Is Long-Term Use of Antismoking Drugs Consistent with Public Health Goals or Pharmaceutical Marketing Goals?

IN RESPONSE:

The recent evidence-based 2008 U.S. Public Health Service guidelines recommend pharmacotherapy as a first-line treatment for tobacco dependence (1). These guidelines support the consideration of tobacco dependence as a chronic disease and support the longer-term use of nicotine replacement therapy.

In my opinion, the best evidence for helping our patients stop smoking continues to be a comprehensive treatment program, including any of the medications approved by the U.S. Food and Drug Administration. In terms of duration, if I have a patient who is doing well with nicotine replacement therapy, varenicline, or bupropion for 6 months, but states that he feels he will relapse to smoking if we stop the medication, I continue the medication to help keep that person from returning to smoking. In my view, it is not a matter of who is paying for that medication, but rather a matter of good clinical practice—the risk of smoking is much greater than the risk of the treatment.

Do we count the days our patients with hyperlipidemia are taking their cholesterol medications and criticize cardiologists for prescribing these medications for years? No. In fact, our health care system often provides incentives for physicians who meet clinical benchmarks, such as low-density lipoprotein cholesterol levels. Why should we have a unique standard for treating smokers? On the contrary, if helping patients avoid the health dangers of smoking means that they use nicotine replacement for longer than it “says on the box,” we should do so.