Your guide to using Nicotine Replacement therapy products

According to the Global Adult Tobacco survey 2009-2010, one third of all adults in India use tobacco in one form or the other. Out of this, nearly half of the current smokers (47%) and smokeless tobacco users (46%) want to quit their tobacco use but the quit ratio remains extremely low at 13% for smokers and 5% for smokeless tobacco users. Often people trying to quit say they do not know how to deal with the withdrawal symptoms that accompany quitting and end up relapsing back into their old addiction. So, if you are one of the several tobacco users struggling to quit but don't know how to, fret not, tobacco cessation expert, Dr PC Gupta, advises you on how to deal with tobacco withdrawal symptoms with the help of Nicotine Replacement Therapy (NRT) products. Dealing with withdrawals For a tobacco user, addiction to nicotine creates a chemical dependency wherein the body develops a need for a certain level of nicotine at all times. Unless that level is maintained, the body begins to go through withdrawals. These withdrawal symptoms can be quite unpleasant and stressful. The physical withdrawal symptoms mainly experienced by tobacco users are sweating, headache, nausea and intestinal disorders. Psychological withdrawal symptoms can be explained as irritability, anxiety, depression, frustration, insomnia or mental vagueness. These withdrawals lead to a strong craving for tobacco, thus making it extremely difficult to quit. This is where Nicotine Replacement Therapy (NRT) products come into the picture. NRT products cover various forms of alternate nicotine delivery methods into the body intended to replace the nicotine obtained from smoking or other tobacco usage. They provide a small dose of therapeutic clean nicotine to the body which is sufficient to help control cravings for cigarettes and other withdrawal symptoms that smokers experience when they quit. Different forms of NRT Globally, NRT products are available in various forms. Nicotine gum- These chewing gums contain nicotine that is releases upon chewing and gets absorbed through the lining of the cheek. Nicotine patch- This transdermal patch that releases nicotine into the body through the skin. Nicotine inhaler-These inhalers are metered dose inhalers that administer nicotine through the lungs Nasal spray- The nasal spray contains a small dose of nicotine, which enters the blood by being absorbed through the lining of the nose. Sublingual tablet- When placed under the tongue these tablets release nicotine that gets absorbed into the blood. Lozenge- It is a form of tablet (usually flavored) that contains a dose of nicotine which dissolves slowly in the mouth to release nicotine. Working of nicotine products In India however, the general availability of NRT is limited to chewing gums and patches. Nicotine chewing gum releases nicotine which is absorbed through the lining of the cheek. It is suitable for individuals who require a flexible administration form of NRT as it allows them to actively control the amount of nicotine and occasion of use. Nicotine gum should be used in a 'chew and park' technique to get best results. The gum should be chewed slowly until the taste becomes strong, for about one minute, which should be followed by resting the gum between the cheek and gum and chewing it again as the taste fades. Nicotine patch is a discreet, easy-to-use, once-a-day solution to help tobacco users deal with the cravings and withdrawal symptoms associated with quitting smoking. The nicotine is released through the skin over 16 hours once the patch is applied. It is absorbed quite slowly as compared to smoking a cigarette so one should be prepared to wait a little longer for the nicotine to get absorbed into the system. Choosing the right dose Before one decides on the dosage, it's important to understand the kind of smoker you are. Smokers who smoke more than twenty cigarettes a day, or who smoke their first cigarette in less than 30 minutes after waking up, are classified as heavy smokers. Smokers having lesser intensity of tobacco intake than this can be termed as light smokers. For light smokers one should use nicotine 2 mg gum, whereas for heavy smokers one should start with nicotine 4 mg gum. There is also evidence that combining a nicotine patch with a nicotine gum or inhaler is more effective than using a single type of an NRT product. Usually NRT products are underused by smokers who are trying to quit because there are misconceptions and smokers don't have clarity on the usage of these products. Remember it's a therapy! The crucial point to understand is that NRT should be used as a complete therapy and not just for a one-time use. A complete course of NRT should be taken up to 12 weeks and can help the smoker break free from his addiction to embrace a healthier life. NRT products should be used as intended and prescribed. Chances of quitting are best when you combine the nicotine replacement therapy with a complete smoking cessation program that includes appropriate counseling. (Dr. Prakash Chandra Gupta is the Director of Healis - Sekhsaria Institute for Public Health Mumbai and visiting scientist for Harvard School of Public Health Boston.)