Smoking pill

WASHINGTON – Doctors typically wait until smokers are ready to quit before prescribing pills to help them do it. But a new study has found that even for those who are not ready to stop smoking immediately, medicine taken over time can substantially improve their chances of eventually quitting.

Clinical practice guidelines have long advised doctors to have their patients set a precise quit date before prescribing medicine such as Chantix, the pills used to treat nicotine addiction that were examined in the study. The idea was that such medicine should not be prescribed for someone who is not serious about quitting. In some cases, insurance plans would not pay for the pills if no quit date had been set.

But in a study published in JAMA on Feb. 17, researchers found that even for patients who wanted to stop smoking eventually, the pills were effective, opening the way to a much larger population of patients whom doctors could potentially treat.

David Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies, said studies of nicotine replacement therapy, such as patches and gum, have long shown that attempts to quit gradually over time are a good way to change lifetime habits. The current study appears to show the same for pills, he said.

About 1,500 patients at 61 clinics in the United States and abroad participated in the study. None were willing to quit immediately but all said they wanted to smoke less and to quit for good within three months. They were randomly assigned to two groups. One got Chantix, the brand name of the drug varenicline, which is taken twice a day by mouth as a pill, and the other, a placebo.

Almost a third of the patients who got the drug quit within six months of starting the pills, compared with 6 percent who took the placebo. The study did not follow patients long term so it was unclear whether those who quit smoking had permanently rid themselves of the habit.

“It’s a paradigm shift because instead of only giving the medication to patients who have set a quit date, you are potentially giving it to every smoker,” said Dr. Jon O. Ebbert, one of the authors, who is a professor of medicine at the Mayo Clinic College of Medicine in Minnesota. “It opens the door to a much larger population of smokers that we can treat.”

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