Talk:Nicotine replacement therapy

message: Does anyone else think the "criticism" section doesn't really belong, as at no point does it mention any real criticism of NRT? Not to mention it has no citations and is poorly written. Chocobomastr (talk) 21:42, 3 May 2010 (UTC)
thread_title: Criticism

message: Taking nicotine increases the endorphins in the body.  That's what a smoker really craves, endorphins.  Why replace the nicotine, if what the smoker really wants are the endorphins?  Exercise is a great way to create endorphins in the body.  When withdrawal symptoms from nicotine get strong, taking a long, fast walk will ease withdrawal symptoms tremendously.  Moreover, exercise is a free treatment, unlike nicotine replacement.  In any case, why replace nicotine at all when endorphins are the ultimate goal of the therapy?  Years ago, I knew a doctor in Baltimore who gave endorphin replacement therapy by injecting endorphins.
No its nicotine that smokers get addicted to, exercise is not addictive.203.94.54.14 (talk) 03:23, 6 October 2008 (UTC)
thread_title: Nicotine Replacement

message: I tried to put the following into the nicotine patch article, but it was removed within minutes:
Nicotine is a relatively easy drug to quit. As far as I know, not one person has ever died from nicotine withdrawal. Moreover, nicotine dependency is short-lived. Nicotine is completely out of the body in 48 hours. At that point, physical cravings cease. Anyone who can go 48 hours without a cigarette stands a really good chance of quitting. Nicotine is highly addictive, however. Any small amount, even from second-hand smoke, will immediately reenforce nicotine addiction - resetting the clock back to 48 hours. The nicotine patch will guarantee that the addiction clock is reset back to 48 hours every time it is used. Logic might suggest that one  cannot end nicotine addiction by taking nicotine. Unlike heroine or alcohol withdrawal, you cannot die from smoking cessation. Therefore, a step-down program would appear to be unnecessary, and fails as a quitting aid in a great many cases.
Perhaps the best method to fight cravings is exercise which causes the body to produce its own endorphins.  These endorphins in turn negate many of the effects of withdrawal.
It seems likely that the cigarette industry would love to convince everyone that it is impossible to quit smoking.  That way, people would not ever try to quit.  Short of this, the next best thing would be to convince everyone that it is very difficult to quit smoking.  Then people will give-up trying more easily.
How can this information be included in the article?  Or is this article monitored by the advertising agencies and public relations firms for the patch sellers and the cigarette companies? 
This was probably removed because it is poorly written, reads like a personal rant, has absolutely no cited references for any of the 'factual' claims made by the author, and is, as far as I know and have read, riddled with inaccuracies.  For instance, it is well known that death from heroin withdrawal is *extremely* rare, and those that do typically have serious underlying health problems which are simply exacerbated by the strain of acute withdrawal.  This is an encyclopedia for better or worse, not a blog.  You can't simply state something without any cited references to back it up.Untilzero (talk) 19:52, 9 July 2009 (UTC)
thread_title: Withdrawal and reenforcing addiction

message: This linkpage has some interesting links that challenge the efficacy of NRT. For example this JAMA article on the effectiveness of over the counter sales and this discussion on some flaws in the blinding of the NRT clinical studies (cf. links). -- user unknown
I suggest the 'clinically proven' part be left out of the article until it really has been prov Beck 08:26, 21 October 2006 (UTC)
thread_title:  Usefullness of NRT 

message: icotine is the addictive drug in tobacco products, and some research indicates that it may be a carcinogenic substance. While studies have shown that many of the constituents of tobacco smoke are carcinogenic, they fail to produce any evidence that nicotine itself is a carcinogen.
The first sentence says research may indicate nicotene is carcinogenic, the second that research does not "prove" nicotene carcinogenic.  These sentences are not mutually contradictory only in the strictest sense.
I replace the text with: Nicotine is the addictive drug in tobacco products. According to the research consensus, many of the constituents of tobacco smoke are carcinogenic.  That nicotene itself is a carcinogen, on the other hand, remains disputed.  68.148.160.10 (talk) 20:38, 29 August 2009 (UTC)
thread_title:  near self-contradictory text 

