Table of Contents
- WHAT IS NICOTINE REPLACEMENT THERAPY?
- WHAT ARE QUIT SMOKING PATCHES?
- WHAT ARE THE TYPES OF QUIT SMOKING PATCHES?
- HOW DO YOU USE QUIT SMOKING PATCHES?
- HOW DO NICOTINE PATCHES WORK?
- WHAT ARE THE BENEFITS AND SIDE EFFECTS OF QUIT SMOKING PATCHES?
- HOW EFFECTIVE ARE QUIT SMOKING PATCHES?
- QUIT SMOKING PATCHES - CONCLUSION
- REFERENCES
Smoking cigarettes causes around 78,000 deaths per year in the UK and over 7 million deaths per year worldwide - it is the leading cause of preventable death in the world. Unless global smoking trends change, the predicted yearly deaths worldwide will hit 8 million by 2030. (1)
Methods to help people stop smoking are vital for getting this trend to change, and the products invented to do this contain nicotine - the addictive substance found in tobacco - so a person can feed the nicotine addiction without smoking. These nicotine replacement products are known as Nicotine Replacement Therapy or ‘NRT’.
WHAT IS NICOTINE REPLACEMENT THERAPY?
Nicotine Replacement Therapy (NRT) is a way of delivering nicotine to address cravings and withdrawal symptoms without taking in all the harmful chemicals found in tobacco smoke. Nicotine replacement therapy is available in many forms, and these can be prescribed by a doctor, all in an effort to help smokers give up tobacco completely. The products work a bit differently in terms of how and where the nicotine is absorbed, how much is delivered, and in what time frame.
Nicotine lozenges and nicotine gum see nicotine absorbed through the lining of the mouth over time, nicotine mouth spray is absorbed in a similar way but much faster. Nicotine nasal spray is absorbed via the blood vessels in the nose. There are medications in pill form to be taken orally, and a product known as an inhalator which delivers nicotine to be absorbed in the mouth too.
WHAT ARE QUIT SMOKING PATCHES?
One of the longest standing nicotine replacement products is the transdermal patch. It is a layered square with an adhesive surface. Nicotine patches are applied to the skin and release nicotine over a period of time and is absorbed via the skin, drip feeding a constant stream to the body over the period indicated by the type of patch (2). The idea is a small but steady stream of nicotine will reduce cravings and withdrawal symptoms throughout the day.
WHAT ARE THE TYPES OF QUIT SMOKING PATCHES?
Nicoderm CQ brand of patches has 3 strengths available: 21mg, 14mg and 7mg strengths for their 24 hour patch (3). Other brands do offer a 16 hour patch, with the nicotine strength adjusted for the shorter time frame: 25mg, 15mg and 10mg. The 24 hour patches are suggested for smokers that have their first cigarette within half an hour of waking, the 16 hour patches are suggested for those who smoke after 30 minutes of having woken up.
HOW DO YOU USE QUIT SMOKING PATCHES?
Nicotine patches are meant to be applied when you wake up, and worn throughout the day, and only the 24 hour patch should be worn through your sleep - the 16 hour patch should be removed after 16 hours has elapsed since the patch was applied.
Heavy smokers are likely to smoke within that first half an hour of waking, and need the highest dose of nicotine available, so they would choose the 24 hour patch in the 21mg strength. They would then stick with this product for up to 6 weeks, switching at the end to the next strength down - in this case, the 14mg patch. After 2 weeks on the new patch, the user can hopefully make another switch down to the lowest strength - the 7mg - for another 2 weeks, before finally stopping use altogether.
A lighter smoker - someone who smokes 10 cigarettes per day or less - could start on the 14mg 24 hour patch, switching down to the lowest strength after 6 weeks, and stopping completely after another 2 weeks. If you don’t smoke within half an hour of waking, the 16 hour patch may work better, but otherwise the method is the same: stay on the first patch for 6 to 8 weeks, switch down to a lower strength for 2 weeks, then switch down again for a further 2 weeks before stopping use.
HOW DO NICOTINE PATCHES WORK?
Nicotine patches are made in a few different configurations, but fundamentally work in the same way: controlled delivery of nicotine. Sometimes a plastic chamber is used to contain the nicotine, covered by a selectively permeable membrane that controls the drug delivery rate. Another version suspends the nicotine in a plastic matrix, and yet another mixes nicotine with the adhesive that is used to stick the patch in place. All patches have a top layer that is designed to stop any leaking or degradation, and an adhesive layer on the bottom to stick the patch to the skin.
The patch works as the nicotine slowly reaches the skin through the adhesive layer, gets absorbed by the skin and makes its way into the bloodstream. This small but constant stream of nicotine builds the blood nicotine level over time, until the time on that patch is up - 24 hours if it’s a 24 hour patch, 16 hours for the 16 hour patch. This constant delivery of a small amount of nicotine into the blood will help keep nicotine cravings and withdrawal symptoms at bay.
WHAT ARE THE BENEFITS AND SIDE EFFECTS OF QUIT SMOKING PATCHES?
Of all the NRT products available, why choose the patch? The biggest advantage for the patch is that it is applied in the morning, and forgotten about until either later in the day or the following morning. It’s simple, easy, discrete, and should keep you somewhat satisfied throughout the day, taking the edge off the more aggressive cravings when they would usually hit.
With some of the other forms of NRT, it is useful to know when these cravings appear so that you can take your nicotine before the cravings hit because, with most forms of NRT, the blood nicotine level takes time to rise enough that cravings are sated. With patches, this may be the case in the morning, when the patch is first applied, but after that the blood nicotine level is sufficient to reduce cravings.
