Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

(14) Price JH, Jordan TR,
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nicotine replacement
therapy with adolescent
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smokers and nonsmokers.
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Management
of adolescent
smokers
The clinical management of adolescent
smokers poses a basic problem: the toxic effect
of the nicotine from cigarettes seems more
marked than in adults, in whom maturation of
the nervous system is complete. Furthermore,
the younger subjects start smoking, the
slimmer their chances of successfully quitting
seem to be (7). Furthermore the use of
nicotine replacement therapy to treat
dependence involves using a substance that is
potentially harmful in this age-group.
Moreover, very few studies have been
conducted on the efficacy of nicotine
replacement therapy and their results are
rather contradictory.
One of the first studies monitored a group
of 22 adolescents aged between 13 and 17
years for 6 months. They smoked 20 cig/d or
more and were treated with nicotine patches.
Nineteen completed the study but only 3
(14%) were abstinent after 6 months. The
adverse effects were minor (8).
In an open-label study conducted in the
year 2000 in a group of 101 adolescents
smoking 10 cigarettes/day or more, and
treated with nicotine patches, Hurt observed a
6-month abstinence rate of 5% (9).
A randomized study (nicotine patch vs.
placebo) conducted in 100 adolescent smokers
showed no difference between the two groups
in the 10-week abstinence rate, but the mean
duration of abstinence was longer in the active
group (18 days) than in the placebo group (4
days). The adverse effects were minor and
were identical in both groups (10).
Another randomized study on a group of
adolescent smokers treated with nicotine
patches, nicotine gum or placebo for 12 weeks
showed a clear advantage in the 3-month
abstinence rate for the active group (18% for
the patch, 6.5% for gum and 2.5% for
placebo). Here again, the adverse effects were
minor and identical in all the groups (11).
In a group of 98 adolescent smokers living
in an deprived area of Nottingham (UK) and
treated with nicotine patches or placebo, 7
participants were abstinent after 4 weeks and
none after 3 months (12).
In contrast, a Japanese study showed that in
a group of 39 adolescent smokers treated with
nicotine patches, 36% were abstinent after 1
month and 25% after 3 months (13).
Pediatricians rarely prescribe nicotine
replacement therapy. A recent study showed
that only 59% of pediatricians encountering
adolescent smokers ask about their intention
to quit and only 10% regularly prescribe
nicotine replacement therapy (14).
In contrast, adolescents appear to use
nicotine replacement therapy spontaneously,
and this is not only true for smokers (5% to
16% depending on their cigarette
consumption) but also for non-smokers (1.8%)
(15), which suggests that some adolescents use
nicotine replacement products for their
neurotropic properties.
According to current regulations in the
United States, adolescents are not permitted to
procure nicotine replacement therapy over the
counter. In practice, these products are easily
accessible and over 80% of adolescents can
obtain them without difficulty (16).
J.A. Costa e Silva.
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