message: I was wondering about something in the article that may be outdated by recent fluctuations in price of both cigarettes and nicotine replacement therapy. The article mentions that NRT is more expensive than cigarettes, which was undeniably true several years ago, but that may no longer be the case. I realize that the cost of said items will vary from location to location (particularly within the U.S., given individual states' taxation on cigarettes) and that it's not a sourced statement to begin with in the strictest sense, but I think that mentioning the relative cost of NRT to smoking is extremely useful to readers and definitely has a place in the article. 
In short, I was extremely surprised earlier this year to note that the "nicotine gum" was significantly less expensive than the equivalent amount of cigarettes needed by a heavy smoker over the same time frame. 
Additionally, the high- and low-dose versions of each NRT generally retail at the same price (meaning that the light or moderate smoker could obtain the highest dose possible, at the same cost, and modify their usage of the NRT to further cut expenses). I'd understand if the 'modification' thing is too WP:OR to go into the article, but I think what is already there should be updated to reflect the decreasing cost of NRT vs. the increasing costs of cigarettes (presumably due to public health concerns). I brought this to the discussion page rather than just adding it myself because I'm not sure if what I've observed is typical in other areas. I'm also not sure if my calculations are relying too heavily on the fact that I smoke like a freight train transporting chimneys. Thoughts, anyone? *Vendetta* (whois talk edits) 06:13, 13 November 2010 (UTC)
thread_title:  Accuracy of section "Cost" in Criticism (was: Outdated? Thoughts on expense) 

message: The section labeled "Ineffectiveness" under Criticisms has been removed.  It consisted largely of a rant about possible toxic effects of nicotine, unrelated to whether NRT is an effective therapy for smoking cessation or not.  (And even the few facts it stated are disputable.  As noted on another tobacco related talk page, the research relating nicotine to cancer is at best suggestive, and the authors of it recommend "further research".  The link between MAOI compounds is also rather speculative: the rant says it's a "fact" that tobacco addiction is the result of both nicotine and MAOI substances in tobacco smoke, the abstract of the referenced source for this claim states, "However, the molecular mechanisms underlying tobacco dependence are still not completely understood. Nicotine's action on nicotinic acetylcholine receptors, and the downstream release of dopamine, is believed to be the major pathway underlying tobacco dependence. However there is mounting evidence indicating that non-nicotinic components of tobacco smoke also play a role by inhibiting monoamine oxidase (MAO) and subsequently altering neurotransmitter levels."  Mounting evidence that MAOI's may play a role do not amount to a fact that it is the combination which results in addiction.  Beyond those two false statements, the only other relevant statement is that NRT efficacy is "controversial" (which could mean anything, and is unsourced).  I've been making my way around the smoking cessation circuit of articles at wikipedia this morning, and many appear to be infected by the non-NPOV of "cold turkey only" smoking cessation advocates; I have no particular inclination to clean up the mess, from whomever, but this pointless and mislabeled rant was my limit, and it had to go.  It had basically nothing to do with its title, and was little more than a scare piece to discourage use of NRT therapies.  If the effectiveness of NRTs is disputed in the professional community, and can be appropriately source and explained in a NPOV way, by all means, do so.  The existing section I removed did not.  Apophenian Alchemy (talk) 15:59, 9 July 2011 (UTC)
thread_title:  Criticism Ineffectiveness section removed 

message: I'd like to see if someone could include a section on non-fda approved cessation products (e-cigarettes and vaping) which, while not having had government studies conducted, have apparently offered outstanding success rates. Also, nicotine inhalers have been ignored. Simply because a product or technique is not FDA approved does not mean that it is ineffective. There is also some indications of successful smoking cessation due to diet changes, acupuncture, acupressure, and a plethora of herbal remedies (of varying effectiveness.) The important part seems to be that while many of the methods mentioned seldom have effectiveness ratings above that of 'cold turkey', e-cigarettes and nicotine inhalers appear to offer a much-higher than cold turkey rate of smoking cessation, and e-cigs in particular are cost effective.  — Preceding unsigned comment added by 67.2.9.41 (talk) 20:06, 10 September 2011 (UTC)
thread_title:  Alternative and non-FDA approved smoking cessation products 

