To quit, 'nicotine-free' smokes as good as lozenges

Interesting article.

By Joene Hendry

NEW YORK (Reuters Health) - Trying to quit smoking? So-called nicotine-free cigarettes may be as helpful as nicotine lozenges, hints a small study.

Smokers who used the nicotine-free cigarettes before quitting were as likely not to be smoking six weeks later as those who used nicotine lozenges, authors report in the journal Addiction. (Such cigarettes actually have a tiny amount of nicotine.)

And nicotine-free cigarettes and the lozenges both beat low-nicotine cigarettes, Dr. Dorothy K Hatsukami, at the University of Minnesota Tobacco Use Research Center in Minneapolis, and colleagues note.

Nicotine-free cigarettes have 0.05 milligrams of nicotine per cigarette, while low-nicotine cigarettes each have 0.3 milligrams. For comparison, light cigarettes have between 0.7 and 1.0 milligrams of nicotine.

While scientists have tried various ways to reduce the amount of nicotine smokers inhale to help them cut down, they have been concerned that smokers may just smoke more cigarettes to make up for what they're missing.

The idea of nicotine-free cigarettes is to make that much less likely, because it would take so many such cigarettes.

Hatsukami's team compared smoking habits and rates of quitting in 165 mostly middle-age men and women who had smoked for an average of about 15 years, reported multiple previous attempts to quit, and appeared highly motivated to try again.

The investigators supplied nicotine-free cigarettes to 53 participants and identical looking low-nicotine cigarettes to another 52. Each group was to solely smoke supplied cigarettes for 6 weeks, then quit. The remaining participants went cold turkey and used nicotine lozenges for 6 weeks.

Urine and lung tests in those who completed the study showed 19 in the nicotine-free group and 12 in the lozenge group abstinent after 6 weeks. Just 7 in the low-nicotine group were not smoking at that point.

Compared with the low-nicotine group, the nicotine-free smokers had lower levels of tobacco-related toxins and symptoms of withdrawal, though both groups reported similar cravings.

As scientists have suspected, low-nicotine cigarette smokers were more likely to compensate their withdrawal by smoking more cigarettes. Nicotine-free cigarette smokers were not.

Although nicotine-free cigarettes "can be used potentially as a cessation tool," the authors note, the results from this one small study aren't enough to suggest that smokers should use nicotine-free cigarettes instead of nicotine lozenges, Hatsukami told Reuters Health by email.

Part of what limits the conclusions scientists can draw from the study is that a third of the smoking group and half the lozenge dropped out during the course of it.

Still, the results are "encouraging," write Mitch Zeller and Saul Shiffman of Pinney Associates, Bethesda, Maryland, in an accompanying editorial, and should be followed up to explore "how nicotine reduction might affect smokers."

Pinney has consulted for GlaxoSmithKline, which has a smoking control division. Members of the study team have served as expert witnesses in lawsuits against tobacco companies, and have consulted for various drug companies.

SOURCE: Addiction, February 2010.