.

Mos of the NRT products are available over the counter, with the exception of the nasal spray and the inhaler. The nasal spray and the inhaler need a prescription. The different NRTs all have different dosages, and your dose is determined by your level of dependence on nicotine, number of cigarettes per day you use, how soon you need a cigarette upon waking up in the morning, and previous experiences with trying to quit. According to the manufacturer’s label on the NRTs, treatment usually lasts 6 to 8 months. But if you need to use an NRT longer than it says on the box, thats ok! Just make sure to speak with your primary care provider or pharmacist if you think you need to use it longer. People who shouldn’t use NRT include people who just had a heart attack, have heart arrhythmias or angina. In addition, the inhaler/nasal spray options should be avoided if you have asthma or COPD.

Before we can into specifics of each NRT, I wanted to talk about e-cigarettes.

When I speak with my patients about quitting, I usually get a lot of questions about e-cigarettes. At the time of this recording, using e-cigarettes for smoking cessation has not been well studied. We also don’t know the true short term and long term effects of these. However, it is possible to use and can possibly be effective to quit smoking, but there’s just no real proof unfortunately. And they do have some drawbacks, there is a potential you are getting more nicotine than even cigarettes, and because of this you can also get addicted to e-cigarettes. They also possibly contain carcinogens, stuff that could cause cancer. My overall recommendation is that if you wanted to try an e-cigarette to quit, use only if you have already tried and failed an NRT plan in conjunction with counseling from a healthcare provider, and would absolutely not try prescription drugs.

Let’s get specific. Which NRT is best for you?

Everyone is different. Everyone has different lifestyles. It would be hard to give a blanket statement on exactly would would be best for you. but if you need help. Please reach out to me. I’d love help you pick the best option for you.

In general, chronic smokers usually should start with a nicotine patch. And they can use a nicotine gum or lozenge for bad cravings, as needed. For people who are more social smokers, not someone who smokes everyday, they usually do well with treating cravings with nicotine gum, lozenge, or even the inhaler or nasal spray.

It is important to note that if you start using NRT, its ok to have a cigarette. You don’t have to stop the NRT. It happens, and it is completely safe. Obviously, not smoking is the goal. But it happens. Just continue with the plan if you have a slip up.

A bonus of using NRT to quit? The gum and lozenges delay weight gain that’s associated with smoking cessation. A lot of people (some men, but mostly women) are concerned with the weight gain that comes with quitting smoking, but now you cant use that excuse 😉

Using NRTs:

Patches

Nicotine patches are long acting, and again these are best for chronic smokers. As stated above, the dose can depend on how many cigarettes you smoke per day. Usually, you use one patch every 24 hours. However, they can cause insomnia or vidid dreams, and if this becomes a problem, you can remove the patch before bed. Do not cut patches to try to create a specific dose, cutting a patch can cause it to not work properly. It is important to note to remove patches for MRI’s. To apply the patch, make sure it is on a clean, dry, preferably hairless area of the skin every morning. It should be placed somewhere on your torso or arms, not below the waist or above the neck. Remove adhesive backing only immediately before you will put on the patch, then press on the skin for 10 seconds. Do not use more than one patch at a time and remove after 24 hours. Patches can cause mild skin irritations that usually go away, to minimize this, you should rotate the places where you apply the patches. You can use hydrocortisone if your skin does get irritated. But do not apply patches to where you have put a cream as it will not adhere properly.

Make sure to wash your hands after applying and removing patches as you can get nicotine residue on your hands. After removing, fold sticky sides together and throw away.

Now lets talk about the gum and the lozenges. When using these NRTs, make sure to wait 15 minutes after eating or drinking anything other than waster as nicotine absorption can be affected.

Gum

Nicotene gums are used for people who either have cravings while using a patch, or are more social smokers, smokers who do not smoke every day. The dose to start with depends on who much you smoke per day. Make sure to chew slowly until you feel the effects of the nicotine, usually a tingling or specific change of taste in your mouth. Then park the gum! Parking is when you store that gum in between your cheek and gums. It helps with absorbing more of the nicotine into your system. Parking usually lasts about 30 minutes. When you don’t taste the nicotine anymore or the tingling goes away, start chewing again and repeat.

Try to use every 1 to 2 hours and a minimum of 9 gums per day if you are only using a nicotine gum as your only NRT. Start with 1–2 hours for 6 weeks then use every 2–4 hours for 3 weeks then 1 every 4–8 hours until you have no more cravings.

Lozenge

Nicotine lozenges are used in similar situations as the nicotine gum, as needed when using a nicotine patch or for social smokers. It can also be used throughout the day for chronic smokers. These are meant to dissolve slowly in the mouth. When dissolving, make sure to move it to different parts of your mouth. It usually takes about 30 minutes for it to dissolve. Only use one lozenge at a time, taking more than one or using one right after another can cause side effects, like hiccups, heart burn and nausea. Again, these are meant to dissolve in your mouth, do not chew!

Now, lets move on to the prescription NRTs

Inhaler

The NRT inhaler is great for people who need hand to mouth mimicking to cope and help with smoking cessation. These are people that have a specific fixation on the motion of putting a cigarette to their mouth and smoking it. These come in cartridges that you place into a provided inhaler. To prepare for use, remove the mouth piece to place cartridge inside. You should hear a pop when the cartridge has been properly inserted. Replace mouthpiece and twist to finalize preparation. You can then puff on the inhaler in shorter, frequent inhalations. Each cartridge is good for about 20 minutes of active puffing and only lasts for one day after opening. Make sure to clean the inhaler regularly with soap and water.

Nasal Spray

The nasal spray provides the fastest delivery of nicotine for cravings and withdrawal symptoms when compared to all options. But it has the highest dependence potential. Great for immediate relief of withdrawal symptoms. The nasal spray needs to be primed before first use or if not used for 24 hours, usually about 6–8 sprays (1 to 2 if not first use) or until you see a fine spray. Blow/clear your nose prior to use. Do not sniff, swallow, or inhale this through the nose. When using the spray, tilt your head back. Usually 1 spray in each nostril does the trick. Like most other nasal sprays, it can cause you to sneeze, have a runny nose, and have runny eyes.

Wow, a lot of info right?

Recap

1. Smoking cessation is really hard but its really important
2. Don’t try to quit cold turkey, use nicotine replacement products
3. Find what works best for you, its the only way you’ll be successful

Please, if you need help with smoking cessation send me an email. As you can see, there are many different ways to quit and getting help is the best thing you could do to ensure success. Below I have included some resources with more detailed information on NRTs and how to quit smoking.

Thanks for reading.

Take care.

-Richard