Nicotine Replacement May Help Smokers Quit Gradually

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Participants in the studies who used nicotine replacement also received regular behavioral support and monitoring, and the researchers said that this support may have been as important as the nicotine replacement itself.

Aveyard said that use of nicotine replacement would allow treatment of many more smokers than the small number who say they want to quit. "It potentially opens the door to treat almost all smokers with treatments that were formally reserved for people who are wanting to quit right now," he said.

Because most nicotine replacement drugs are available over-the-counter but are not approved in the United States for smoking reduction, Aveyard suggests that people who want to try this approach should first consult with their doctor.

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Dr. Norman H. Edelman, chief medical officer of the American Lung Association, predicted that the topic is going to be widely discussed in the United States.

"In Britain, they are a little bit ahead of us," Edelman said. "Right now, the FDA approval for nicotine replacement therapy is as an aid to cessation. The next issue is whether we should use nicotine therapy to reduce smoking without worrying about whether people quit or not."

The American Lung Association says that it should be used to help people quit smoking, but the group has "not adopted the idea of using nicotine replacement therapy for risk reduction," Edelman said.

And whether the Food and Drug Administration will approve its use to cut down on smoking is unclear, he said.

"It's a hot potato topic," Edelman said. "Cigarette companies are manufacturing nicotine delivery devices of all kinds, and there is a tendency to be negative about that. Nobody feels kindly disposed to letting tobacco companies make nicotine delivery devices."

And using nicotine replacement to reduce smoking sends the message that you can benefit by just smoking less, and "the American Lung Association is very opposed to that," Edelman said. "We do not support risk reduction by just smoking fewer cigarettes."

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