Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

The Importance of the Proper Use of NRTs

It is important to express to those trying to quit the use of tobacco that there can be immediate reactions to the use of NRTs.  Understanding these reactions and preferences can lead to tailoring the choices appropriately for your client/patient.

How to talk to patients about the proper use of NRT

Research has indicated that the effectiveness of NRT has been hampered by misuse.1  To combat the misuse of NRT in patients, it may be simpler to just remember the recommended points of use for NRT.  Recommendations include considering2:

  • Pragmatic concerns of your patient (i.e. dermatitis with the patch, difficulty chewing gum with dentures, insurance coverage, out of pocket patient costs).
  • Patients’ level of nicotine dependence and the most appropriate NRT for that level of dependence.  Previous studies have shown that higher dose preparations of nicotine gum, patch, and lozenges to be effective in highly dependent smokers. 
  • Patients’ previous experience and concerns in using NRTs.  For instance, some medications and NRTs can delay, but not prevent weight gain commonly associated with quitting smoking.

Guided use of NRTs is recommended to assist in the prevention of NRT misuse.  Guided use implies careful instruction about the use and side effects of NRTs to assist in controlling use problems and aid in nicotine extraction.  Guided use is associated with allowing for proper sampling of types of NRTs to find the best match for your patient.  Understand that smokers can have reactions to an NRT that leads to instant rejection of the drug. Efficacy with acute NRTs, or NRTs higher in their nicotine concentration, may be enhanced with better awareness of those reactions and with sampling for choice of treatment.1  In communicating with your patient about their use of NRTs, it is important to discuss the recommended use of NRTs and the effects of misuse including increased withdrawals if not used on schedule.  NRT misuse increases chances of relapse and sporadic use (not effective) of NRT.

References: 
  1. Schneider, N. G., Terrace, S., Koury, M. A., Patel, S., Vaghaiwalla, B., Pendergrass, R., & ... Cortner, C. (2005). Comparison of three nicotine treatments: initial reactions and preferences with guided use. Psychopharmacology, 182(4), 545-550.
  2. Hughes, J. R., Pillitteri, J. L., Callas, P. W., Callahan, R., & Kenny, M. (2004). Misuse of and dependence on over-the-counter nicotine gum in a volunteer sample. Nicotine & Tobacco Research, 6(1), 79-84.