Medications for smoking cessation

In a recent post, I talked about the importance of behavioral change in preventing early death. This post is the third in a series looking at the evidence behind changing health-related behaviors. Previous posts in this series include:

9 surprising facts about weight loss.

Every doctors visit should include smoking cessation counseling.


As I discussed last week, even brief counseling interventions dramatically increase smoking cessation rates. This effect can be multiplied even further by providing appropriate medications.

There are essentially two main medication strategies for smoking cessation. The first is to replace nicotine from cigarettes with a nicotine-containing gum, lozenge, patch, inhaler or nasal spray. There are some subtle differences between each form, but they all appear to be similarly effective and they increase quit rates by 50-70%.

The second medication strategy for smoking cessation is to use medications such as buproprion, nortriptyline, or varenicline. Bupropion and nortriptyline are considered antidepressant medications, but their effect is probably not related to their antidepressant properties (in fact, other antidepressants have not been shown to be effective for smoking cessation). Both bupropion and nortriptyline produce similar quit rates to nicotine replacement therapies. Varenicline, however, is not an antidepressant. It is thought to work by weakly binding to nicotine receptors, thereby decreasing cravings for nicotine. This is a newer drug, but the early data suggests that varenicline may be the most effective medication yet for smoking cessation.

Every medication has risks and should be discussed with a doctor before starting, but these drugs have been helpful for many people who quit. It would be wonderful if these treatments were offered to more people!

Every doctor’s visit should include smoking cessation counselling

In a recent post, I talked about the importance of behavioral change in preventing early death. This post is the second in a series looking at the evidence behind changing health-related behaviors. Previous posts in this series:

9 surprising facts about weight loss.


Doctors often get frustrated by the behavior of their patients. It can be hard to empathize when a patient continues a behavior that they know is profoundly detrimental to health. Some doctors have cynically accepted that they cannot assist with meaningful behavioral change, and therefore should not waste time making the attempt. Fortunately, their is ample data to suggest that even brief counselling interactions from physicians can produce positive behavioral change.

Take smoking cessation as an example. A Cochrane review found that brief counselling interventions increase a person’s odds of quitting by 66%. With all we know about the dangers of smoking, that result alone should be enough to encourage every physician to incorporate smoking cessation counselling into every visit with patients who smoke.

With a baseline quit rate of approximately 2-3% per year, an increase of 66% results in a quit rate of 3-6% per year. Although the absolute numbers may appear small, these results are promising. However, this data may not look so good from the clinician’s desk. If the clinician does nothing and sees 100 patients who smoke, 97 of them will still be smoking one year later. If the doctor provides a brief intervention for smoking, 94 of those people will still be smoking. In either case, day-to-day experience will show that the overwhelming majority of patients have not quit. Without tracking data, it is unlikely that the doctor will notice any change in quit rate at all. In other words, a low quit rate produces the illusion that counselling doesn’t work.

There are two morals to this story. The first is that doctors do have the potential to change patient behavior, and thus improve their lives. Second, its important to let data drive our decisions, as repeated failure may make it difficult to determine what actually works.