NRT, behavioural therapy lead to 5-fold higher quit rates of smoking, tobacco use: Study
New Delhi: Nicotine Replacement Therapy combined with behavioural intervention resulted in nearly five-fold higher quit rates of smoking and tobacco use compared to counselling alone, according to a new study.
The trial, which was conducted from October 19, 2021 till January 31, 2023 at the Tobacco Cessation Cell under the Department of Public Health Dentistry at SCB Dental College and Hospital in Cuttack, involved 93 tobacco users (smokers and chewers) who were randomly assigned to one of three groups —nicotine gum, nicotine patch, or counselling only.
The investigators provided extended follow-up for up to 26 weeks, well beyond the recommended 12 weeks of Nicotine Replacement Therapy (NRT).
“Combined NRT and behavioural therapy resulted in nearly 5-fold higher quit rates compared to counselling alone. The clinical trial demonstrated the efficacy of NRT for both smokers and smokeless tobacco users,” said Dr Utkal Mohanty, associate professor, Department of Public Health Dentistry at the SCB Dental College and Hospital and an ex-national consultant (Oral Health) of the Union health ministry.
This is the first-of-its-kind study in the world as no survey has documented efficacy of NRT in chewers, Mohanty said.
Notably, the study documented the efficacy of the NRT approach in smokeless tobacco users, with almost 70 per cent of trial participants being chewers.
Integrating NRT with comprehensive cessation programs holds the key to reducing tobacco-related illnesses and deaths.
Relying solely on individual willpower has burdened tobacco cessation in India.
The trial highlights the transformative impact of a holistic approach, where integrating NRT with personalised behavioural support not only enhances quit rates but also provides vital guidance, Mohanty said.
“This model should be expanded to ensure broad access to comprehensive quit resources. The results, highlighting NRT’s efficacy for smokeless tobacco users, mark a landmark moment shaping future policies on accessibility,” he said.
Referring to the study findings, a group of health experts have batted for keeping NRT available over-the-counter (OTC) to combat the alarming rise in smoking rates in India.
The Drugs Technical Advisory Board (DTAB) under the Central Drugs Standard Control Organisation (CDSCO) has been deliberating over making NRT available only on the prescription of authorised medical practitioners in future and not as over-the-counter preparation.
Dr Chandrakant S Pandav, former Head of Department of Community Medicine at AIIMS, Delhi, and a global public health expert emphasized the imperative to keep the NRT available on the counter, especially in the remote areas.
In lauding the clinical trial, Dr Pandav exclaimed, “It is a game-changer against tobacco addiction. The extended follow-up period showcased the NRT’s potential as a readily available tool for lasting tobacco cessation.
Urgent accessibility and sustained behavioural support programmes could liberate millions from tobacco’s grip, contributing to a healthier future for all.”
The NRT is a WHO-approved therapy and the first line of treatment for tobacco cessation. It reduces the withdrawal symptoms and cravings that often lead to relapse and increases the chances of quitting by 50-70 per cent compared to unassisted attempts.
“It is urgent to address tobacco challenges affecting 28.6 per cent of the adults, particularly impacting 42 per cent of men and 14.2 per cent of women,” he said.
Dr Sajeela Maini, Head of Tobacco Cessation and De-addiction at Sir Gangaram Hospital, Delhi, stressed that substituting cigarettes with nicotine products is the most effective approach, significantly reducing cravings and withdrawal symptoms.
Recognising tobacco addiction as a complex mind-body issue, she further said, “It is very important to address both physiological and psychological aspects for effective treatment.”
She advocated for enhanced access to the NRT, considering it a crucial supportive element in alleviating discomfort during the cessation process.