What is nicotine replacement therapy?
Nicotine replacement therapy (NRT) is a smoking cessation method where the nicotine from cigarettes is supplied to the body using alternative means. Smoking cessation means to stop smoking or quit smoking.
Rather than getting nicotine from cigarette smoke the nicotine is replaced with another form of nicotine.
For example, the nicotine is delivered to the body using nicotine patches or nicotine gum.
Why is nicotine replacement therapy important to a quit smoking program?
Nicotine is the drug found in cigarettes that makes cigarette smoking addictive. Going cold turkey from nicotine is very difficult.
Replacing nicotine found in harmful cigarette smoke with forms of nicotine that are less harmful is important. Cigarette smoke contains dangerous, carcinogenic chemicals.
NRT allows the smoker to receive nicotine from less harmful sources and to gradually wean off the nicotine. This increases the likelihood of successfully quitting smoking.
What makes nicotine so addictive?
Nicotine creates a brief sensation of relaxation due to a rise in endorphins within the reward centers of the brain. This “high” is much more brief than with other recreational drugs.
Nicotine also raises the levels of dopamine in the reward centers of the brain. This increase in dopamine reinforces the drug taking behavior.
The brain adapts to these increased levels of neurotransmitters created by nicotine. Over time this leads to brain changes which create the addiction to nicotine. These changes in the brain and the need to have nicotine is called dependence.
If nicotine is not consumed it leads the dependent brain to create symptoms of withdrawal. It is these symptoms of withdrawal that make it very difficult to stop smoking.
Nicotine is very rapidly absorbed from the lungs and delivered to the blood stream. The drug reaches the brain in about 10 seconds where it creates its brief euphoric effect.
The effects of nicotine disappear nearly as quickly. This is what compels the smoker to repeatedly dose to get the “good feelings” from inhaling cigarette smoke and to prevent withdrawal symptoms.
What are the symptoms of nicotine withdrawal?
The symptoms of nicotine withdrawal include cravings, irritability, anxiety, depression, cognitive and attention deficits, increased appetite and sleep disturbances.
Withdrawal symptoms can start within an hour or two of stopping smoking.
How does nicotine replacement therapy help a person to quit smoking?
The symptoms of nicotine withdrawal can be very bothersome and tough to deal with.
The dependent body and brain need nicotine to prevent the symptoms of withdrawal.
Nicotine replacement allows the body to receive the needed nicotine without harmful cigarette smoke. It is also important to remove the rituals of smoking as much as possible.
For many smokers the sensations and habits around smoking are associated with the enjoyable effects of the drug. These sensations and habits can make the cravings for a cigarette worse.
These sensations and habits include the smell, the sight of and the feel of a cigarette in their hand. It also includes the well-formed routine of getting a cigarette out of the package, handling, lighting, and smoking the cigarette.
As you can see NRT removes these sensations and habits, and over time, removes these from the process of receiving the nicotine.
So basically NRT provides the body with the physiologically “needed” nicotine while also removing the habits and sensations associated with receiving the nicotine from smoking.
What forms of nicotine replacement therapy are available?
The forms of NRT can be divided into long-acting and short-acting forms of nicotine replacement.
Nicotine transdermal patches are considered long-acting NRT.
All the other forms are considered short-acting and include nicotine gum, nicotine nasal spray, nicotine oral inhalers and nicotine lozenges.
How do nicotine transdermal patches work?
The transdermal patches work by delivering nicotine from the adhesive on the patch onto your skin and then the nicotine moves through your skin and into your bloodstream.
Transdermal literally means “through the skin”.
The adhesive holds the nicotine and releases it slowly through your skin into your bloodstream.
There are three levels of patches. Step 1 releases 21 mg of nicotine into the body every 24 hours. Step 2 delivers 14mg of nicotine into the body every 24 hours. Step 3 delivers 7mg of nicotine into the body every 24 hours.
Most people use Step 1 for one to six weeks and then they step down to Step 2. Step 2 is used for two weeks before stepping down to Step 3. Step 3 is used for two weeks and then if the patient is ready the patches are stopped.
Gums and other short-acting nicotine replacement products can be used to help the patient further wean from the patches if needed.
To learn more about the Quit Smoking With Your Manitoba Pharmacist program visit our Quit Smoking Manitoba page.
For more information about nicotine replacement therapy visit https://www.camh.ca/en/professionals/treating-conditions-and-disorders/smoking-cessation/smoking-cessation—treatment/smoking-cessation—overview-of-nicotine-replacement-therapy