Moving on to Being Free

Quitting smoking is not based on will-power or personality. It is based on figuring out what you will do “instead of” smoking in the situations where you usually smoke.

There are medications to help you quit, but these only help with the physical addiction — you still have to figure out what you will do instead of smoking.

Some of the main reasons people have trouble quitting smoking or cutting down:

1. Lack of a plan.
2. Not enough strategies in the plan that will help them do something instead of smoking.
3. Strategies are not used long enough.
4. The step is too big.
5. Testing themselves with “just one”.

Nicotine replacement therapy medicines (NRT) come packaged in patches, gum, inhaler, and lozenges. NRT products help you manage withdrawal symptoms by replacing the nicotine you used to get in cigarettes. You can buy NRT in drug stores without a prescription. Talk to your provider about which medicine is best for you. Talk to a pharmacist to find out how to use it and about the side-effects.

For NRT, you typically quit smoking first and then start taking the medicine. It is usually taken for 2 to 3 months (8-12 weeks) but can be extended in for 6 months (26 weeks). Your provider may suggest that 2 medicines together may help you better handle cravings (e.g., patch with nicotine gum).

The most common side-effects for all NRT products include dizziness, headache, upset stomach, nausea, sleep disturbances/insomnia, abnormal or vivid dreams and heartburn or indigestion. Discontinue use if you experience irregular heartbeat, heart palpitations, severe rash, or symptoms of nicotine overdose. Even low doses can be toxic for children and pets so keep out of reach.

• The patch is “long” acting, giving a steady stream of nicotine over time.
• Patches come in different strengths: 7, 14 and 21 mg, and take about 1-3 hours to feel the effect.
  • The patch strengths are similar to the number of cigarettes smoked. So if you smoke 20 or more cigarettes/day, you would normally start by using a 21 mg patch; if you smoke 15 cigarettes/day, start with the 14 mg patch.
• How to use:
  • Peel the back off the patch and stick it on your chest or high on your arm.
  • Put on a new patch every 16 or 24 hours; use a different spot each day.
  • You may swim, shower and exercise while wearing the patch.
  • If starting with a 21 mg patch, it is used for the first 6 weeks, then decrease to 14 mg patch for the next 2-4 weeks, and 7 mg for 2-4 weeks.
• The patch can cause skin sensitivity, irritation, or rashes so put it on a different spot each day.

• The gum is “short” acting and can be used in a given moment to handle cravings.
• The gum is available in two strengths: 2 mg and 4 mg. It takes about 10 minutes to feel the effect.o4 mg gum will be most helpful if you smoke 25 or more cigarettes/day.o2 mg gum is recommended if you smoke less than 25 cigarettes/day.•
• How to use:
  • Do not chew nicotine gum like regular gum or it won’t work properly and you might feel nauseous, light-headed, or experience mouth and throat discomfort or irritation.
  • Use one piece at a time, bite it twice and then hold it (“park it”) between your cheek and teeth for a few seconds – bite, bite, park. You should feel a slight tingle when you “park” the gum; that will indicate the release of nicotine. Each piece lasts 30 minutes.
  • Do not drink coffee, orange juice, cola or alcohol while you have the gum in your mouth or for 15 minutes before. These drinks weaken the effect.
  • For the first 6 weeks, chew 1 piece of gum every 1 to 2 hours that you are awake. Do not use more than 20-24 pieces per day.
  • After 6 weeks, decrease the amount you chew to 1 every 2-4 hours for 3 weeks, then 1 piece every 4-8 hrs for 3 weeks, and then stop.
• Side-effects specific to nicotine gum, aside from those resulting from incorrect use of the gum, include mouth soreness, jaw ache and hiccups.
• The nicotine inhaler is a “short” acting form of nicotine replacement that looks like a cigarette holder. You inhale and nicotine vapor (mist) is absorbed into your mouth and throat, not your lungs like a cigarette, so you do not get the same “hit” of nicotine you do with smoking.

