Reduction In Nicotine Craving Predicts Ability To Quit Smoking

The stronger the reduction in nicotine craving after smoking the first cigarette in the morning, the more difficult it will be to quit smoking, according to a Yale School of Medicine study in Drug and Alcohol DependenceIn a study of 207 smokers, the researchers found significant reductions in craving, withdrawal and mood after smoking the first cigarette of the day. The greater the craving reduction, the more likely the smoker would relapse, said Benjamin Toll, assistant professor in the Department of Psychiatry and lead author of the study.

“This preliminary study provides evidence that there are significant changes in craving, withdrawal, and affect related to smoking the first cigarette of the day, with the largest of these changes observed for craving,” Toll said. “Moreover, changes in tobacco craving in response to the first cigarette of the day may be a novel predictor of smoking relapse that should be tested in future studies.”

Toll said it is known that smokers who light up immediately after waking are more dependent on nicotine and may have more trouble quitting smoking than those who do not. Existing evidence also suggests that individuals who experience less light-headedness in response to the initial cigarette of the morning are generally heavier smokers with a longer smoking history.

What has not been studied extensively, he said, and what was examined in this study are changes in craving and mood in response to the first cigarette of the day and examining the relationship of these changes to treatment outcome.

The standard measures of dependence include the Fagerström Test for Nicotine Dependence, which asks smokers how soon after they wake up do they smoke; do they find it difficult to refrain from smoking in places where it is forbidden; which cigarette do they most hate to give up; how many cigarettes do they smoke daily; is smoking more frequent earlier in the day after waking; and do they smoke when bedridden with an illness. Other measures include time to first cigarette, carbon monoxide in exhaled air, level of cotinine, a byproduct of nicotine, in the blood, daily cigarette consumption, and number of years smoking.

Co-authors include Ty Schepis, Stephanie O’Malley, Sherry McKee, and Suchitra Krishnan-Sarin of Yale. Published in Drug and Alcohol Dependence: (May 2007). The research was supported by the National Institutes of Health.

Pfizer readies consumer ads for its year-old anti-smoking pill

Although most Americans with health insurance are unlikely to get coverage for Pfizer Inc.’s smoking pill Chantix, the pharmaceutical giant says the pill is still much cheaper than a pack of cigarettes, which figures into its marketing plan.

Pfizer, which launched Chantix last summer, said it did not expect much health insurance coverage of the prescription, which costs about $3 a day, so it priced the pill below that of a package of cigarettes.

Cigarettes are expensive and can cost $8 to $10 a pack in Manhattan and some bars in Chicago, or $3 to $4 in rural America or certain areas where taxes on cigarettes are not as high, according to Pfizer and other sources.

“It’s the difference between putting money into making yourself sick or putting money into making yourself healthy,” said Terri O’Gorman, a Pfizer director of marketing.

The U.S. Food and Drug Administration said Chantix was the first new prescription aid to smoking cessation treatment to be approved in nearly a decade when the agency cleared the drug for marketing a year ago.

With more employers and health insurers pushing high-deductible health plans on consumers that require them to pay more out of pocket for drugs anyway, Pfizer is not expecting a huge boost in coverage for the pill. The New York-based drugmaker, citing government figures, said about one in four Americans with health insurance get coverage for smoking cessation treatments and programs, according to research it did before launching Chantix.

Chantix was approved to be taken for up to 12 weeks, according to its government-approved label. Upon consultation with their doctors, smokers can take Chantix for another 12 weeks if they have demonstrated they have quit, Pfizer said.

In the next stage of Pfizer’s marketing blitz for Chantix the company this summer will begin branded consumer ads for the pill. Chantix sales were $162 million in the first quarter, with the bulk of sales coming from the U.S.

Since December Pfizer has been marketing the pill with unbranded ads through its campaign dubbed “My time to quit.” The ad campaign includes a Web site ( www.mytimetoquit.com) and offers smokers a chance to calculate the amount of money they are spending on smoking. It does not, however, compare savings to the cost of the drug.

Ex-smokers say new drug will make you kick butts for good

How much does former smoker Donna Patrick believe in the new stop-smoking prescription drug, Chantix?

“I like it so much, I bought 100 shares of Pfizer,” she says. “I really think I’m going to reap from the benefits.”

