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nosmokingAs in all addictions, quitting smoking has proven to be challenging to many. Even for good friends who are physicians and care for patients afflicted with terminal tobacco-related illnesses, tobacco cessation has been an oft-unconquerable challenge.

Multiple modalities have been proposed as aids in quitting smoking. From gums, to patches, to electronic cigarettes. To date, none of these adjunctive measures have proven to be a consistently successful measure.

Study subjects in a recent double-blind, randomized clinical trial published in the NEJM who were given a free reign to smoke (unrestricted access) voluntarily smoked less when they were given cigarettes with less nicotine content. Quitting a certain addiction is made artificially harder when the subject consciously knows the substance is being withheld. But by giving the subject free reign to smoke whenever he wants, this artificial craving is not created. Then, when the subject UNKNOWINGLY receives less nicotine, the satisfaction associated with smoking becomes less. Because of this, the subject seemingly subconsciously craves for smoking less. The successful strategy employed in this study appears to be two-fold: 1.) not place any restriction on an individual’s access to the substance, and 2.) to fool an individual into thinking he is receiving the usual amount of the substance, even though he isn’t (placebo effect).

Unresolved issues include: 1.) whether this is enough to decrease complications associated with smoking, 2.) whether this is just as good as completely quitting smoking, and 3.) whether this is a good step into completely quitting smoking. If proven to lead to good clinical endpoints, it will become interesting to see if cigarette manufacturers will eventually be mandated by law to produce cigarettes with lower nicotine content.

By Timothy C. Dy, MD, FPCP, FPCC