See treatments to stop smoking – 08/02/2023 – Health

A herbal drug that reduces cravings and withdrawal effects is new hope for people who need help quitting. This is cytisinicline (cystine).

The last phase of clinical trials has shown that the drug is safe and has few side effects. The research with the results was recently published in the scientific journal Jama. If approved by regulatory agencies, the medication will be a new option for treating nicotine addiction.

The mechanism of cytisinicline is similar to that of Pfizer’s champix (varenicline tartrate). It acts on nicotine receptors located in brain cells, reducing the pleasure of inhaling and the feeling of withdrawal.

“The patient with withdrawal loses concentration, becomes irritable and anxious, has a change in bowel habits — sometimes he has difficulty evacuating”, explains Andrea Sette, pulmonologist at Hospital São Luiz Itaim, Rede D’Or.

Approved by Anvisa (National Health Surveillance Agency) in 2006, varenicline has been discontinued. Pfizer told the report that there is a temporary shortage of medication in all presentations (coated pills of 0.5 mg and 1.0 mg), but did not clarify the reason.

The citisiniclinine research had the participation of 810 volunteers. In 2024, Achieve Life Sciences, responsible for the product, intends to submit the drug data to the FDA (agency that regulates and supervises food and medicine in the USA). It is not yet known when the request will be made to Brazil.

The effects of tobacco are long term. Even if a person stops smoking, it can take 10 to 20 years for the body to eliminate carcinogens.

Getting rid of cigarette addiction is difficult, but not impossible. The following are smoking treatment options.

Does SUS offer treatment for those who want to quit smoking?
Yes. It is free. Actions are developed in partnership with state and municipal health departments in all states and the Federal District. Inca (National Cancer Institute) is responsible for the National Tobacco Control Program and for articulating the treatment network in the SUS. Find out where treatment is offered in your state.

What is the duration of treatment?
One year is recommended.

How is the treatment in the public network to stop smoking?
In general terms, it includes clinical evaluation, approach and drug therapy. During the consultation, health professionals collect the patient’s clinical history, check for contraindications to the use of medication, analyze the patient’s motivation to quit smoking, the level of physical dependence on nicotine and the possibility of psychiatric comorbidities.

Depending on the need, 7 mg, 14 mg, and 21 mg nicotine patches, chewing gum, lozenges, and the 150 mg bupropion hydrochloride antidepressant are available.

Pneumologist Felipe Marques da Costa, physician and coordinator of the Pulmonary Checkup Program at BP – A Beneficência Portuguesa de São Paulo, makes a positive assessment of smoking cessation programs.

“If you compare groups of people who want to quit smoking after quick medical advice, the chance of that happening is around 1%. When you introduce a patient into a structured program for smoking cessation, whether municipal, state or federal government, the chance of that person to stop smoking jumps to 35%, 40%”, says Costa.

“So-called first-line medications –nicotine replacement therapy— work. The patch is a slow way to administer nicotine. There are gums and mints that release nicotine more quickly. Bupropion hydrochloride is an antidepressant, used in low doses. It is as good as nicotine replacement therapy. All are dispensed by the SUS.

Where to seek treatment in the city of São Paulo?
The person interested must look for the UBS of reference, with an identity document, and enroll in the SUS Smoking Cessation Program. There are individual and group strategies. The meetings address topics that allow understanding of the reasons that lead to smoking, the risks of consumption, the benefits of quitting smoking and even how to prevent relapses.

During the meeting session of the anti-smoking groups, approaches are carried out in an intensive and structured way, in addition to questions that assess the degree of physical dependence and motivation. In each group, 10 to 15 patients participate. Coordination is carried out by one or two health professionals through four weekly sessions, followed by two fortnightly meetings and an open monthly meeting with the participation of all groups, for the prevention of relapses until the treatment completes one year.

Treatment and meetings take place at the UBS. There is also support from Integrative and Complementary Health Practices, which are offered to help in the process of giving up addiction —traditional Chinese medicine (acupuncture, body and meditative practices), phytotherapy and medicinal plants, circular dance, traditional Indian medicine (yoga, shantala), laying on of hands, aromatherapy, reflexology, massage therapy, naturopathy, art therapy, music therapy, chiropractic, osteopathy, homeopathy and others.

Every participant takes the Fargeström test, used to assess the degree of nicotine dependence.

Why is it difficult to stop smoking?
Nicotine, present in any tobacco derivative, has psychoactive properties. When inhaled, it can lead to abuse and dependence. Despite being the main substance present in cigarettes that creates addiction, it does not act alone. There are others that enhance this effect, such as acetaldehyde, also present in electronic cigarettes.

“Each time you inhale a cigarette, it reaches the brain very quickly, in seconds. You inhale around 4,750 substances, including nicotine, which causes addiction. That’s why it’s so difficult to stop smoking. The smoker’s brain is dependent . You need the substance to concentrate and feel good”, explains Sette.

“The patient who smokes loses about 7 to 8 years of life, apart from the fact that the smoker’s life —after 40, 50 years— starts to suffer a series of bad weather, from clinical limitations, vascular alterations, increased incidence of cancer, stroke , heart attack, peripheral arterial disease. We cannot forget that 80% of people who have lung cancer in Brazil smoke or have smoked,” says Costa.