Patching Up a Problem : No-Smoking Aid Has Ignited Big Demand, but Experts Warn It's No Cure-All

By STEVE EMMONS

March 13, 1992 12 AM PT

TIMES STAFF WRITER

Brian Bennett of Garden Grove heard about it over a computer smokers network: a patch you wear like a Band-Aid that helps you quit smoking.

A 15-year smoker working in a no-smoking office, Bennett had failed to quit with hypnosis, acupuncture or raw willpower and thought he’d give the patch a try.

Now he can’t say enough good things about it.

“It’s going great. I don’t call it easy. I call it the least difficult way I’ve ever tried. I’m nine weeks into the program, and I don’t think about smoking anymore.”

Hitting the market in December just before the New Year’s resolution season, the no-smoking patch has ignited a demand manufacturers now admit surprised them.

The device, which leaches nicotine through the skin and into the blood to reduce smoking withdrawal symptoms, is available only by prescription, yet one firm already reports $109 million in sales since December. The most potent patches cost $112 to $120 for a 30-day supply. The typical program lasts 10 to 12 weeks.

At least two manufacturers have seven-day-a-week, round-the-clock production underway, and one of them cannot keep up with demand. Pharmacies in areas of Southern California, New Jersey and New York report occasional shortages.

Manufacturers introduced the patch with TV and magazine advertising, unusual for a prescription drug. But word-of-mouth testimonials such as Bennett’s (“I rave about it to people--there’s no physical craving”) are fueling much of the demand among smokers, who nowadays feel increasing pressure to quit what UCLA research psychologist William J. McCarthy calls “the most tenacious addiction we’ve ever seen.”

But if they believe the new nicotine patch is a painless, magic escape from smoking, “they’re going to be disappointed,” McCarthy said. “There’s much more to being a smoker than the nicotine. There are strong psychological components.”

“People may look at these as a panacea,” said Dr. Alfred Munzer, a Maryland pulmonary specialist and a director for the national American Lung Assn.

“The important thing is, these patches should not be used by themselves. We have some concern that they’re being prescribed without a proper support system. All the studies were with people in some sort of formal smoking program.”

One study published in the Journal of the American Medical Assn. last December reported on 935 people who enrolled in six-week quit-smoking programs, some using nicotine patches, some using placebos. Of those who had used the full-strength patches, 26% were still abstaining from tobacco six months later.

Quit-smoking programs run by such organizations as the American Lung Assn. and the American Cancer Assn. typically have not used nicotine substitutes, and 20% to 25% of their graduates remain nonsmokers after a year, McCarthy said. “That’s not so good, but they are the state-of-the-art programs. Other programs--hypnosis, acupuncture, aversion--work for some but are unproved for the general population.

“The most effective method of smoking cessation is a heart attack. Of those who survive, 50% quit smoking over the long term.”

Most agree, however, that the nicotine patches can be a big help.

“What’s so hard for a smoker is dealing with both addictions at the same time,” said Bennett. “You’re trying to overcome the psychological addiction at the same time your body is giving you a headache or making you edgy.

“The patch gets rid of the physical part--or delays it. Eventually you have to deal with it, but it gives you time.”

The patches use “transdermal” technology, which is based on the discovery that some drugs will dissolve into the skin like sugar dissolves into wet cloth. Once the drugs get past the outermost layer of skin, they quickly soak down to the capillaries and into the blood.

Nowadays, medicines to treat motion sickness, high blood pressure, angina, pain and female hormone deficiency are being administered through skin patches.

The nicotine patches contain the drug in a thin gel. One kind of patch has a membrane that controls the rate the nicotine is released. Another lets the skin absorb the drug as fast as it will, a rate that varies from person to person.

The smoker stops smoking and begins applying one patch per day to the upper body. About four hours after applying the strongest patch, the nicotine in the blood has risen to a concentration somewhat below that of a one-pack-a-day smoker.