message: The articles on nicotine and tobacco are much better examples of an attempt to be thorough and unbiased.
This article contains little of the information someone would look for -- for example, a longer discussion of delivery methods, a history of NRT (I believe gum was introduced in the 80s by prescription), a longer discussion of public health efforts to encourage NRT (New York City will give you a coupon for free nicotine replacement products), and above all, a more balanced discussion of the pros and cons of NRT.  
As someone (like Mark Twain) who has quit smoking many times, with and without NRT, I have done a lot of research on quitting smoking.  The current article reads very much like it was written by one of the stop smoking support groups, such as whyquit.com, that have a strong ideological objection to using NRT.  I don't have any issue with those who feel it is better to stop "cold turkey", but it is important to realize that there are very strong POV feelings about whether you should or should not use NRT to quit smoking -- and to my mind, this article reflects a particular POV.  
In short, editors should be aware that there is controversy and guard against it.  They should also be aware that NRT is endorsed by many health officials.  That endorsement is legitimately subject to criticism, but this *entire* article as it currently stands only represents that criticism -- quite imbalanced. Most of the article is contained under the heading "Criticism", which alone indicates clear bias. I would also ask those editors who believe that NRT is unhelpful to cessation efforts, or harmful, to at least allow a balanced explanation of the various POVs.  No one trusts a clearly biased article, so you hurt your own cause.  Let smokers make up their own minds on how to quit. (And I truly challenge you to find anyone who says that using NRT is even remotely as harmful as continuing to smoke.) StrangeAttractor (talk) 01:13, 11 October 2012 (UTC)
thread_title: Article currently seems highly biased to me

message: Hello! I am a fourth year UCSF medical student enrolled in the Expanding WikiProject Medicine course. The goal of this course is to introduce health professional students to the WikiProject Medicine in an effort to improve the quality of existing content. I am excited to begin editing articles and contributing to this open source resource used by so many people worldwide. 
I have selected the Nicotine replacement therapy article to contribute to. This is an article that is listed as "high importance" by WikiProject Medicine and is in the "start" phase. This article has had 2540 views in the last 30 days. I feel this is a great opportunity to provide quality evidence-based information to those looking to learn more about nicotine replacement treatment options.
Please feel free to leave me comments and feedback as I work over the next month. JKSinghMD (talk) 22:03, 28 October 2014 (UTC)
replies: text: Great idea. On Pubmed, when searching for reviews with "Tobacco Use Cessation Products"[MAJR] you get a number of excellent sources that can be of help in expanding this. MeSH doesn't have a separate header for NRT, so you will also find data for bupropion and varenicline; this may be relevant if it compared with NRT as a smoking cessation tool. JFW | T@lk 21:16, 29 October 2014 (UTC)
thread_title: Contribution from a medical student

message: Hi All!
I am adding edits on the page to include use in populations that need special consideration (including pregnant women and those under the age of 18). Please let me know what you think of the edits. Thank you!
Yendu (talk) 02:02, 3 November 2014 (UTC)
replies: text: Hi Yendu! Thanks for helping out with this page. I went through and reorganized the article a bit. Would you be interested in writing out the side effects portion of the page? Remember to keep the language simple for a broad audience and cite your resources. I will do the effectiveness portion. Thanks! JKSinghMD (talk) 21:57, 4 November 2014 (UTC)

text: Hello Jksingh2014! I can definitely help write the side effects. After I upload the side effects, do you think the precautions such as pregnancy and CV population would best fit under your future "Safety" category? Thank you! Yendu (talk) 08:41, 17 November 2014 (UTC)
thread_title:  Edits from UCSF Pharmacy Student 

