Use of smokeless tobacco helped hard-to-quit smokers give up their habit

Use of smokeless tobacco helped hard-to-quit smokers give up their habit, according to a seven-year follow-up of participants in a University of Alabama at Birmingham (UAB) clinical study.

The study, published in the January-March issue of the Journal of Psychoactive Drugs, reports on subjects who were contacted seven years after completion of a smoking cessation program that replaced cigarettes with smokeless tobacco products as a harm-reduction strategy.

In 1998 Rodu and UAB co-authors Ken Tilashalski, D.M.D., and Phil Cole, M.D., Dr.P.H., reported on one-year success rates from a clinical trial that was the first to use smokeless tobacco as a nicotine substitute. That program resulted in quit-rates of 31 percent among men and 19 percent among women using smokeless tobacco. Before that study, most participants had failed to quit with prescription nicotine products, and more than half had used both a nicotine patch and nicotine gum.

This month’s journal article reports that 75 percent of smokers who had quit with smokeless tobacco at one year still were smoke-free at seven years. In contrast, among smokers in the program who failed to quit after one year, only 29 percent were smoke-free at the seven-year mark.

“We started this program because we had documented that the use of smokeless tobacco carries a 98 percent lower risk of dying than does cigarette smoking,” said Dr. Brad Rodu, pathology professor and a senior scientist at the UAB Comprehensive Cancer Center. “It is the inhaled smoke and not the nicotine that causes lung cancer, heart disease and other health problems. We wanted to see if offering inveterate smokers a smoke-free alternative could help them finally quit smoking.

“Very few cessation programs have attempted to measure success rates for periods exceeding 12 months, primarily because of abysmal long-term results,” Rodu said. He is a leading proponent of harm reduction, involving the substitution of safer tobacco products for cigarettes, and his research documented the impact of harm reduction in Sweden, where men’s smoking rates, and related deaths, are the lowest of any Western country. According to a 2004 study by Rodu and Cole, 200,000 smoking-related deaths could be avoided yearly in the European Union at Swedish smoking rates. “The UAB smoking cessation strategy differs significantly from conventional approaches,” Rodu continued. “It uses minimal intervention. First, each participant attended only a single counseling session instead of intensive behavioral modification and frequent counseling sessions that are expensive and impractical.

“Second, because of the safer profile of smokeless relative to cigarettes, nicotine maintenance with smokeless is permanent, if necessary,” he said. “Conventional cessation programs, whose goal is nicotine abstinence, employ nicotine substitutes only temporarily to wean individuals from cigarettes – but it is clear that abstinence from nicotine is not necessary to obtain health benefits of smoking cessation.”

The authors point out that conventional nicotine medications “deliver inadequate nicotine concentrations and are expensive, making them unappealing to inveterate smokers.” The journal article continues: “The current practice of limiting nicotine substitutes to temporary use as an aid to smoking cessation is unfortunate. By requiring smokers to abstain from nicotine use, that strategy makes overcoming nicotine addition a higher priority than overcoming smoking and smoking-induced diseases.”

Rodu’s research was supported by an unrestricted gift from the United States Smokeless Tobacco Company to the Tobacco Research Fund at UAB.

More information about the strategy may be found at http://www.uab.edu/smokersonly.