Although pharmaceutical drugs are commonly prescribed to help people quit smoking, a new study shows that the use of medication alone does not appear to improve one’s chances of quitting, despite the high success rates claimed by drug trials.
The findings are published online in the Journal of the National Cancer Institute.
“Thirty four percent of people who are trying to quit smoking use pharmaceutical aids and yet most are not successful,” said senior study author John P. Pierce, Ph.D., Professor Emeritus in the Department of Family Medicine and Public Health at the University of California (UC), San Diego School of Medicine and Moores Cancer Center.
“The results of randomized trials that tested these interventional drugs showed the promise of doubling cessation rates, but that has not translated into the real world.”
For the study, the researchers evaluated the effectiveness of three first-line medications recommended by clinical practice guidelines: varenicline, bupropion, and nicotine replacement therapy (patch).
The data was collected from the Current Population Survey-Tobacco Use Supplement, a U.S. Census survey of adults 18 years and older conducted to obtain information about the country’s use of tobacco products.
Studying two groups of people surveyed approximately one decade apart, the team used a technique known as “matching” to help balance comparison groups on factors that could lead individuals to be more likely to use a cessation aid but simultaneously make it more difficult for them to quit. For example, one factor was the amount of cigarettes a person regularly smoked.
“In these analyses, matching helped reduce bias,” said first author Eric Leas, Ph.D., who conducted the study while a graduate student researcher at UC San Diego and is now a postdoctoral scholar at the Stanford University School of Medicine.
“Still, we found no evidence that the pharmaceutical cessation aids that we assessed improved the chances of successfully quitting. This was both surprising, given the promise of smoking cessation seen in randomized trials, and disappointing because of the need for interventions to help smokers quit.”
In fact, the researchers point to the use of intensive behavioral counseling which was used in combination with pharmaceutical aids as a factor that may have contributed to an increase in smoking cessation rates during clinical trials.
Previous studies that have looked at the effect of free behavioral counseling offered by phone has shown improvement in smoking cessation rates when combined with pharmaceutical interventions.
“Evidence is pointing to an important role of behavioral counseling when prescribing pharmaceutical aids,” said Pierce. “If the products were approved with counseling we may have better success rates. As it is, less than two percent of smokers who use a pharmaceutical aid are using any behavioral counseling. In both of these longitudinal studies, this was a recipe for relapse to smoking.”