message: Hello all! I have reorganized the article in what I believe to be a simple, logical way. I have not adjusted the content majorly thus far, I mainly just reorganized. This is the outline I am envisioning: 
    Introduction/Lead paragraph: Quick overview of NRT in simple, easy-to-read language
    Mechanism: Explanation of how NRT options work
    Side effects: Known side effects of NRT options
    Effectiveness: Evidence behind effectiveness or non-effectiveness of NRT options     
         compared to alternatives (placebo, pharmacologic treatments including buproprion  
         and varenicline)
    Safety of NRT
    Economics: Cost-effectiveness of NRT
    “Exempted populations”: I didn’t write this bit. It feels out of place. I will need to do some 
               more reading on this. 
     Global Health: This is a reference to WHO’s list of essential medicines. It is not absolutely 
               necessary to this article, but provides an interesting factoid. 
What do you all think? The next step is to add appropriate content to the sections. JKSinghMD (talk) 22:31, 4 November 2014 (UTC)
thread_title: Update from Med Student 11/4/14

message: "The claims for high efficacy and cost-effectiveness of NRT have not been substantiated in real-world effectiveness studies.Doran et al. (2006), pp. 758–766Pierce & Gilpin (2002) JAMA 288 pp. 1260–1264 Pierce and Gilpin (2002) stated their conclusion as follows:  “Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation” (p. 1260)."
- no refs after 2006, one appears wrong/dead. Bauld et al (2009) more recent, & appears to contradict. Also the statement is vague and subjective; NRT works for many but not enough. Thoughts? Johnbod (talk) 11:34, 20 November 2015 (UTC)
thread_title:  too old? 

message: These products are over the counter in many areas of the world. Thus medical approval is not needed. Nor is medical advice. Doc James (talk · contribs · email) 04:21, 25 December 2015 (UTC)
replies: text:  Really? Nor is "medical advice"? That seems like a very strange directive for taking a powerfully addictive pharmocological agent, regardless of whether it's OTC or not. (And I say that as someone who believes NRT should be OTC, and has no philosophical objection to being addicted to nicotine, or indeed anything, if addiction is the only consideration.)  Nonetheless, as medical professional who contributes here frequently and enthusiastically, you truly don't think using nicotine ever warrants a consultation with one's physician? No need to disclose, or consult, or worry about conflict with other medications or conditions?  I had no idea that nicotine was as safe and worry-free as H20, and frankly feel sincerely relieved, since I have been using nicotine for decades. I'll no longer mention to the physicians treating me. Thanks. StrangeAttractor (talk) 05:58, 17 September 2016 (UTC)
thread_title: medically-approved

message: Ref says "Evidence suggests that combinations of nicotine replacement therapy may be more effective than using a single formulation"
I guess the question is how do we want to summarize this? Doc James (talk · contribs · email) 04:26, 25 December 2015 (UTC)
thread_title: Use of multiple forms

message: Joanna - Instead of listing the side effects like that in the introduction/side effects sections, it might be more informative to make a table, list the common s/e of all NRTs, and individualize for each product. Readers who are looking for specific side effects for the products they are using might be able to easily locate their product this way.
Add precaution section to warn the readers about who shouldn’t be taking NRT (other than pregnant population and adolescents)
“Pregnancy,” “ Youth,” “Cardiovascular conditions” sections should be in a different section, maybe “special population,” not under side effects.
Katherine - The introduction section mentions the price of patches/gum based on a source from 2015.  We can update this to more current prices if applicable.  The medical uses section cites sources that seem like they may be old.  We can utilize PubMed to find more current resources if any are available to update this section of the article.  The economics section mentions the price of patches, gum, and lozenges.  We can update this section with prices of each of the different formulations.
Marilyn - Under Mechanisms of Action, describe in more detail the science behind how it reduces cravings d/t nicotine addiction (eg. stimulation of neural nicotinic acetylcholine receptors (NAChRs) in the ventral tegmental area of the brain → release of dopamine in the nucleus accumbens → reduction in nicotine withdrawal symptoms in regular smokers who abstain from smoking; source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003586/). Under Formulations, add  more detailed description of each NRT formulation, including advantages/disadvantages, dosing (move Dosing from Medical Uses section to each individual formulation’s subsection).. Also, can include newer forms of NRT, such as Nicotine Preloading, True Pulmonary Inhaler, and Nicotine Vaccines under the Society and Culture section. 
Tony - Under the subtitle “Dosing” subtitle, I would include tables to show how each formulation should be recommended to patients (i.e. time to first cigarette, etc.). I would like to add more/update images for the formulations so that the general public has an idea of available products. I would also add a note about the availability of NRT over the counter at pharmacies. I would also like to expand on costs in the “Economics” section to give people an idea of how much treatment would cost them. I would also like to add a subtitle “Contraindications” to show people who CAN’T use it. Letony331 (talk) 00:03, 15 October 2019 (UTC)
thread_title:  CP133 2019 Group 27 Proposed Edits 

