Nicotine-Replacement Samples From Primary-Care Docs May Help Smokers Quit

By Anne Harding

January 24, 2020

NEW YORK (Reuters Health) - Handing out free nicotine patches and lozenges to smokers after they visit their primary care doctor can help them quit, new research suggests.

Seven-day point prevalence abstinence rates were significantly higher for smokers given a two-week supply of nicotine replacement therapy (NRT) after a routine clinic visit along with smoking cessation advice, compared with those who only received advice.

"Giving out these samples of products to smokers led to improvements," Dr. Matthew J. Carpenter of the Medical University of South Carolina in Charleston, the study's lead author, told Reuters Health by phone. While the approach is no "silver bullet," he added "we can reach a lot more smokers this way and hopefully get these people to the point of making a quit attempt."

Brief physician advice can spur some smokers to try quitting, but while healthcare providers do ask patients about their smoking status and advise them to stop, they "are less well equipped to provide patients with concrete tools to achieve this goal," Dr. Carpenter and his team note in Addiction.

The authors previously conducted two clinical trials of NRT sampling with two- to four-week starter kits, and found positive effects. In the new study, a pragmatic cluster-randomized clinical trial, they tested the approach in a "real world" setting among smokers seeking routine care at 22 primary care clinics in South Carolina.

At 12 clinics, 652 patients received advice only, and at the remaining 10 clinics, 593 patients received advice along with a two-week supply of nicotine patches and lozenges and "minimal instructions" on using them.

Twenty-four percent of the NRT sample group made a quit attempt within a month of visiting the clinic, versus 18% of the control group (odds ratio, 1.5; 95% confidence interval, 1.0 to 2.3). The percentage who made any quit attempt or any 24-hour quit attempt was similar for both groups.

Seven-day point prevalence abstinence by self-report was 5% at one month in the NRT sample group and 2% in the control group; 10% and 5%, respectively, at three months; and 12% and 8% at six months (adjusted odds ratio, 1.7; 95% confidence interval, 1.1 to 2.6).

Rates of floating abstinence, meaning a one-week period without smoking at any point in the study, were 26% with NRT sampling and 22% in the control group, also a significant difference after adjustment.

Quit attempts lasted about nine days longer for the NRT group (21.8 days vs. 12.8 days, P<0.001). Among those who tried to quit, abstinence duration was about 12 days longer with NRT (32.8 days vs. 20.9 days, P=0.003).

Fifty-five percent of the NRT group used smoking cessation medication in the month after their clinic visit, vs. 10% of the control group.

Dr. Carpenter said he came up with the idea of NRT samples while he was at the dentist, where everyone gets a bag with a toothbrush and toothpaste after a cleaning.

"They don't ask if you want to brush your teeth. Why can't the doctor do something similar with evidence-based medicines to help smokers quit? It's a pragmatic, brief, concrete and I think scalable intervention that takes minutes to deliver."

The study had no commercial funding.

SOURCE: Addiction, online January 8, 2020.