Frequently Asked Questions

Smoking Cessation and Pharmacotherapy:

  1. Nicotine replacement therapy (NRT, e.g. patch, gum, inhaler, lozenge and mouth spray) will interfere with my medications.
  2. I have to follow the standard dosing recommendations from the product manufacturer.
  3. All nicotine patches contain the same dose of nicotine.
  4. I have to chew my NRT gum in a specific way in order to achieve the optimal effects.
  5. Varenicline (Champix®) and NRT can be used together.
  6. I can wear the NRT patch during the day as well at night.
  7. NRT inhaler is not to be inhaled, but rather “puffed”.
  8. My uncle quit cold turkey. I don’t need counseling or medication to help me quit smoking.
  9. I shouldn’t use nicotine patches because nicotine is harmful.
  10. Smoking while wearing a nicotine patch is dangerous.
  11. Some people need to wear more than one patch to successfully quit.
  12. Using patches in combination with other NRT products (such as gum, inhaler, lozenges, mouth spray) can be beneficial.
  13. Quit smoking medications are expensive.
  14. I can only use patches for a limited number of weeks. Using them longer can be dangerous.
  15. The e-cigarette has been shown to be safe and can help people quit.
  16. I could become addicted to the patches.
  17. I have tried to quit too many times before. I clearly cannot succeed.

Cigarettes:

  1. “Light” or mild cigarettes are safer and less harmful than smoking the traditional cigarette.
  2. There is an abundance of harmful chemicals within cigarettes.

Mental Health and Smoking Cessation:

  1. Individuals suffering from mental illness have no desire to quit smoking.

Diabetes and Smoking Cessation:

  1. Smoking does not impact my diabetes.

Cancer and Smoking Cessation:

  1. It is still worth quitting if I've already been diagnosed with cancer.
  2. Smoking significantly increases my risk of lung cancer, but not other types of cancer.

Pregnancy and Smoking Cessation:

  1. I can still use NRT while pregnant, as it can function as an effective method for quitting, without causing any harm to the infant.

Heart Disease and Smoking Cessation:

  1. Smoking increases my risk of developing cardiovascular disease.
     

Smoking Cessation & Pharmacotherapy:

  1. Nicotine replacement therapy (NRT, e.g. patch, gum, inhaler, lozenge and mouth spray) will interfere with my medications.

FALSE. NRT is safe to use with all medications. Smoking can actually interfere with the effectiveness of many medications.

** Which medications need dose adjustment when a patient stops smoking? Click here for more information.

  1.  I have to follow the standard dosing recommendations from the product manufacturer.

FALSE. The type, amount and length of treatment can be changed to meet your needs, based on the amount of nicotine you’re used to getting in a day and your level of dependence.

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

  1. All nicotine patches contain the same dose of nicotine.

FALSE. NRT patches are available in 7mg, 14mg and 21mg doses. Speak to your healthcare provider to see which dose would be right for you.

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

  1. I have to chew my NRT gum in a specific way in order to achieve the optimal effects.

TRUE. NRT gum should be chewed until you detect a peppery taste, at which time you should stop chewing and “park it” in your cheek before continuing to chew. This should be done for 30 minutes per piece of NRT gum. Nicotine absorption can be affected by food remnants; therefore the NRT gum should not be used within 15 minutes of eating or drinking.

Ebbert, J. O., Sood, A., Hays, J. T., Lowell, D. C. & Hurt, R. D. (2007). Treating tobacco dependence: Review of the best and latest treatment options. Journal of Thoracic Oncology, 2(3): 249-256.

  1. Varenicline (Champix®) and NRT can be used together.

TRUE. Patches and other nicotine replacement products can safely be used while using varenicline (Champix®) and may increase your chances of being successful. Start with the recommended dose of varenicline (Champix®). If cravings persist, speak to your healthcare provider regarding the addition of NRT.

Hajek, P., Smith, K. M.,  Dhanji, A.  & McRobbie, H. (2013). Is a combination of varenicline and nicotine patch more effective in helping smokers quit than varenicline alone? A randomised controlled trial. BMC Medecine, 11(140).

Fiore, M. C., Jaén, C. R., Baker, T.B., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service.

  1. I can wear the NRT patch during the day as well at night.

TRUE. It is safe to wear the patch both day and night. Studies have shown that individuals who wear the patch 24 hours a day typically have fewer withdrawal symptoms (especially early morning withdrawal) in comparison to those who do not. However, if the patch begins to cause sleep disturbance or odd dreams, it can be removed before bedtime and reapplied upon waking.

American Cancer Society. (2013). Guide to Quitting Smoking. 

  1. NRT inhaler is not to be inhaled, but rather “puffed”.

TRUE. When using the NRT inhaler, a cartridge containing nicotine is inserted into the plastic device. You should puff on the inhaler as needed throughout the day to manage cravings and triggers. You can puff on and off over a 5 to 20 minute period until your cravings have passed.  Puffs should be slow to avoid throat burn, as the nicotine is absorbed in your mouth, not in the lungs. Please refer the product monograph for the Nicorette Inhaler for further instructions.

