Many smokers clearly show their preference for electronic cigarettes, as a tool to help quit smoking. The important thing is to choose the method that suits you best, knowing that it is possible to combine several techniques. A tobacco specialist will be able to advise you to put an end to smoking for good. Smoking is a scourge that kills nearly 75,000 people each year in France.
In a cigarette, it is the smoke which is dangerous because it contains carcinogens. To successfully quit smoking, you need to provide the body with the nicotine it has become dependent on, without going through tobacco. This is the role of nicotine substitutes, available in different forms: gums, patches, spray … The key to successful weaning? “The important thing is to have a sufficient dose of nicotine”, answers Prof. Bertrand Dautzenberg, pulmonologist.
The patches deliver nicotine continuously over several hours. There are different dosages, which allows you to modulate the doses according to your needs. “A cigarette provides 1 milligram of nicotine. 20 cigarettes therefore represent 20 mg of nicotine. This is what a patch of 21 mg / 24 h delivers”, summarizes Dr Anne-Marie Ruppert, coordinator of the Tobacco group of the French-speaking Pneumology Society. In heavy smokers (2 to 3 packs of cigarettes per day), several patches are necessary to eliminate the lack.
In addition, gums and lozenges can be used on demand to manage compulsive cravings. “With oral nicotine substitutes, nicotine passes through the body through a transmucosal route. For a gum or lozenge to be effective, you have to chew it twice, then stick it against the cheek for a few minutes,” explains Dr Ruppert.
Benefits : nicotine substitutes are available over the counter in pharmacies. They can also be prescribed by a doctor, a midwife, a dentist, a nurse or a physiotherapist. In this case, Social Security reimburses them up to 65%. Mutuals take care of the remaining 35%.
Disadvantages: side effects are rare (mouth irritation, hiccups, skin irritation, insomnia …). In addition, these products do not suppress the addiction to nicotine. After stopping smoking, the doses of nicotine substitutes should be reduced gradually. The risk of remaining dependent on nicotine replacement therapy is rare. This risk seems to be higher with the oral forms, because of their faster action on the brain.
The electronic cigarette is now part of the therapeutic arsenal. It allows to preserve the gestures of the smoker and to bring to the organism the necessary dose of nicotine (liquids can contain up to 20 mg / ml), while avoiding inhaling all the carcinogenic substances of tobacco. It is estimated that, in recent years, 700,000 smokers have successfully quit using “vaping”. “An English study compared the electronic cigarette with nicotine substitutes. At one year, there was 18% of smoking cessation with the electronic cigarette against 10% with the nicotine substitutes”, observes Dr Ruppert who adds: “However, at one year, 80% of smokers who quit with e-cigarettes still use e-cigarettes; while only 20% keep nicotine substitutes among those who quit with nicotine substitutes”.
A French study is underway to compare the e-cigarette to a drug, varenicline. The results are expected in two years.
The group of independent researchers Cochrane Library published, on October 14, 2020, a review of the scientific literature in which it concludes that electronic cigarettes are more effective than nicotine substitutes. Basically, when 100 smokers stop smoking thanks to nicotine substitutes, the e-cigarette allows four additional smokers to quit. The researchers recognize, however, that the level of scientific evidence remains, at this stage, “moderate”.
Another study published in June 2021 in Addiction. has shown that the e-cigarette is more useful than nicotine substitutes for very addicted smokers. 135 smokers not having been able to wean with conventional devices received either a supply for a nicotine replacement therapy (NRT) of their choice, or an e-cigarette by choosing the e-liquids in the flavor of their choice and with the nicotine content that suits them best . The results revealed a significant difference in smoking reduction in the e-cigarette group: 27% of the participants in the group had reduced their smoking at least half against 6% of participants in the TNS group. Note, however, that the researchers emphasize that the effectiveness classic weaning devices is not called into question.
Benefits : the smoke from an e-cigarette is a lot less toxic than tobacco. “It allows you to free yourself from carbon monoxide and reduce your dose of nicotine, thus becoming less dependent”, estimates Professor Dautzenberg.
Disadvantages: the e-cigarette contains substances whose effect on long-term health is still poorly evaluated. In addition, the electronic cigarette, like nicotine substitutes, helps with smoking cessation but does not cure addiction. “Many patients recognize that it is important for them to keep in touch with the smoke on their throats. For some, it’s more important than nicotine ”, says Professor Dautzenberg. After stopping smoking, it takes several months to wean yourself off your vapoteuse, by gradually reducing the doses of nicotine.
A few years ago, the Champix (varenicline) has been accused of increasing the risk of depression and suicide. Since then, a study of thousands of smokers has cleared him. “There are no more psychiatric complications with Champix”, notes Dr Ruppert. Weaning remains, anyway, a difficult time. “Some 30% of heavy smokers experience depression when they quit smoking”, observes Prof. Pier-Vincenzo Piazza, specialist in the pathophysiology of addiction at Inserm. “It is stopping smoking that weakens morale, not the drug”, confirms Dr Ruppert.
Benefits : this drug reduces the deficiency by acting, in the brain, on the same receptors as nicotine. Social Security reimburses very dependent smokers after failure of nicotine substitutes. “Varenicline is a good drug, more effective than bupropion (marketed under the name Zyban, Editor’s note) and nicotine substitutes. Its advantage for highly dependent people is that there is no research into dose adjustment “, explains Dr Ruppert.
Disadvantages: Taking Champix can cause nausea, which is why it is recommended to be taken with a snack. Likewise, it is better to avoid taking it late at night so as not to disturb sleep.
Originally, Zyban (buproprion) is an antidepressant. Studies have shown that it is less effective than varenicline and nicotine replacement therapy.
Benefits : it decreases the craving, the irrepressible urge to smoke.
Disadvantages: it has side effects (risk of insomnia, neurological disorders …) and can interact with other drugs (certain antidepressants, beta blockers …). It is only prescribed as a last resort for heavily addicted smokers. It is not reimbursed by Social Security. “There is little room left today for this drug”, concludes Dr Ruppert.
Hypnosis and meditation have not provided scientific proof of their effectiveness in stopping smoking. However, they are popular with some smokers.
Benefits : Like meditation, hypnosis is of great help to people who have difficulty coping with stress. Smoking is often used to mask anxiety. Stopping smoking is a difficult course to take on a psychological level. It is in this sense that these relaxation methods can help.
Disadvantages: They are not reimbursed by Social Security.