• The inhaler comes in 10 mg cartridges (delivering 4 mg nicotine) and has 1 mg of menthol.
  • Cartridges last 20 minutes with continuous puffing and provides nicotine equivalent to about 2 cigarettes. Using it for 5 minutes at a time will give you 4 uses of each inhaler.
  • Inhalers do not work properly in cold weather (below 10°C).
• How to use:
  • Inhale the mist into your mouth as you would a cigarette. It takes about 3-4 times more puffs than a cigarette to get an effect. You will feel the effect in about 5 minutes.
  • Do not drink any beverages 15 minutes before or after you use the inhaler, especially acidic ones like coffee, juices, and pop.
  • For the first 6-12 weeks, use at least 6 cartridges/day to a maximum of 12/day.
  • After 6-12 weeks, gradually taper off the amount you use over 12 more weeks.
  • Empty cartridges still contain enough nicotine to make children and pets sick so dispose of empty cartridges carefully.
• When you first use it, the nicotine inhaler may cause mild throat or mouth discomfort, and rhinitis symptoms (runny nose, sneezing, coughing).

• The nicotine lozenge is a “short” acting form of nicotine replacement.
• The lozenges come in 2 strengths: 2 mg and 4 mg. You will feel the effect in about 7-10 minutes.
  • Use 4 mg if you usually smoke your first cigarette within 30 minutes of waking. Otherwise, use the 2 mg.
• How to use:
  • Dissolve the lozenge in your mouth moving side to side over 20-30 minutes. Do not chew or swallow whole, and minimize swallowing.
  • Do not eat or drink for 15 minutes before and during use.
  • For the first 6 weeks, take 1 lozenge every 1-2 hours (at least 8/day). Do not exceed 5 lozenges over a 6 hour period or 20 lozenges/day.
  • After 6 weeks, use 1 every 2-4 hours for 3 weeks. After 9 weeks, use 1 every 4-8 hours for 3 weeks. At 12 weeks, stop.
• Side-effects specific to the lozenges include throat or mouth irritation, upset stomach, and hiccups.

• This is a well-known pill-based medicine for depression, but it also helps people quit smoking. It does not contain nicotine. It blocks the flow of chemicals in the brain that make you want to smoke. If you already take Wellbutrin® or Wellbutrin SR® for depression, do not take more bupropion to help you quit.

• The pill comes in one strength (150 mg).
• How to use:
  • For the first 3 days, take 1 pill (150 mg.) per day in the morning.
  • After 3 days, take 2 pills a day (150 mg each)—1 in the morning and one 8 hours later.
  • Can be used with nicotine replacement products. Talk to your doctor or nurse practitioner.
• Side-effects other than those mentioned above include blurred vision, disturbed concentration, dizziness, dry mouth, hearing changes, increased sweating, and rapid heart rate (tachycardia).
• Stop taking the medicine and seek immediate help if you experience: 1) a seizure; 2) an allergic reaction (rash, hives, itching, unexplained swelling, wheezing, difficulty, breathing or swallowing); or 3) you notice a difference in your thoughts, feelings, moods, or behaviour (feeling upset/edgy, aggressive, paranoid, hallucinating, having suicidal thoughts, or acting on dangerous impulses).

• Champix®: is the newest pill-based medicine to help people quit smoking. It works on sites in the brain affected by nicotine but does not contain nicotine. It will help reduce the craving that comes with giving up cigarettes. 
• The pill comes in two strengths—0.5 mg and 1 mg.
• How to use:
  • For the first 3 days, take 1 low dose pill (0.5 mg) in the morning. 
  • After 3 days, take 2 low dose pills a day (0.5 mg) for the next 4 days, one in the morning and one 8 hours later.
  • After the 1^st week, take 2 higher dose pills a day (1 mg)—one in the morning and one 8 hours later.
• Nausea is the most common side-effect. Try taking the medicine with a full glass of water or food.
• Other side effects include abnormal dreams (vivid, strange, different dreams), diarrhea, constipation, and flatulence (gas).
• Stop taking the medicine and seek immediate help if: 1) you experience an allergic reaction (rash, hives, itching, unexplained swelling, wheezing, difficulty, breathing or swallowing); or 2) you notice a difference in your thoughts, feelings, moods, or behaviour (example: feeling upset or edgy, aggressive, paranoid, hallucinating, having suicidal thoughts, or acting on dangerous impulses).