Nicorette Inhaler: Product Monograph 2014 

  1. My uncle quit cold turkey. I don’t need counseling or medication to help me quit smoking.

FALSE. While 1% of people are able to quit privately on their own each year, you can double and triple your chances of quitting by using the appropriate medications and receiving the suitable counseling and support.

Reid, J.L., Hammond, D., Rynard, V.L. & Burkhalter, R. (2014).Tobacco Use in Canada: Patterns and Trends, 2014 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.

Fiore, M.C., Jaén, C.R., Baker, T.B., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service.

  1. I shouldn’t use nicotine patches because nicotine is harmful.

FALSE. To many people’s surprise, nicotine does not cause cancer, lung damage or cardiovascular disease. Nicotine is the addictive ingredient in a cigarette. The harm from smoking comes from the thousands of chemicals contained in cigarette smoke. What’s in a cigarette? 

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

  1. Smoking while wearing a nicotine patch is dangerous.

FALSE. Smoking while wearing a patch will not cause more harm. If you are still craving cigarettes while wearing the patch, it may indicate that you need a higher dose of the patch or a combination of NRT products.

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

  1. Some people need to wear more than one patch to successfully quit.

TRUE. The key to success is adjusting the dose to meet your needs. Patches emit a lot less nicotine than cigarettes and it is perfectly safe to use more than one patch at a time to properly control your cravings and withdrawal symptoms. 

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

  1. Using patches in combination with other NRT products (such as gum, inhaler, lozenges, mouth spray) can be beneficial.

TRUE. Using patches in combination with other nicotine replacement products is safe. Along with behavioural support, it will almost triple your chances of success.

Carpenter, M. J., Jardin, B. F., Burris, J. L., Mathew, A. R., Schnoll, R.A., Rigotti, N. A. &   Cummings, K. M. (2013). Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: A review of the literature. Drugs, 73(5): 407-426.

Ebbert, J.O., Hays, J. T. &Hurt, R. D. (2010). Combination Pharmacotherapy for Stopping Smoking. Drugs, 70(6): 643-650.

  1. Quit smoking medications are expensive.

TRUE and FALSE. On a weekly and monthly basis, quit smoking medications can cost less than cigarettes. In the short-term, though, the price can seem high. Speak to your doctor, healthcare provider, and/or pharmacist for information on resources in your community. Also, check your workplace benefits, provincial drug and benefits plan or public health to inquire about discounts on medications. In the end, quitting smoking can help you save money.

Cromwell, J. Bartosch, W. J., Fiore, M. C., Hasselblad, V. & Baker, T. (1997). Cost-effectiveness of the clinical practice recommendations in the AHCPR Guideline for Smoking Cessation. The Journal of the American Medical Association, 278(21): 1759-1766.

Ottawa Model for Smoking Cessation. (2011). Quit smoking- Its pays off! Ottawa, Ontario: The University of Ottawa Heart Institute.

  1. I can only use patches for a limited number of weeks. Using them longer can be dangerous.

FALSE. There is no time limit on using patches and other NRT products. They are safe to use as long as needed.

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

Ontario Medical Association. (2008). Rethinking stop-smoking medications: treatment myths and medical realities. [update 2008]. Ont Med Rev,75(1):22-34.

  1. The e-cigarette has been shown to be safe and can help people quit.

FALSE. We simply don’t know enough about the e-cigarette yet. There has been no unbiased, reliable scientific research to date that has demonstrated that it is safe and that it can help people quit. The University of Ottawa Heart Institute currently only recommends evidence based treatments to help smokers quit (NRT, Champix®, Zyban®). Watch this video.

Reed, J. L., Gervais, A. A. & Reid, R. D. (2013). Five things to know about… Electronic   Cigarettes. Canadian Medical Association Journal, 185(16), 1427. doi: 10.1503/cmaj.130806

  1. I could become addicted to the patches.

FALSE. Nicotine replacement therapy (NRT) provides substantially lower amounts of nicotine in comparison to the traditional cigarette. The NRT serves to provide the individual with just enough nicotine to maintain steady state levels. You will not become addicted to the patches. The NRT patches will help to gradually diminish a nicotine addiction that has already been established through the smoking of cigarettes.

Zwar, N., Bell, J., Peters, M., Christie, M. & Mendelsohn, C. (2006). Nicotine and nicotine replacement therapy – the facts. Pharmacist,25: 969–973.

  1. I have tried to quit too many times before. I clearly cannot succeed.

FALSE. Past quit attempts are a predictor of success. The more often you have tried to quit, the more likely you are to finally succeed. Practice makes perfect.

Mendelsohn, C. (2013). Optimising nicotine replacement therapy in clinical practice. Australian Family Physician, 42(5): 305-309.

Cigarettes:

  1. “Light” or mild cigarettes are safer and less harmful than smoking the traditional cigarette.