Possible side effects from the patch can include: skin irritation resulting in itchiness, burning and stinging sensations (see a doctor if this doesn’t subside within 4 days); trouble sleeping - unusual dreams are common with the 24 hour patch - muscle aches and stiffness, in addition to the potential side effects from nicotine overdose like dizziness, nausea, fast heartbeat and headache.
Symptoms of nicotine overdose could mean the strength is too high for you, so stop using the patch and talk to your doctor - they may recommend using a lower strength patch.
Symptoms of nicotine overdose could mean the strength is too high for you, so stop using the patch and talk to your doctor - they may recommend using a lower strength patch.
HOW EFFECTIVE ARE QUIT SMOKING PATCHES?
To assess the efficacy of patches as a smoking cessation tool, studies have investigated Nicotine Replacement Therapy methods and success rates, and one meta analysis from the Cochrane Library in 2018 showed that the risk ratio (RR) for any form of NRT in relation to a control is 1.55 - this means that any form of NRT increases the odds of a person quitting by 55%, not that they are 55% more likely to quit. (4)
This analysis found the risk ratio for quitting with nicotine patches to be 1.64 - a 64% increase in the odds of quitting. This is better than their risk ratio for nicotine gum, which came out at 1.49, and the ratio for oral tablets, which came out at 1.52. The products with better ratios were the inhalator (RR of 1.90) and nasal spray (RR of 2.02).
The analysis concluded by saying that NRTs increase the rate of quitting by 50%-60%, but suggested that the effectiveness of the NRT is independent of the level of additional support given, i.e. the NRT is not dependent on behavioural support to work, though it does increase the likelihood of quitting.
Understanding how nicotine patches work can help you plan your quitting regime - one study examined the blood nicotine levels of a variety of NRT methods over a period of 120 minutes after dosing, and from the graph we can see that transdermal patches take a while to get that blood nicotine level up - 30 mins for a 16 hour patch, and about 100 minutes to reach the same level from a 24 hour patch. This shows us where the patch is useful; maintaining nicotine levels over a long period of time - and where it could present problems; like a patch’s inability to tackle immediate cravings soon after it has been applied.
It is the advantages and disadvantages of each form of NRT that has led people toward using complementary forms of NRT together to cover all the bases - one fast acting for immediate relief in times of particularly strong cravings or stress, and one slow acting that maintains the blood nicotine level to keep withdrawal symptoms away. A 2019 meta analysis from the Cochrane Library concluded as much, stating ‘There is high-certainty evidence that using combination NRT versus single-form NRT, and 4mg versus 2mg nicotine gum, can increase the chances of successfully stopping smoking’. (5)
Another study examined the success rate of e-cigarettes compared with NRT in the UK, providing support to both groups, and found the quit rate at 1 year for NRT was 9.9% compared with 18% in the e-cigarette group. The e-cigarette group demonstrated better adherence and experienced fewer urges to smoke than those in the NRT group, and more positive feelings toward their product (6). This could indicate e-cigarette use may be better for quitting smoking than all forms of NRT, when accompanied by behavioural support. E-cigarettes used in conjunction with a complementary form of NRT could be a very powerful smoking cessation tool.
QUIT SMOKING PATCHES - CONCLUSION
Quit smoking patches have been around since the 80’s, and have stuck around for good reason - they may help you to quit. They deliver nicotine as desired, are easy to use, and are available in a few strengths to allow a quitter to reduce their nicotine intake over a period of 10 weeks. In the case of Nicotine Replacement Therapy, the products available are much safer than smoking, and so while any form of NRT is accompanied with a typical timeline, users should still use NRT over going back to smoking - and shouldn’t feel bad about it.
Quitting is a big mental challenge, and using nicotine patches may allow you to spend the day not thinking about smoking as it provides a constant supply of nicotine. If you find there are times where strong cravings get the better of you while using a nicotine patch, try using an e-cigarette to attack these cravings - or for use at particularly stressful times - for more immediate relief.
The evidence for e-cigarette use for quitting tobacco is promising and building every day, so having an e-cigarette to hand might just be the secret weapon in your toolbox that you didn’t know you needed.
In fact, a recent study by the NHS' Stop Smoking Service found that e-cigarettes can be up to twice as effective to help you quit smoking compared to other Nicotine Replacement Therapies (NRT).
So if you have tried quitting with a nicotine patch and struggled to quit, why not check out one of our popular electronic cigarette or vape starter kits?
The evidence for e-cigarette use for quitting tobacco is promising and building every day, so having an e-cigarette to hand might just be the secret weapon in your toolbox that you didn’t know you needed.
In fact, a recent study by the NHS' Stop Smoking Service found that e-cigarettes can be up to twice as effective to help you quit smoking compared to other Nicotine Replacement Therapies (NRT).
So if you have tried quitting with a nicotine patch and struggled to quit, why not check out one of our popular electronic cigarette or vape starter kits?
REFERENCES
(1) Tobacco and the Developing World
(2) How to Use Nicotine Patches
(3) Medscape: nicotine transdermal (OTC)
(4) Nicotine replacement therapy versus control for smoking cessation
ABOUT THE AUTHOR
Written by Dan Overgage
Dan Overgage – is a former smoker of 10 years until he became a client of SMOKO E-Cigarettes. Dan started working with SMOKO 5 years ago after successfully quitting using our e-cigarettes and works across our Customer Service and heads up our content creation and research with a strong focus on all things quitting smoking. During his tenure with SMOKO, Dan has written countless blogs and consults with countless clients every day to help them to stay smoke-free.
