Commentary: It's Time to Repackage the Fight Against Cigarettes

Lisa M. Fucito, PhD

Assistant Professor of Psychiatry

Licensed Clinical Psychologist

Yale University School of Medicine

Department of Psychiatry

Benjamin A. Toll, PhD

Associate Professor of Psychiatry

Yale University School of Medicine

Yale Comprehensive Cancer Center

Program Director, Smoking Cessation Service

Twenty million people in the United States have died from cigarette smoking since 1965. Take a minute to consider that figure. Twenty million people in this country have died from tobacco use. And we keep addicting new people to this irredeemable product. Each day, 4000 children and adolescents will try their first cigarette and 1200 will become daily smokers.

Cigarette smoking is one of the toughest addictions to break. Only 5% to 7% percent of smokers who try to quit “cold turkey” will be smoke-free a year later. Many people who have successfully defeated other addictions—alcohol, heroin, etc—are unable to quit smoking. This is why smokers who want to quit need as many options as possible and the most accurate information about their options.

While the safety and effectiveness of e-cigarettes will be hotly—and rightly—debated for some time to come, it is critical to remind the public that nicotine replacement therapies (NRT) have been around for 30 years and are, in fact, one of the best methods available for quitting smoking. There is ample science to support this.

Last year, the FDA updated its guidelines on NRT use and package labeling. While these updates align more closely with scientific evidence, they did not go far enough. This deprives smokers of the best information available about these products, information that ideally should be found on the packaging—but isn’t.

What the most current research tells us is that NRTs can be used earlier, longer, and in more combinations than FDA guidelines and product labeling indicate.

It is more effective to start the nicotine patch before a target quit date and use it in combination with either the nicotine gum or nicotine lozenge (termed “dual NRT”) than alone. NRT is sold in combination packages over the counter in other countries for this reason. Use of NRT beyond the package recommendations, typically within 3 months, is safe and helpful for preventing smoking relapse. This is powerful information that stands to help people desperate to break free of this intractable addiction.

In a policy statement on behalf of the Society for Research on Nicotine and Tobacco and the Association for the Treatment of Tobacco Use and Dependence, published in June in Nicotine and Tobacco Research,¹ we outline the evidence for further updating of guidelines and call on the FDA to adopt the recommendations and allow NRT manufacturers to change packaging.

This year marked the 50th anniversary of the first Surgeon General’s report linking smoking and illness. Progress has been made since this initial report. Tobacco control efforts and treatment advances have substantially reduced smoking rates and saved many lives. Yet far too many are still dying from tobacco use. We must do better.

Reference

1. Fucito LM, Bars MP, Forray A, et al. Addressing the evidence for FDA nicotine replacement therapy label changes: a policy statement of the Association for the Treatment of Tobacco use and Dependence and the Society for Research on Nicotine and Tobacco [published online June 11, 2014]. Nicotine Tob Res. 2014;16(7):909-914.