It’s hard to help patients quit smoking. Many of us, myself included, received limited training in tobacco cessation and may harbor misconceptions about effective treatments. To clear the air, we invited Michael Baca-Atlas, MD, our addiction medicine specialist, to join us on Primary Care RAP to debunk some common myths about tobacco cessation. Here are some highlights from that conversation.
Myth: We should not treat Tobacco Use Disorder (TUD) at the same time as Substance Use Disorder (SUD).
This is a common misconception. Research supports the simultaneous treatment of TUD and SUD. Addressing tobacco use alongside other substance use disorders can improve overall treatment outcomes and reduce the risk of relapse for both conditions.
Myth: Nicotine itself is harmful.
The primary harm from tobacco use comes from the other toxic substances in cigarette smoke, not nicotine. Nicotine, while addictive, is relatively safe when used as part of nicotine replacement therapy.
Myth: You cannot use the nicotine patch while smoking due to the risk of myocardial infarction.
Contrary to popular belief, studies have shown that nicotine patches are safe for patients with a history of coronary artery disease, even at doses up to 63 mg/day. The concern about myocardial infarction risk while using the patch is mainly unfounded.
Myth: You can’t use more than a 21 mg nicotine patch for patients with high levels of nicotine dependence.
High-dose nicotine patch therapy is safe and well-tolerated in patients who smoke more than 20 cigarettes per day. A Cochrane review has even suggested a slight improvement in smoking abstinence outcomes with higher nicotine patch doses. Note that this may require using multiple patches.
Myth: Nicotine patches should not be used while sleeping due to vivid dreams and activation.
While vivid dreams can occur, a sleep study found that patients who stopped smoking while using a 24-hour nicotine patch had better quality of sleep compared to those using a placebo patch.
Myth: I need to taper NRT for my patients.
A Cochrane review found no significant differences in adverse symptoms between abrupt discontinuation and tapering of the nicotine patch. Tapering is not necessary for successful cessation.
Myth: Bupropion is as effective as combination NRT and varenicline for tobacco cessation.
The gold standard therapy for tobacco cessation is a combination of NRT and varenicline. Bupropion can be considered for individuals with comorbidities like ADHD, depression, or concerns about post-cessation weight gain.
Myth: I cannot combine different types of pharmacotherapy or adjust doses.
Combining short-acting NRT with the nicotine patch has proven superior to the patch alone. Meta-analyses suggest that combining varenicline with NRT or bupropion increases smoking abstinence outcomes compared to monotherapy.
By debunking these myths and applying evidence-based strategies, we can significantly enhance our patients’ chances of successfully quitting smoking and improving their overall health. Learn more by listening to the "Top Six Smoking Myths" segment on Primary Care RAP.
