BACKGROUND: Tobacco use is the leading preventable cause of morbidity and mortality globally. Nicotine replacement therapy (NRT) is propagated as a harm-reduction strategy for tobacco cessation and mitigate withdrawal symptoms. However, long-term safety and efficacy of NRT products, their carcinogenic potential and their role in sustaining and propagating nicotine addiction arouse concerns. Commercial nicotine products such as e-cigarettes and smokeless tobacco impair cessation efforts by promoting dual use of nicotine consumption and off prescription abuse. This paper evaluates NRT's efficacy, limitations, and implications for public health policies.
METHODS: A review of literature, clinical trials, and WHO guidelines compared NRT and non-nicotine cessation products and interventions like varenicline, bupropion, clonidine and behavioural therapy (CBT) for safety, efficacy, and compliance. This paper assessed nicotine delivery products and their impact on cessation outcomes. Strategies to optimize NRT usage and integrate CBT cessation were identified.
RESULTS: NRTs deliver controlled doses of nicotine. Supervised prescription is effective in reducing withdrawal symptoms and doubling quit rates when combined with CBT. Prolonged use of NRT perpetuates nicotine addiction and leads to adverse effects on Cardiovascular System/ oropharyngeal irritation. The industry-driven nicotine products, marketed as safe alternatives, have significant health risks and undermine cessation efforts. Non-nicotine pharmaceuticals are effective in addressing nicotine withdrawal symptoms in combination with CBT. Faster nicotine metabolism in women, unique cessation barriers in pregnancy, low compliance and high risks of misuse in resource limited settings need structured programs for pharmacological and CBT.
CONCLUSIONS: NRT, although effective for tobacco cessation, can perpetuate nicotine addiction. Non-nicotine products and CBT offer a robust alternative, addressing both physiological and psychological aspects. Regulation of NRT products and industry-driven nicotine delivery devices is crucial to prevent nicotine abuse.