Pharmaceutical interventions are often used to help people quit smoking, but a new study found that despite promising results in clinical trials, cessation drugs don’t really work in the real world.

Giving up smoking is a difficult task, as millions of people worldwide can attest to.There’s no silver bullet when it comes to quitting. Of course, some things tend to work better than others, but overall, people find the drive to quit through different methods. Because this habit is so difficult to shake off, medical treatments are especially appealing to some. There are several different treatments available from shops, pharmacies, or on prescription to help you beat this addiction and reduce withdrawal symptoms. Of course, the best treatment depends on personal preference, age, and many other parameters, but the treatments seemed to work –with ‘seemed being the key phrase here.

“Thirty-four percent of people who are trying to quit smoking use pharmaceutical aids and yet most are not successful,” said senior study author John P. Pierce, PhD, Professor Emeritus in the Department of Family Medicine and Public Health at UC San Diego School of Medicine and Moores Cancer Center.

“The results of randomized trials that tested these interventional drugs showed the promise of doubling cessation rates, but that has not translated into the real world.”

In a new study, Pierce and his colleagues assessed the effectiveness of three first-line medications recommended by clinical practice guidelines: varenicline, bupropion, and nicotine replacement therapy (patch). Unfortunately, the results they found weren’t good — essentially, the treatments didn’t work.

“We found no evidence that the pharmaceutical cessation aids that we assessed improved the chances of successfully quitting. This was both surprising, given the promise of smoking cessation seen in randomized trials, and disappointing because of the need for interventions to help smokers quit,” Pierce added.

He also proposes a theory why the treatments worked in the clinical trials but failed in real life: it was because of the intensive behavioral counseling. Researchers suggest that if people want to replicate the success that cessation drugs reported in clinical trials, they should also enroll in counseling programs. Otherwise, the odds of relapse increase drastically.

“Smokers who are committed to quitting and want to use a pharmaceutical aid should also enroll in a program that could help them track their progress and support them in their attempt,” said first author Eric Leas, PhD, who conducted the research while a graduate student researcher at UC San Diego and is now a postdoctoral scholar at the Stanford University School of Medicine.

Thankfully, counseling is available in many shapes and forms so you don’t necessarily need to go to the counseling office. Many states offer free behavioral counseling over the phone, and e-counseling is also becoming more and more prevalent.

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The study “Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers” has been published online in the Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djx240

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