In the summer of 2018, the government announced it had laid out an ambitious plan to make England cigarette-free. Named the Tobacco Control Plan (TCP), the ultimate aim of the plan is to reach the first generation of non-smokers by 2030.
By why the urgency? Yes, smoking levels in England are the lowest since records began; having been almost continually falling since the 1970s. Yet as the percentage of smokers gets smaller and smaller, it becomes an increasingly stubborn number to reduce.
Furthermore, smoking remains worryingly prevalent amongst the most disadvantaged demographics in England. Duncan Selbie, Chief Executive of Public Health England, has admitted that “reaching the most vulnerable and disadvantaged will undoubtedly be the hardest” part of the process. This stage is made even more tricky with cuts in public health funding, and no new money being put towards the TCP.
As we enter the NHS’ annual Stoptober campaign, which encourages smokers to get through October without a cigarette, what better time to look at ways to help end nicotine addiction.
Health risks of smoking
It’s common knowledge that a smoking habit presents a number of health-risks. Combined with the financial burden it brings, finding reasons to quit shouldn’t be too difficult. Smoking has been linked to health risks such as:
- Cancer. 90% of lung cancers are caused by smoking, and it has been linked to cancers of the mouth, lips, throat, larynx, bladder, kidney, liver, stomach and pancreas.
- Damaged heart and blood circulation. Smoking increases the risks of heart disease, heart attacks and strokes.
- Damaged lungs. Smoking can also lead to bronchitis, emphysema and an easier trigger of pneumonia.
Smoking during pregnancy can also lead to health problems for both mother and child, with it causing 2,000 premature births, 5,000 miscarriages and the deaths of 300 babies per year.
All these health risks not only run apply to the smoker, but to those around them too, with children being especially susceptible to the effect of passive smoking. With all the damage that smoking can cause - to both you and your loved ones - it’s a wonder why anyone would start smoking in the first place. As with most things, however, the issue is not that black and white.
Why is smoking so addictive?
The tobacco in cigarettes contains a substance called nicotine. Nicotine has been proven to be highly addictive, which is why quitting smoking continues to be such a tough task for many.
Within a healthy brain there are positive feedback loops that cause a pleasant reaction to natural stimuli in the environment, such as eating after being hungry. The neurotransmitters that cause these good feelings (e.g dopamine) are often linked to memory, and this memory of a certain pleasurable experience is what motivates you to do it again.
However, with this sudden rush of dopamine, the brain reduces the number of receptors in order to return to a normal level of dopamine as an auto-balancing mechanism. So when someone re-uses the substance (nicotine in this case) they must take even more to reach that same good feeling due to the dopamine receptors being reduced. This cycle repeats and thus addiction sets in. When you then decide to give up smoking, the lack of nicotine can make you irritable, depressed and anxious, and it’s this strong craving that makes smoking such a hard habit to break.
If you started smoking due to social situations that you found yourself in (whether it was a stress-reliever, to help weight loss or as a method of escapism), quitting becomes all the more difficult as the addiction can become an integral part of your life. In fact, it can help you to feel better.
Most withdrawal symptoms only last two to four weeks, so making sure you get through the first few weeks is the biggest battle. Don’t worry, though; the physical, mental and financial benefits of quitting will soon massively outweigh these initials withdrawals.
What treatments are available for smoking cessation?
Thankfully, there are a number of treatments out there to help you quit smoking, many of which are available on prescription. Before you decide on a treatment, speak to your GP or pharmacist. They’ll be able to give you advice on which type of treatment is best for you.
Varenicline (also known by the brand name Champix) was discovered and developed by Pfizer and evidence suggests it’s the most effective treatment for smoking cessation.
Varenicline works by activating the nicotine receptors, reducing cravings to smoke. However, it also reduces pleasure gained from smoking as it blocks nicotine from binding with said receptors. Varenicline is taken as one to two tablets a day, and the treatment usually lasts for 12 weeks but can be prolonged if need be. It’s important that you set yourself a “Quit Date”, and you start taking the treatment for a week or two before this date.
Varenicline is suitable for anyone except for those under 18 years old, pregnant women or people with severe kidney problems.
Potential side effects of varenicline include feeling and being sick, difficulty sleeping, dry mouth, constipation or diarrhoea, headaches, drowsiness or dizziness. As always, contact your GP if you experience troublesome side effects.
Bupropion (brand name Zyban) was originally used as an antidepressant but has also proven to be useful as a cessation aid. It’s thought that bupropion affects the regions of the brain involved in addictive behaviour, although it’s not totally understood how it works.
Just like varenicline, bupropion is taken in tablet form once or twice a day and should be started a week or two before the “Quit Date”. However, the course of bupropion will last only seven to nine weeks.