Studies say that’s more than enough to forestall the usual nicotine withdrawal symptoms that smokers often complain of: irritability, frustration, anger, anxiety, scattered concentration and restlessness. The higher concentration is needed, however, to allay nicotine craving.

Through the weeks, smaller patches administer less nicotine, then the nicotine supply is cut off.

“The proof of the pudding is going to be when I don’t have this patch anymore and I’m cold-turkey like the rest of them,” Bennett said. “But I feel confident, because I’ve built up a reservoir of days. It’s given me a 90-day start I’m not willing to throw out the window.”

But Bennett is doing it on his own without classes or counseling, and even the manufacturers of the patch say that bodes ill for his chances.

“When they quit smoking, they initially find a new world out there,” McCarthy said. “More than 90% started smoking when they were kids. The point here is, since they’ve been smoking all their adult lives, they don’t know how the be an adult non smoker. Quitting smoking is the most anxiety they’ve had since adolescence. They’re creating a whole new identity.

“I have never seen as much palpable anxiety as when I walk into a room full of people who are about to stop smoking. How are they going to look sexually attractive without a cigarette when they’ve gone their whole lives using cigarettes to look sophisticated and mature? Now they’re treated as pariahs, spreaders of disease. They’re barred from restaurants, meeting rooms, ostracized from everywhere but home. A lot are quitting for that reason.”

California, which in 1988 voted to tax cigarettes 25 cents a pack to fund anti-smoking efforts, now has a national reputation as a quit-smoking capital, and statistics bear out the image.

A survey by the federal Office on Smoking and Health showed that in 1985, 29% of men and 22% of women in California smoked cigarettes. Surveyed five years later by state health officials, the percentage of men smokers had fallen by 8%, women by 4%. Only Utah, with its large, anti-smoking Mormon population, has a smaller percentage of smokers.

“California has had such an incredible push to get people to stop smoking, a very successful campaign, that people are eager to quit,” Munzer said. “People really want all the help they can get.

“In the past, most people could quit smoking without outside help. The thing is, as the number of smokers has gone down, the smokers remaining are more and more hard-core smokers who are heavily addicted and do need some help.

“For them, the patch is a breakthrough, especially compared to the (nicotine) chewing gum, which did not work all that well. With the gum, the craving would come back periodically. With a constant level of nicotine (from patches), you really get rid of the craving.”

McCarthy estimates that the nicotine patch may double the number of people who can quit smoking for the short term. “It gets them started. The question is, what good will it do for permanent cessation?”

In the past, he said, the strongest predictor of long-term success has been the smoker’s environment. If the smoker’s spouse does not smoke, if his workplace is smoke-free, his chances improve dramatically, McCarthy said.

“If they think a patch is going to do it all for them, then it won’t do anything for them.”

How the Nicotine Patch Works

Seventeen million Americans try to quit smoking every year, but only 1.3 million succeed, according to the Surgeon General. However, a nicotine replacement therapy developed by pharmaceutical firms may help smokers gradually overcome their addiction.

NICOTINE’S JOURNEY:

* A skin patch containing nicotine is attached to torso, lower back or upper arm. Each lasts 24 hours and should be applied to a different site every day.

* Nicotine passes from skin into the blood vessels, where it travels to the brain via the bloodstream.

* In the brain, the nicotine binds to receptor cells, helping to reduce nicotine withdrawal symptoms.

* Smokers are gradually weaned from nicotine through a series of reduced dosages. Typical treatment begins at 21 mg. reduced to 14 mg. and 7 mg. over an interval of up to three months.

DISADVANTAGES: Some users have reported skin irritation from the nicotine patches. Should not be used by pregnant women.

ADVANTAGES: Reduced withdrawal symptoms such as depression, inability to concentrate and cravings for cigarettes. Nicotine is delivered to the body in a less toxic form, without inhalation.

Source: CIBA-GEIGY Corporation, Pharmaceuticals Division, ALZA Corporation.

Researched by JANICE L. JONES / Los Angeles Times