FALSE. Light or mild cigarettes are not safer than the traditional cigarette. Research shows the individuals who smoke “light” cigarettes tend to “oversmoke” by smoking more deeply, puffing more frequently and smoking a larger portion of the cigarette in order to satisfy their individualized level of nicotine. As a result of oversmoking, the nicotine and tar intake levels remain essentially unchanged in comparison to the normal cigarettes.

Pipe, A. L. (2005). “Light” and “Mild” Cigarettes: Let’s end the confusion. Now. Canadian Journal of Public Health, 96(3), p.165.

  1. There is an abundance of harmful chemicals within cigarettes.

TRUE. Cigarette smoke contains over 5,000 dangerous chemicals. The following are examples of cancer causing chemicals contained in cigarettes:

  • Tar
  • Arsenic
  • Benzene
  • Cadmium
  • Formaldehyde
  • Polonium-210
  • Chromium
  • 1,3-Butadiene
  • Polycyclic aromatic hydrocarbons
  • Tobacco-specific nitrosamines
  • Acrolein

Cancer Research UK. (2014). Smoking and cancer: What's in a cigarette? London, England. 

Mental Health and Smoking Cessation:

  1. Individuals suffering from mental illness have no desire to quit smoking.

FALSE. Although many people believe that smoking can function as an outlet for individuals dealing with mental illness, the reality is that most people want to quit smoking. Smoking cessation does not induce a mental illness relapse and with appropriate support and the use of interventions, individuals with mental illness can successfully quit smoking.

Kunyk, D. & Els, C. (2009). Duties and opportunities for healthcare providers when mental health facilities ban smoking. Smoking Cessation Rounds, 3(5).

Diabetes and Smoking Cessation:

  1. Smoking does not impact my diabetes.

FALSE. Smoking has negative impacts for all people; however, the effects of smoking has a more profound effect on those with diabetes. Individuals with diabetes who smoke are at greater risk arteriosclerosis, which results in impaired oxygen transport to the tissues. In addition, smokers with diabetes have a 3 fold increase in the risk of a heart attack compared to those who do not smoke. Smoking also increases insulin resistance.

Canadian Diabetes Association. (2013). Smoking and Diabetes.

Cancer and Smoking Cessation:

  1. It is still worth quitting if I’ve already been diagnosed with cancer.

TRUE. Even after being diagnosed with cancer, smoking cessation can improve overall health, and the effectiveness of cancer treatments. Continued smoking following a cancer diagnosis may not only reduce the effectiveness of radiation but can also shorten survival time, increase the risk of recurrence and cause numerous treatment complications.

De Bruin-Visser, J. C.,  Ackerstaff, A. H., Rehorst, H., Retèl, V. P. & Hilgers, F. J. M. Integration of a smoking cessation program in the treatment protocol for patients with head and neck and lung cancer. (2012). European Archives of Otorhinolaryngology, 269: 659-665.

  1. Smoking significantly increases my risk of lung cancer, but not other types of cancer.

FALSE. Studies have shown that cigarette smoking increases a smoker’s risk of not only lung cancer but at least 15 other types of cancers including head, neck, larynx, esophagus, bladder, stomach, pancreas, kidney and colon.

Carter, B. D. et al. (2015). Smoking and mortality- Beyond established causes. The New England Journal of Medicine, 372: 631-640.

Surgeon General Report 2014

Pregnancy and Smoking Cessation:

  1. I can still use NRT while pregnant, as it can function as an effective method for quitting, without causing any harm to the infant.

TRUE. Nicotine replacement therapy is considered to be a safe and effective method for assisting pregnant women in smoking cessation. Accelerated nicotine metabolism can be observed in pregnant women, meaning it can be even more difficult to quit. Higher doses of nicotine may be needed in order to combat cravings. Studies have shown that there are no significant effects of using the NRT patches during pregnancy and the smoking cessation leads to healthier pregnancies, deliveries, and fewer developmental impairments.

Pipe, A. (2012). Effective smoking cessation in primary care: Special populations.

Cooper, S. et al. (2014). The SNAP trial: a randomised placebo-controlled trial of nicotine replacement therapy in pregnancy--clinical effectiveness and safety until 2 years after delivery, with economic evaluation. Health Technology Assessment, 18(54), 1-128.

Dempsey, D., Jacob, P. & Benowitz, N. L. (2002). Accelerated metabolism of nicotine and cotinine in pregnant smokers. Journal of Pharmacology and Experimental Therapeutics, 301(2), 594-598.

Heart Disease and Smoking Cessation:

  1. Smoking increases my risk of developing cardiovascular disease.

TRUE. Nicotine, carbon monoxide and oxidant gases are the three main components of a cigarette that are associated with the development of cardiovascular disease. Research has shown that smoking causes, on average, 140,000 premature deaths from cardiovascular disease each year in the United States. This accounts for approximately 30% of all smoking related deaths.

Benowitz, N. L. (2010). Nicotine addiction. The New England Journal of Medicine, 362: 2295-2303.