It’s suitable for anyone to use except those under 18 years old, pregnant women or people with epilepsy, bipolar disorder or eating disorders.
Possible side effects of Zyban include dry mouth, difficulty sleeping, headaches, feeling and being sick, constipation, difficulty concentrating and dizziness. Again, it’s important to contact your GP if you experience negative side effects.
Nicotine Replacement Treatment (NRT)
Nicotine Replacement Therapy (NRT) is a form of medication that offers a lower dosage of nicotine without the harmful chemicals found in a cigarette - with the aim of weaning users off the drug.
There are several forms of NRT that are mostly available over the counter but can still be prescribed. Using the Echo app can make adhering to dosage instructions far easier. The main ways of administering nicotine are:
- Nicotine patches. One of the most popular ways to give up smoking, these release nicotine at a slow rate and are worn most of the day. Patches release nicotine through your skin, and can come in different strengths depending on how heavy a smoker you are. Patches may cause skin irritation for some but it’s simple to change to a different NRT if necessary.
- Nicotine inhalers. The inhaler sprays a mist of nicotine vapour that is absorbed by your mouth and throat. Whereas the skin patches give a slow release of nicotine, the inhaler is an instant hit and can thus be used whenever the cravings are particularly strong. It also mimics the hand to mouth habit of smoking.
- Nicotine nasal sprays. This form is inhaled through the nose several times a day. It is the strongest form of NRT and provides relief very quickly. Each dose is the equivalent of one cigarette.
- Nicotine lozenges. These come in the form of a small tablet. They dissolve slowly (taking up to 30 minutes) when they become warm and then rest on the inside of your cheek.
- Nicotine gum. This is just like chewing gum, except that you only chew occasionally and then rest the gum on the inside of your mouth - much like with the lozenges. This tends to be available in 2mg or 4mg strengths (the 4mg are for those who are used to smoking 20+ cigarettes per day).
Adults and children over 12 years of age are fine to use NRTs, although under 18s should get medical advice before using the lozenges. Any side effects of NRTs tend to be very mild and not cause any long-lasting discomfort. If this is the case, it’s important to contact your GP for another plan of action.
No form of NRT is better than the other, it is purely down to suit. However, what is evident is that a combination of NRT products tends to lead to higher rates of quitting. For example, using the patches for a constant rate of nicotine in combination with the nasal spray when suffering a particularly strong urge should minimise the risk of having a cigarette. This is crucial as total cessation is the biggest key to quitting – one cigarette puts you right back to your “Quit Date”.
A risk with all NRTs, however, is that they contain the addictive part of tobacco, nicotine, and therefore carry a mild risk that you may simply transfer the addiction to the NRT. This risk tends not to materialise if you follow the manufacturer’s directions carefully and gradually reduce the NRT dosage once you no longer crave cigarettes. It is recommended that all NRT products should be used for between eight and twelve weeks.
An electronic device that gives you nicotine in the form of flavoured vapour, e-cigarettes allow you to inhale nicotine without most of the harmful effects of smoking cigarettes. This is because the vapour contains no tar or carbon monoxide.
This alternative to smoking cigarettes has entered popular culture as “vaping”, and it’s becoming increasingly commonplace as a method of smoking cessation (a 2017 survey found that 2.9 million people now vape in the UK). Although further research into the long-term effects of vaping is necessary, a recent report by MPs says that e-cigarettes are a positive tool for public health.
E-cigarettes are not currently available on prescription. According to the NHS, however, when medically licensed e-cigarette products do become available in the near future, GPs and stop smoking services will be able to start prescribing them.
The cost (and quality) of e-cigarettes tends to vary, although it’s still a much cheaper alternative to smoking cigarettes. (The average cost of a pack of 20 cigarettes is £10.40 - for a 20-a-day smoker the annual outlay on the habit is a staggering £3796!)
If you have any questions or concerns about e-cigarettes as an alternative treatment, ask your GP.
How Echo can help
For all the aforementioned treatments, the Echo app can be the perfect companion to help you through your cessation journey.
Consistency is key when giving up smoking, and sticking to a routine will help you turn away temptations and overcome obstacles. Echo’s reminders help you to manage your treatment from the ease of a smartphone, ensuring you won’t miss a dose and fall back into old habits. By reducing the difficulty of quitting, you’ll give yourself a better chance of keeping your cravings at bay and achieving your final goal of being cigarette-free.
You can download the app here.
This BBC Health article provides an overview of the Tobacco Control Plan.
The NHS’ Smokefree resource is used by millions of people to help them quit, providing free support.
If you’re looking for further information and advice on giving up smoking, this comprehensive list of addiction and dependency resources from Mind is a good place to start.
Some advice for pharmacists to help smokers quit from the Royal Pharmaceutical Society of Great Britain.
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