Patrick hasn’t smoked since January, which may be benefit enough. But Pfizer Inc., the pharmaceutical company, ought to be paying Patrick instead of the doctor who prescribed it for her. She has enlisted 10 or 12 others to take Chantix pills.

Patrick, a social worker at Methodist Medical Center in Peoria, Ill., smoked about a half pack of cigarettes a day, on and off for 35 years. One of her recruits, nurse Barbara Kelly, smoked a pack and a half a day for 40 years. She hasn’t had a cigarette in three months.

Both women have tried nicotine patches unsuccessfully. Kelly also has tried Zyban, another prescription smoking-cessation drug. With Chantix, they say they haven’t experienced cravings, withdrawal pangs or much in the way of side effects. In fact, neither one can stomach the smell of cigarette smoke.

“You really notice the smell,” Kelly says. “To be honest, I can’t believe I leaned over sick people smelling like an ashtray. I can’t believe I did that to people.”

Chantix, the first stop-smoking drug of its kind, entered the market with a splash. Its success rates were high enough that the U.S. Food and Drug Administration put it on the fast track for approval. Television commercials came out featuring people talking about “my time to quit,” but not the product.

The timing was excellent for employees of Methodist Medical Center who smoke. In March, Peoria-area hospitals announced plans to ban smoking on their grounds by July 4 of this year – one reason it’s been easy for Patrick to convince colleagues to try the drug. But they’re not the only ones interested.

“We’ve gotten a number of calls about it,” says Linda Preckwinkle, who manages the American Lung Association’s quit-smoking line out of Springfield, Ill. The line, funded by proceeds from the state attorney general’s lawsuit against tobacco companies, provides basic stop-smoking counseling services.

But there are those who are leery about Chantix, its success rates as a stop-smoking aid and its side effects.

“There are still so many unknowns,” says John Polito of South Carolina, an ex-smoker who advocates quitting cold turkey through his Web site, whyquit.com.

“If you go back and look at the gum, the patch, Zyban, there was tremendous excitement when they first came out, too.”

Unlike Zyban – also known as the antidepressant Wellbutrin – or nicotine patches and gums, Chantix goes straight to the brain and blocks the receptors that produce physical cravings for nicotine. Soon after smokers start the initial 12-week regimen, many say they lose the desire to smoke. Like Patrick and Kelly, they say they can’t stand the taste or smell of tobacco products. A second 12-week regimen is prescribed for successful quitters to boost the drug’s effectiveness.

Doctors recommend smokers continue smoking one cigarette a day for the first week after they start taking the drug.

“It got to the point I had to force myself to smoke that last day because it tasted so horrible,” Patrick says.

In clinical trials, the most common side effects include mild nausea, headaches, vomiting and vivid dreams.

“About 3 percent of people have to stop taking the drug because of severe nausea,” says Dr. Michael Peil, a Peoria pulmonologist, “But most can get by that by taking it with food or cutting the dosage.”

Peil states up front that he’s a paid speaker for Pfizer, makers of Chantix. But he’s more measured in his responses about the drug than Patrick, who got her prescription from him.

He says he has seen success with people who haven’t been able to stop smoking using other smoking-cessation aids. But he’s also seen people who aren’t able to quit smoking the first time around.

“As with any drug, there’s going to be failures.”

Less than half – 44 percent – of Chantix users completely abstained from tobacco after three months. The percentage dropped to 22 percent after one year, according to the results of several clinical trials.

Still, those quit rates create excitement in the low-success arena of smoking cessation.

“In the past, if you got a 7 to 10 percent success rate at the end of a year, you were doing good,” Peil says.

He and Preckwinkle emphasize that Chantix is not a magic pill. It can help reduce the physical addiction to nicotine, but newly-quit smokers need additional help dealing with the psychological addiction to nicotine.

Doctors, smoking-cessation counselors, even Pfizer, recommend using Chantix or nicotine replacement therapies in combination with counseling, support groups or other resources designed to help recovering smokers change habits associated with smoking.

Peil tells patients not to consider themselves failures if they fall off the wagon.

“It can take up to 10 attempts to quit smoking successfully,” he says. Even using a Chantix pill.