Don't try to quit by willpower alone; get medicine first, which more than doubles your chance of success
- High value
- Evidence A
- Buys life
- Costs a little
- Takes minutes
- Some willpower
In plain words
Most people can't quit on willpower alone. People who take varenicline succeed more than twice as often as people who take a placebo. People who use replacements such as nicotine patches or gum do about 50% better than people who use no medicine. Using the patch and the gum together adds another 20% or so.
- Cost
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Nicotine patches and nicotine gum are over-the-counter drugs, sold at the pharmacy counter. A course lasts 8 to 12 weeks and costs a few hundred to a bit over 1000 CNY. Varenicline and bupropion are prescription drugs, prescribed at a quit-smoking clinic or a respiratory medicine department. The cost roughly cancels out against the cigarettes you no longer buy over the same period.
- What you get
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Pooling 41 randomized trials with 17395 people, the quit rate in the varenicline group was 2.32 times that in the placebo group (RR 2.32, 95% CI 2.15–2.51, the plausible range; high-certainty evidence). Varenicline also did better than bupropion (RR 1.36, about 36% higher) and than a single nicotine replacement product (RR 1.25, about 25% higher). Nicotine replacement compared with no medicine: 133 trials with 64640 people, with success about 55% higher (RR 1.55, 95% CI 1.49–1.61). A patch plus a fast-acting form (gum or lozenge) did about 27% better than a single product (RR 1.27, 95% CI 1.17–1.37, 16 trials, 12169 people, high-certainty evidence).
- Notes
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The quit-smoking medicines sold in China are the three kinds above, and only nicotine replacement is available without a prescription. The common side effects of varenicline are nausea, vivid dreams and poor sleep; tell your doctor if you have a history of psychiatric illness. A course of nicotine replacement usually lasts 8 to 12 weeks. Don't stop suddenly on your own; cut down as your doctor says. Medicine only handles the discomfort of the withdrawal weeks, not the situations that make you want to smoke, so use it together with §2.4 (set a quit day) and §2.5 (go to a quit-smoking clinic).
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. https://doi.org/10.1002/14651858.CD006103.pub8
- Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. https://doi.org/10.1002/14651858.CD000146.pub5
- Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. https://doi.org/10.1002/14651858.CD013308.pub2
- 上海市卫生健康委员会 (2021). 选对药物，让戒烟轻松一点：「市场上可见的戒烟药物主要有三种，即尼古丁替代疗法药物、安非他酮、伐尼克兰」，「尼古丁替代疗法药物属于非处方药（OTC），可通过药店柜台购买；而安非他酮、伐尼克兰属于处方药，须到医院戒烟门诊或呼吸内科就诊，凭医师处方经药师调配后才能得到」. https://wsjkw.sh.gov.cn/jtyx/20211119/df50681e01ba49f896d54f771d8176ae.html
Mentioned in
- Quit smoking, and the earlier the better
- Go to a quit-smoking clinic, or call 12320 (China's public health hotline) to ask whether there is a quit-smoking service near you
- Consider e-cigarettes only if you really can't quit otherwise, and don't touch them if you don't already smoke
- Put your own money on the line to make yourself follow through, but first ask whether you would be willing to
Translated from the Chinese original. Original book, section 2, tip 3. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer