be good to yourself...


The Patch

(Material for this FAQ was contributed from various sources, as credited.)

[Adapted from Brad Olin's contribution.]

The 'patch' is the common name for a nicotine replacement therapy (NRT) which delivers varying dosages of nicotine to the bloodstream via a plaster which adheres to the skin. There are several brands of the patch available, manufactured by different drug companies in different dosages and with slightly different properties, but all operate by weaning the nicotine addict off the drug over a period of weeks or months. (Nicotine gum is another form of NRT - see below.) Your body has become addicted to nicotine, and nicotine addiction is a medical problem that can be treated medically. However, NRT is not a sure-fire way to quit smoking.

Used properly, the patch can provide relative comfort from the physical symptoms of withdrawal (e.g., irritability, frustration, anger, anxiety, difficulty concentrating, restlessness), allowing those who feel overwhelmed by the physical addiction some relief while dealing with the behavioral habit. The discomfort felt when going from smoking to the patch, or when reducing dosages, is not as sharp as that felt when going cold turkey. But, some quitters contend that because the patch stretches withdrawal out over a longer period of time, it isn't any easier than quitting cold turkey.

Cravings may not be as intense when using the nicotine patch, but do not expect them to disappear magically. For most smokers, nicotine addiction is just one part of the habit. We develop behavioral and psychological addictions as well. Certain feelings, times of the day, or activities all become strong cues and make us crave a cigarette.

How many cigarettes does a patch equal? The nicotine released from the 21mg patch during a 24-hour period is roughly equivalent to that ingested from a pack of 20 cigarettes, whether they be high or low tar and nicotine. (Cigarettes are made 'light' by modifying the filter, not the tobacco; but it has been shown that smokers of 'Lights' and 'Ultra Lights' then modify the way they hold and inhale cigarettes, so that they get the same amount of nicotine as with the stronger brands.) You and your medical provider or pharmacist/chemist will determine, based upon factors such as your weight, general health, and smoking habits, the nicotine dosages you use and the length of time you will remain at each level.

Nicotine from the patch is not delivered to the bloodstream in the same way as it is when you smoke. When you inhale, the nicotine in cigarette smoke enters your bloodstream through your lungs. It is carried to your brain very quickly (faster than an injection into your veins) and it almost immediately satisfies your craving. At least for the moment. The amount of nicotine in your blood is known as 'blood nicotine level.' After a cigarette, the level of nicotine drops quickly. When it gets to a low level, your body signals that it needs more and you experience a craving. The desire is temporarily satisfied when you inhale your next cigarette. You may need a cigarette every 20 to 30 minutes. Throughout the day your blood nicotine level is raised and lowered like a roller coaster, and your system becomes a participant in a constant 'need-feed' cycle of addiction.

The nicotine patch, on the other hand, delivers the drug at a controlled rate into your bloodstream through your skin. The rate is intended to be steady, but it's not perfect. When the patch is first applied, the blood nicotine level quickly increases to its peak at about the two hour period; it remains at peak delivery through about the sixth hour; then it slowly tapers off through the remainder of the 24 hour cycle.

[Please note that nicotine remains in the blood for several hours even once the patch is removed; therefore, it is crucial that once you begin using the patch, you do not smoke. A nicotine overdose can result in illness, heart failure, even death. Also, a significant amount of drug remains in the patch itself even once it is discarded. See information provided by Michiko Walraven further on in this section.]

While nicotine is nicotine regardless of its delivery system, using the patch is not as harmful for you as continuing to smoke cigarettes. First, you receive no more nicotine, and usually far less, through the patch than you do from smoking. The patch does not contain tar or the poisonous gases that are found in cigarettes. The patch does not present health hazards, via second hand smoke, to those who share your living space. And most important, the patch is easier to stop using.

It is not associated with qualities such as sexiness, rebelliousness, or creativity; nor will you look to it to see you through tough times or to join you in celebrations (though you may find yourself giving it a little pat now and again)! And, as explained above, the relatively constant nicotine level supplied by the patch, delivered passively and regardless of whether you think you need it or not, ends the need-feed cycle, allowing the body to disassociate itself from the expected reactions to nicotine intake.

It is unfortunate that the cost of the nicotine patch sometimes presents a barrier to its use, and although national governments and insurance companies agree that smoking is a highly significant source of senseless illness and premature death, few back up this belief by subsidizing the cost of this treatment. But even if your health insurance won't pay for the patch, remember that the cost of using the patch is usually no more than continuing to smoke a pack a day. And patch use will usually end within 10 to 16 weeks; cigarette buying never ends until the smoker stops, one way or another.

