Prescription drugs included in the basket of health services to help smokers kick the habit are only mildly effective a year later, and they also may present annoying and even serious side effects. So says a Tel Aviv University meta-analysis published in the journal Addiction.
The research was led by Dr. Leah (Laura) Rosen of TAU’s School of Public Health in the Sackler Faculty of Medicine, in collaboration with TAU colleagues Prof. Laurence Freedman and Dr. Tal Galili, and with Sackler graduates Dr. Jeffrey Kott and Dr. Mark Goodman.
They found that only eight out of 100 smokers who take smoking cessation medications - varenicline (commercially known as Champix/Chantix), bupropion (Zyban) or nicotine-replacement therapies in chewing gum, patches, sprays, inhalers or lozenges - remained non-smokers after a year’s time due to the medications.
Smoking cigarettes is the most common cause of preventable death in the world today.
Rosen told The Jerusalem Post that the low rate of success from the drugs should lead policy-makers to find better methods to help smokers quit and to prevent young people from taking up smoking to begin with.
“We don’t have a magic pill to get smokers to quit,” she said.
“Policy-makers should use all possible means to prevent young people from starting to smoke. Prevention of entry into the cycle of addiction is the best possible medicine.”
“This study is particularly important in Israel, where 22.5% of adults smoke and the rate of smoking is rising. In the US, smoking has declined from 20.6% of the population in 2009 to 15.1% of the population in 2015,” she said. “While the Israeli national healthcare system offers a strong package of aid to smokers who want to quit, there is no permanent funding for other tobacco control strategies.”
The scientists used meta-analysis to combine the results of 61 randomized controlled trials involving some 28,000 participants who took the first-line drugs. In all of the trials, participants were randomized either to an intervention group, which received smoking cessation medications, or to a control group, which did not receive any. Most of the trials also featured some form of counseling in addition to the medication.
“Less than 40% of those receiving the medications continued to abstain from smoking after three months, about 25% had still quit after six months, and about only a fifth – 20% – remained abstinent after a full year,” Rosen said.
“Importantly,” she continued, “12% of those who did not receive active medication [also] continued to stay away from tobacco after one year.
“Because benefit is calculated by starting with the quit rate among those who received the medication, and subtracting the percentage [of those] who quit in the groups which didn’t receive the medication, just 8% of the smokers who received smoking cessation medications continued to benefit from the drugs after one year.”
“This study is a wakeup call for policy-makers everywhere and for physicians who treat smokers,” Rosen concluded. She said the Knesset must change the law to prevent young people from buying tobacco under the age of 21 instead of the current age, 18. This period, when most young people are in the Israel Defense Forces, is critical, as many soldiers start smoking in uniform.”
In addition, she noted, nicotine addiction is much harder to fight before age 21 because the brain is still developing.
She called for serious measures that have so far not been carried out by the Health and Finance ministries, such as much higher taxes on cigarettes, equalizing taxes on cheaper roll-your-own tobacco to those on regular cigarettes, and strict enforcement of no-smoking laws.