https://apple.news/AfirS-oWlT9aA6dyDCbe35g
There’s a Pill That Helps People Quit Smoking. Why Isn’t It Sold in the U.S.?
Even Canada has it.
OCT 02, 2023, 11:00 AM
If you were to analyze hundreds of studies examining what it takes to quit smoking, what do you think you’d find to be the most effective tool:
1) A nicotine patch?
2) A medication that is also widely prescribed for depression?
3) A natural health product sold over the counter in Canada?
4) Nicotine-free e-cigarettes?
5) A drug created to mimic a shrub that some soldiers smoked during World War II?
If you picked 3 and 5, well done. According to a study published last month in a leading medical journal, cytisine, a compound found in some seeds, and varenicline, a synthetic compound designed to work similarly, are far more effective than most other methods for quitting smoking. Alas, for the millions of smokers in the United States who try to quit each year, neither of these medications is easy to get one’s hands on. Though cytisine has long been popular in Eastern Europe and became available in Canada in 2017, it’s not sold in the U.S. Varenicline is technically available, but doctors often discourage smokers from trying it. Why would this be? The answer has to do in part with the economics of drug development.
One of the researchers is hoping that the finding will help revive interest in widening access to cytisine in particular. “We have all this evidence that it works. Shouldn’t we be throwing everything we can at this?” Jamie Hartmann-Boyce, who is now a professor in the School of Public Health and Health Sciences and the University of Massachusetts, Amherst, told me.
“Works” in the world of addiction, of course, is never anywhere near the 100 percent we all wish it were. Hartmann-Boyce’s meta-analysis found that across hundreds of studies, an average of 14 percent of cytisine users quit for more than six months. But that’s far higher than many other methods.
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To figure out which smoking interventions were most effective, Hartmann-Boyce—then at Oxford—and her colleagues sifted through hundreds of randomized control trials, dating from the 1990s to 2022. This included nicotine-free medications like Bupropion (aka Wellbutrin), nicotine-filled smoking-cessation tools like patches, and e-cigarettes with and without nicotine. After whittling the studies down to 320 that met their criteria, they had a pool of 157,000 or so smokers to analyze.
The researchers plotted the odds of quitting for at least six months while using a particular intervention versus the odds of quitting for that same period without using anything. Just three interventions—a nicotine e-cigarette, cytisine, and varenicline—had more than twice the odds, meaning that around 14 of 100 people trying to quit smoking with these techniques were likely to succeed. (Fourth place went to nicotine patch combined with another nicotine-filled something-or-other, like lozenges or gum.)
As to whether quitting cigarettes to start using nicotine e-cigarettes truly counts as quitting, that’s up to the smoker. (The same is true for replacing the pack of cigarettes with a $40 bag of nicotine mints devoured while wearing a patch.) Experts in this realm are divided about whether it’s wise to present e-cigs as a gentle offramp; some warn that it encourages swapping out one unhealthy addiction for another, while others insist that it’s the most realistic way to save smokers’ lives. I’m going to stay out of this debate for now. The relevant takeaway from this study seems to be: There are two nicotine-free medications that help people stop smoking at comparable rates to e-cigarettes, and unlike e-cigarettes, you may not know anyone who’s tried them.
Why not? It’s more than the impossible-to-remember names. Let’s begin with cytisine. The plant compound found in the seeds of a variety of different trees has been used in Poland and Eastern European countries for many decades. Ultimately it mimics some of nicotine’s effects, thereby reducing withdrawal symptoms and making smoking less enjoyable. This is particularly helpful for the first four-week period after someone vows to take their last drag. Some have reported side effects, such as nausea and abnormal dreams, but overall, the drug has performed impressively in studies.
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