Resource Center: pharmacology

This article is an intervention review. It reviews behavioral and pharmacological interventions for helping users quit smokeless tobacco.

NRT aims to reduce withdrawal symptoms associated with stopping smoking by replacing the nicotine from cigarettes. NRT is available as skin patches that deliver nicotine slowly, and chewing gum, nasal spray, inhalers, and lozenges/tablets, all of which deliver nicotine to the brain more quickly than from skin patches, but less rapidly than from smoking cigarettes. This review includes 132 trials of NRT, with over 40,000 people in the main analysis. It found evidence that all forms of NRT made it more likely that a person's attempt to quit smoking would succeed. The chances of stopping smoking were increased by 50 to 70%. Most of the studies were performed in people smoking more than 15 cigarettes a day. What limited evidence there is suggests no overall difference in effectiveness of different forms of NRT nor a benefit for using patches beyond 8 weeks. NRT works with or without additional counselling, and does not need to be prescribed by a doctor. Heavier smokers may need higher doses of NRT. People who use NRT during a quit attempt are likely to further increase their chance of success by using a combination of the nicotine patch and a faster acting form. Preliminary data suggests that starting to use NRT shortly before the planned quit date may increase the chance of success. Adverse effects from using NRT are related to the type of product, and include skin irritation from patches and irritation to the inside of the mouth from gum and tablets. There is no evidence that NRT increases the risk of heart attacks. (From their website)

The American Psychiatric Association has released practice guidelines and resources for the treatment of patients with substance use disorders.

The burden of suffering due to tobacco use is staggering, and irreconcilable with the relative social and medical complacency with which it is treated. Smoking is the leading cause of preventable premature death in our society, claiming more lives around the world each year than war: it may be the most important public health issue of our time., Since most smokers see a physician each year, and most smokers report a desire to quit, primary care clinicians are well positioned to assist smokers in their cessation efforts. It is essential to provide effective cessation intervention for all smokers at each visit. (From their website)

Recommendations published in 2009 for chronic opioid therapy based on a review of the evidence. Provide guidance on patient selection, risk stratification, informed consent, opioid management plans, and more. Authors: Chou R, Fanciullo GJ, Fine PG, et al.

Dr. Brian Ginsberg, MD talks about the proper treatment of acute pain to avoid chronic pain, gender difference, and use of opioids. Focus on the value of multimodal treatment.

This article discusses both the well-known and the less common side effects of opioid use and the possible complications that can arise from this type of treatment. Author: Smith, HS Issue: 11: S121-S132

This Treatment Improvement Protocol (TIP), Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, provides consensus‐ and evidence‐based treatment guidance for the use of buprenorphine, a new option for the treatment of opioid addiction. The goal of this TIP is to provide physicians with information they can use to make practical and informed decisions about the use of buprenorphine to treat opioid addiction. These guidelines address the pharmacology and physiology of opioids, opioid addiction, and treatment with buprenorphine; describe patient assessment and the choice of opioid addiction treatment options; provide detailed treatment protocols for opioid withdrawal and maintenance therapy with buprenorphine; and include information on the treatment of special populations, e.g., pregnant women, adolescents, and polysubstance users. This TIP represents another step by the Center for Substance Abuse Treatment (CSAT) toward its goal of bringing national leaders together to improve substance use disorder treatment in the United States. (From Their Website)

This Treatment Improvement Protocol (TIP) is a guide to medication-assisted treatment for opioid addiction (MAT) in opioid treatment programs (OTPs). Compared with MAT in other settings, such as physicians' offices or detoxification centers, treatment in OTPs provides a more comprehensive, individually tailored program of medication therapy integrated with psychosocial and medical treatment and support services that address most factors affecting each patient. Treatment in OTPs also can include detoxification from illicit opioids and medically supervised withdrawal from maintenance medications. This TIP combines and updates TIP 1 (State Methadone Treatment Guidelines, published in 1993), TIP 10 (Assessment and Treatment of Cocaine-Abusing Methadone-Maintained Patients, published in 1994), TIP 20 (Matching Treatment to Patient Needs in Opioid Substitution Therapy, published in 1995), and TIP 22 (LAAM in the Treatment of Opiate Addiction, published in 1995). It incorporates the many changes in MAT that have occurred since the publication of TIP 1, primarily as they are reflected in OTPs, and discusses the challenges that remain. (From Their Website)

Nicotine Replacement Therapies (NRTs), when used with the behavior-related information on the other pages of this website, can help you increase your changes of quitting smoking permanently.