Not everyone can use the nicotine patch, so be aware of potential medical side effects associated with using the patch. It is possible, and not uncommon, to have some mild itching, burning, or tingling when the patch is first applied. This is normal and should go away after about an hour. After you remove a patch, the skin underneath might be somewhat red. Your skin should not stay red for more than a day. If you get a skin rash after using the patch, or the skin under the patch becomes swollen or very red, call your doctor. You might be allergic to one of the components of that particular company's patch. You can try switching brands, and see if you react more favourably. And, if you know you have problems with adhesives plasters/bandages, then consult your doctor before using the patch.

Most brands of the patch comes in different dosages, and using the wrong one could result in side effects including headaches, dizziness, upset stomach, diarrhea, blurred vision, weakness, and vivid dreams. Also, you must inform your doctor that you are using the patch if he/she prescribes other medication.

The happy side effect: Many people using the patch, especially one of the brands designed to be worn round-the-clock, experience unusually vivid dreams. One friend told me that the patch gave him extremely erotic dreams every night! It seems that the patch's steady nicotine delivery system keeps the brain relatively active even during sleep, which in turns produces lively dreams.

If the patch is causing insomnia, however, or if the excessive dreaming is disturbing, ask your doctor about switching to a 16 hour patch, or removing the one you're using during the night.

[From The Journal of the American Medical Association. Distributed by: JOIN TOGETHER: A National Resource for Communities Fighting Substance Abuse.

Tel. 617/437-1500. Fax. 617/437-9394. 441 Stuart Street, Sixth Floor, Boston, MA 02116. [email protected]]

_The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis_

- Michael C. Fiore, MD, MPH; Stevens S. Smith, Ph.D.; Douglas E. Jorenby, Ph.D.; Timothy B. Baker Ph.D.

"Our objective was to estimate the overall efficacy and optimal use of the nicotine patch for treating tobacco dependence. Our data sources were from nicotine patch efficacy studies published through September 1993, identified through MEDLINE, Psychological Abstracts, and Food and Drug Administration new drug applications. Our study selection was double-blind, placebo-controlled nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (e.g., coronary artery disease). Pooled abstinence rates and combined odds ratios (OR) at end of treatment and 6-month follow-up were examined overall and in terms of patch type (16-hour vs 24-hour), patch treatment duration, dosage reduction (weaning), counselling format (individual vs group), and intensity of adjuvant behavioral counselling. Across 17 studies (n=3D5098 patients) meeting inclusion criteria, overall abstinence rates for the active patch were 27% (vs 13% for placebo) at the end of treatment and 22% (vs 9% for placebo) at 6 months. The combined ORs for efficacy of active patch vs placebo patch were 2.6 at the end of treatment and 3.0 at 6 months. The active patch was superior to the placebo patch regardless of patch type (16-hours 24-hour), patch treatment duration, weaning, counselling format, or counselling intensity.

"The 16-hour and 24-hour patches appeared equally efficacious, and extending treatment beyond 8 weeks did not appear to increase efficacy. The pooled abstinence data showed that intensive behavioral counselling had a reliable but modest positive impact on quit rates. Our conclusions were that the nicotine patch is an effective aid to quitting smoking across different patch-use strategies. Active patch subjects were more than twice as likely to quit smoking as individuals wearing a placebo patch, and this effect was present at both high and low intensities of counselling. The nicotine patch is an effective smoking cessation aid and has the potential to improve public health significantly.

"Abstract Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker, T.B.,(1994)

The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis. The Journal of the American Medical Association, JAMA 271 (24) 1940 Article Source: Fiore M.C., Smith S.S., Jorenby D.E., Baker, T.B., (1994) The Effectiveness of the Nicotine Patch for Smoking Cessation: A Meta-analysis. The Journal of the American Medical Association, JAMA 271 (24) 1940-1947. Date: 8/9/94"

[From Michiko Walraven, [email protected]]

Warning to Patch Users

This is a summary of an article I found yesterday morning in our local newspaper. I hope this will help all the patch users who live with small animals/children:

Excerpts from Victoria Times-Colonist, Jan 12, 1995, page B3.

"A man in Duncan, BC has been on nicotine patch for the past 40 days trying to quit smoking. He noticed that the patch sometimes gets loose and falls off. So, he has been using duct tape on occasion. Last night his patch fell off during his sleep, and his pet kitten (11-month) accidentally swallowed it. The cat survived her nicotine blast and was recovering fine at the time of newsprint. BC Drug and Poison Information Centre representative says: 'With nicotine patches, when children get them stuck on them, we've had problems with nicotine toxicity where they get very shaky, stomach cramping and if untreated sometimes there's always the risk of seizures.' She recommends that users of patches consider returning the used patches to their pharmacies for proper disposal rather than just throwing them out with the normal trash. The spent patches could still contain traces of medicine."