Butt out – Review of Conventional & Natural Treatment for Smoking Cessation

This post isn’t about the health, financial or social consequences of smoking, second and third-hand smoke exposure. Instead, I want to provide a review on the efficacy of conventional and natural treatment options so someone knows their options when they're ready to quit.

If you’re reading this on behalf of someone in your life who smokes, you could play a pretty vital role. Try to avoid criticizing comments like “you should quit smoking.” They know this and no one likes to be told what to do. You could even push them away without meaning to. The best question to ask is: “Have you considered quitting?” and offer your support, non-judgement, and encouragement.

Fast facts:

-Cigarettes contain ~7000 chemicals, including 70 known carcinogens

-Tobacco use kills approx. 37 000 Canadians each year

-Smoking is the leading cause of preventable death

-Nicotine is highly addictive because it triggers rapid dopamine release in several brain areas

First, there are 5 evidence-based steps that are required to successfully quit.

1. Setting a target quit day

-Share this day with your friends and family, this helps with accountability

-Abrupt quitting vs. gradual reduction has more evidence for success – but ultimately, you have to do what works for you

2. Getting professional help

-Addiction counsellor or Behavioural therapist

-Minimal counselling time (<3min) has an estimated quit rate of 13.4% vs. longer counselling time (>10min) has a rate of 22%.

-Effective formats include: Individual or group counselling, telephone, text and internet sites. See resources below

3. Enlisting social support

-Surround yourself with positive, supportive friends, family, and co-workers

-Avoid people who trigger you to smoke and those who make snide, unsupportive remarks

4. Using medication to quit smoking

-More relevant for those who smoke >10 cigarettes per day

-See below

5. Using problem-solving methods of counselling to quit and remain smoke free

-anticipate challenges: hide lighters, remove tobacco products, avoid triggers (like bars or parties), etc.

Expectations:

Relapse is extremely common when quitting. Don’t feel bad if the first few times aren’t successful – go easy on yourself.

Motivation:

Determine your ‘why,’ why you want to quit, and come back to this when the cravings are strong. Success will be more likely when it’s driven by your own ‘why’ vs. someone telling you that you need to quit. Avoid negative reasons, like “smoking highly increases my risk of lung cancer…” as true as this may be, and instead re-frame it more positively. For example, ‘if I quit smoking, I may live longer which will allow me more time with my grandchildren.’

Pharmacology options

Information obtained from Compendium of Therapeutic Choices by Canadian Pharmacists Association* Note: I have no prescribing rights or experience with these products.

1. Nicotine Patch – increases the rate of smoking cessation by 50-70%. Quitting success rates after 6months = 14.5%. This may not seem great…but compare this to the success rate without using any aid, which is 3-5%.

Since the patch delivers nicotine more slowly compared to smoking, other nicotine products (like gum) can be used as needed and may increase likelihood of quitting. Standard duration of use is between 8-12 weeks, but it’s been found to significantly and safely improves likelihood of quitting. It has a pretty minor side effect profile – skin irritation and headache are the most common.

How it works: the patch supplies nicotine (approx. 50% of the amount found in a cigarette) so it prevents the cravings from abrupt withdrawal while allowing someone to break the habit of smoking. The dose of nicotine per patch is reduced over time.

2. Champix- This is one of the newest smoking cessation medications and it requires a prescription from your medical doctor. It’s quitting rate at 6 months = 26%.

Champix has more side effects – including a black box warning for mood changes, thoughts of harm, and risk of aggression and suicide. It’s also more expensive than other options, so a good drug plan for coverage is a bonus.

There are a few other medications approved by Health Canada for smoking cessation that I haven’t listed. Talk to your doctor about your options.

Natural Options

Treatments like herbal medicine and acupuncture have a lot less research behind them, but are alternative options for those who can’t tolerate the side effects of pharmaceutical treatment, want a natural alternative, or for those wanting adjunctive support alongside the treatments listed above. Due to the limited research, there’s no established quitting success rate at 6 months.

Acupuncture – NADA protocol – Has been used for over 30 years and involves 5 acupuncture needles inserted in each ear. It’s not typically a stand-alone treatment, but used alongside other treatments, like counselling or medications. It’s been found to:

Increase retention time in drug programs
Improve optimism re. quitting
Decrease cravings
Foster encouragement in a supportive environment, with practitioner providing positive intention (aka actively doing something to help someone quit.)

Acupuncture is safe with minimal side effects when performed by qualified practitioner.

Herbal Medicine – There are a few herbs with a historical tradition of smoking cessation. Here are the (known) mechanisms of action:

Passiflora incarnata – traditionally used to help treat insomnia, anxiety, ADHD, and opioid withdrawal symptoms

reduces nicotine withdrawal symptoms, which have been estimated to peak at 1 week and can last months following smoking cessation.
Binds to GABA receptors, preventing the re-uptake of GABA. GABA is our anti-anxiety, ‘chill’ neurotransmitter.

Lobelia inflata a.k.a Indian Tobacco - traditionally used for asthma and respiratory conditions

Binds to nicotine receptors – acting as both a blocker and mild stimulator
Increases dopamine in the brain (via binding of nicotine) = pleasurable, feel good sensation.
Prevents the reuptake of dopamine…so the effect lasts longer
Stimulates the respiratory centre in the brain to induce bronchodilation (opening of airways)

SAFTEY: Allergic reaction is always a possible side effect with any herb (or medication.) Dose matters for these two herbs – especially lobelia. Too high of a lobelia dose can result in vomiting and this herb is contraindicated for those with hypertension. Both herbs are safe to take with nicotine replacements like patch, gum, etc.

I offer these herbs in combination in a liquid form (tincture) that is taken as needed throughout the day. They are safe to take alongside Champix and/or nicotine patch, but could interact with other medications you're taking. I'm also familiar with the NADA acupuncture protocol, which is billed as a Naturopathic Service for those with insurance coverage.

Helpful resources:

www.smokershelpline.ca

www.stopsmokingcentre.net

Questions? I can be reached at drjackson@kawarthatherapeutic.com or book an in-office 15min complimentary consult here.