IN JAMAICA, 27.2 per cent of adolescents (Garfield-Douglas; 1997) have tried a cigarette and 4.8 per cent of them have smoked in the last 30 days. Cigarette smoking kills three million people each year - one death every 10 seconds. Tobacco is also a gateway drug, opening the floodgates that can lead to the abuse of other addictive substances. Ninety per cent of people who die prematurely of cigarette-related disease started smoking as adolescents. Research by the National Institute on Drug Abuse (NIDA) is showing that among 17-year-olds, one-third are interested in getting some form of treatment to help them quit.
Nicotine replacement therapy (NRT) helps smokers learn to abstain from smoking by replacing the nicotine that they previously obtained from cigarettes, thereby preventing withdrawal symptoms and nicotine cravings. The effectiveness of NRT is substantially increased with counselling. Nicotine products are commercially available in Jamaica in the form of a chewing gum and transdermal patch. They are also sold in other countries as nose drops and oral inhalers.
Nicotine chewing gum should be used when the urge to smoke occurs and no more than 8 to 12 of the 2mg product are initially needed. After approximately three months, the amount of gum should have decreased to 1 to 2 pieces daily. Each piece of gum should be chewed slowly and after 30 minutes all the nicotine will be released. The drug is intended to be absorbed via the lining of the mouth. If the gum is vigorously chewed, it will be swallowed and destroyed in the stomach, causing uncomfortable side effects.
Because nicotine is volatile, patches must be applied promptly after removal from the protective pouch. The dry, non-hairy areas on the hip, chest and arm best secure the patch that must be removed after 16 hours, preferably just before going to bed. The next patch is to be applied to a different site. The strength of the patch should be gradually decreased beginning with 15 mg and ending treatment with a 5mg patch. Nicotine is photosensitive and will turn brown on exposure to light or air. Products should be protected from light and heat and stored at room temperature less than 30 degrees centigrade. Used products should be properly discarded since they may contain residues of nicotine that could be toxic to children and pets.
Ellen Campbell Grizzle, director, Information and Research, National Council on Drug Abuse (NCDA)/president, Caribbean Association of Pharmacists.
