Mailed nicotine patches, with no behavioral support, is associated with smoking cessation

Mailing free nicotine patches to smokers, without any behavioral support, does help some of them quit, according to a study by the Centre for Addiction and Mental Health (CAMH).

Smoking is a leading cause of preventable disease worldwide, and 13 per cent of Ontario adults reported that they smoked daily in the most recent CAMH Monitor survey.

It's relevant to study if nicotine replacement therapy without counselling works, because there are many people who purchase nicotine patches over-the-counter and attempt to quit without any support, notes Dr. John Cunningham, CAMH Senior Scientist in Social and Epidemiological Research, and co-authors in their study published in JAMA Internal Medicine.

In past clinical studies where the patch is offered with behavioural supports, its value has been well demonstrated. However, in large population studies of smokers who buy the patch over-the-counter, with no such supports, nicotine replacement doesn't appear to affect quit rates when compared with smokers who don't use nicotine replacement therapy.

To address this issue, the research team conducted a randomized clinical trial, to compare whether smokers willing to receive free nicotine patches by mail, without behavioral assistance, were more successful in quitting than interested smokers who received no patch. Adults who consumed at least 10 cigarettes a day were recruited from across Canada by random-digit dialing of home and cell phone numbers.

In total, 500 participants in the experimental group were mailed a five-week supply of nicotine patches, and 499 participants in the control group were not offered the nicotine patches or any other intervention. After six months, researchers measured whether participants had been abstinent for the previous 30 days.

"Among those who received patches, almost eight per cent reported being abstinent, compared with three per cent who had no intervention," says Dr. Cunningham. Not everyone who received the patch used it. In total, 58 per cent reported using the patches, and among those, most did not complete the full course. Overall, 19 per cent (or 46 people) used the full five-week supply.

The researchers also sought to validate their results by collecting saliva samples to measure cotinine, a tobacco by-product, but due to evaporation during transit, only half of the samples were usable. Despite this, the trend towards abstinence was also higher in the patch-group than those who received no treatment.

Many jurisdictions offer free nicotine patches and counselling to people who call a toll-free number, including the STOP program in Ontario. While this study does not directly reflect these mass distribution initiatives, because study participants were recruited randomly and were not necessarily seeking help, the authors note that, "the results of the trial provide general support for direct-to-smoker programs with free mailed nicotine patches."