message: This article did a great job informing readers about nicotine replacement therapy (NRT), its purpose, who could use it, the price and availability. The writers did an excellent job by adding more depth to the article such as adding more information about generic availability and signs/symptoms of nicotine overdose. Their edits significantly improved the quality of the article. It encompasses a well-rounded explanation of NRT basics, without imposing too much upon personal views and biases. There is certain wording that I would recommend changing such as utilizing the word "should" and replacing this word with "could" in "Medical Uses" section. By telling readers that NRT should be used for those who are heavy nicotine users, the particular sentence might convey a more one-sided view of NRT without addressing other forms of therapy that could additionally benefit individually who are severe nicotine addicts. Overall, the writers did a great job reflecting a neutral point of view regarding NRT.AllisonLee 2019 (talk) 20:32, 2 November 2019 (UTC)
thread_title:  /* CP133 2019 Group 26 Peer Review Edits */  

message: We have two statements that contradict each other
The efficacy for each of the formulations (lozenges, nasal spray, gum, and transdermal patch) to aid in smoking cessation is equal. 
Each formulation varies in its level of effectiveness and rate of absorption and is more effective when combined with concomitant behavioral therapy, such as cessation counseling.  This second one is from a source with an impact factor of less than one https://www.researchgate.net/journal/0924-2287_International_journal_of_health_sciences
The first is better. The second should be removed when it contradicts other sources and ideally replaced with a better source. Doc James (talk · contribs · email) 16:09, 21 November 2019 (UTC)
thread_title: Contradiction

message: Some OR with a statistical sample of 1 ;-) leads me to suspect that large doses of nicotine, as delivered by NRT, especially sprays, may lead to a much greater elevation in diastolic BP than systolic. This can have serious medical consequences. A quick Google didn't turn anything up. Does anyone have info on this? --D Anthony Patriarche, BSc (talk) 09:38, 2 October 2020 (UTC)
thread_title:  Effect on blood pressure 

message: In the table under dosing, instead of giving a number of cigarettes for "heavy" smoking, it says, "1 or more pack of cigarettes daily."
Even if "a pack" is geographically consistent or some form of known measure among smokers, it does not convey any information to someone who has never smoked or handled a pack of cigarettes!
Perhaps someone could add a number?  Indeed, possibly other things in that table would be improved by numbers, too?
FloweringOctopus (talk) 13:23, 17 November 2023 (UTC)
replies: text: No - Pack-year is the accepted measure of smoking in the field, used in vast amounts of scientific literature. A pack of course = 20 cigs. It's not perfect - "king-size", "lights" etc, but it's the best we have. What "numbers" would you want anyway. 1 pack-year = 365 x 20 = 7,300 cigs. Is that any more informative? Johnbod (talk) 16:23, 17 November 2023 (UTC)

text: As mentioned previously, it is a standard scientific term in this case. But to add, think of it this way - if you are asking someone how much they smoke, which number do you think will be more reliable, "how many cigarettes" they've smoked this month, or "how many packs" they've smoked? It's an easier concept for people to think about, and thus it makes data collected (and reported) in this way more reliable. Just-a-can-of-beans (talk) 21:05, 1 January 2024 (UTC)
thread_title:  "Pack" is not a very useful measure