Oct 19, 2016 — Quitting smoking can be really hard. There are so many different methods to help a smoker quit that it can make things complicated. So which one works best? Dr. Clint Allred, a cardiologist at University of Utah Health Care, discusses the best research-based methods for quitting and what resources are available for patients who could use some help with their quit plan.

Interview

Interviewer: What's the most effective way to quit smoking? That's next on "The Scope."

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Interviewer: Quitting smoking can be really, really hard and, I mean, it's complicated even more by the fact that there are a lot of different methods. You've got cold turkey, maybe weaning yourself off of cigarettes, the patch, gum. Everybody will tell you the best way to do it, but we wanted to find out what research says the best way to quit smoking is. Dr. Clint Allred is a cardiologist at University of Utah Health Care. And today, we wanted to find out what the research says. So, does the research have any particular one method that's better than the others?

Dr. Allred: Well, Scott, that's a great question. There have been a lot of research studies performed over the years looking at this very matter. And you're probably going to have some different opinions, depending on who you talk to. None the less, from my own personal opinion, having recently looked at the literature, I would say from my perspective, and from a literature perspective, the most robust would be some pharmacologic or medication-based therapies.

And there are two medication-based therapies that have FDA approval for smoking cessation. Those include a medicine called varenicline, also called Chantix by its trade name. Varenicline is the generic name. There's another medication that is called buproprion, and that's the generic name, and the trade name is Wellbutrin. Most folks will know the trade names more so than the generics.

So again, these two medications have been studied, and over the last . . . one of the bigger studies that supported these medications would have come out about 11 or 12 years ago. And they showed that these two medications were more effective than the nicotine replacement options.

Interviewer: And nicotine replacement, those are available over the counter without a prescription?

Dr. Allred: You can get some of those over the counter without a prescription.

Interviewer: And these medications do need a prescription?

Dr. Allred: These medications absolutely need a prescription. And they carry some warnings with them as well, that all healthcare providers are particularly attentive to, particularly when it comes to mental health.

Interviewer: So from your perspective, if somebody came to you and said, "I have the will to quit smoking. I want to do it. I'm ready," would your first thing that you would recommend would be these medications? Is that where you would start?

Dr. Allred: Depending on the patient's perspective. It's a joint decision between the physician and the patient. I feel like my role is to educate the patient, to provide them with a recommendation of what I feel will help them achieve their goal most effectively, and then offer them alternative options should they be hesitant about the medication approach, and then together make a decision. But yes, from my perspective, I feel that the most effective way would be to use one of these medication-based options.

Interviewer: And then, what do the numbers look like after somebody is on one of these medications, like from as far as how long does it take to quit, what are the relapse rates, that sort of thing?

Dr. Allred: Well, in terms of efficacy of quitting with, we'll just use the varenicline, or Chantix, for example, the study that I cited from 11 years ago. That one suggested that, on the order of about 45% of patients who received the prescription for the varenicline, or Chantix, were able to stop smoking within a given period of time. I'd have to go back to look at exactly what that period of time was, but if my memory serves me correctly, it was about a 12-week interval check.

Interviewer: So then, how many people actually using the medication quit smoking for good? What do we know about that?

Dr. Allred: That's another good question, and again that study that I cited from about 11 years ago, the one that showed that about 45% of patients who were on the varenicline, or Chantix, had quit by 12 weeks, if they extended that out to about one year of time, then 25% of the individuals had maintained abstinence.

Interviewer: All right. And that's the most effective method?

Dr. Allred: That is, as of right now, I would say, literature supported, the most effective method that we have.

Interviewer: That really, I think, shows how hard it is to quit smoking.

Dr. Allred: I totally agree with you.

Interviewer: I mean, because 25%, I expected that number to be a bit higher, I guess. So, and it sounds like that even using the best method, 75% of the people, after a year, will start smoking again, that maybe just even realizing this is an ongoing battle. It's not like you just go, "Well, I failed, so I guess I'll start smoking again." Maybe try it again, maybe try a different method. Is that what you advise your patients?

Dr. Allred: Yeah. If somebody is unsuccessful, then I think that it's worth giving an alternative approach a try. In the same breath though, if the individual did find success with one method, then I think they could find success with that same method again, just with maybe attention to some other of the variables. Again, maybe they didn't throw away the ash trays in their house. Maybe they didn't tell their spouse or their best friend or their lunch companion that they were stopping to smoke. So many different things can go into it.

Interviewer: Is there other support that somebody can get?

Dr. Allred: When the physician is able to prescribe the medication, that's a great first step. But some of the social support is highly needed as well. The state of Utah has a fantastic resource. It's a website, www.waytoquit.org. And this group has some fantastic information out there, not only for patients, but also for healthcare providers, about what the best methods are, what the financial resources are, what some of the health coaching options are, and I encourage all my patients who are considering smoking cessation to look into this website and to contact that group.

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