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Hitting Nicotine where it hurts most!

By Dr. Pramod Niphadkar, M.D.
74 million smokers in India


Around 70% smokers desire to quit and 46% strongly motivated to quit smoking
Nicotine is as addictive as hard drugs and is 5 to 10 times more potent than cocaine and morphine
Dr. Pramod Niphadkar, MD, is a consultant in asthma and allergy, affiliated with various prestigious institutions like Jaslok hospital, Sir Harkishandas hospital and St. George’s hospital in Mumbai. Dr. Niphadkar also runs an Asthma Allergy centre in Dadar. He is associated as an Advisor with Asthma Task Force ICMR, Govt. of India and Institute of Genomics and Integrative Biology. Dr. Niphadkar has been awarded number of scholarships and honours for his research and merits in Asthma and Allergy. He is the recipient of International Scholar Award in Allergy from Cleveland, U.S.A. He was also awarded for Best Research Award in Chest Medicine from Indian Chest Society and National Scholarship in Allergy Research from CSIR, New Delhi. Dr. Niphadkar was appointed as an Advisor for Global Strategy on Asthma Management, WHO, Geneva in 1993.

He has been involved in various research works and presented number of papers which were published in national and international journals. Dr. Niphadkar has received awards for Best Research Paper from Bombay Medical Congress in 1985 & 1986. He has also received award for Research Paper Presentation in Kyoto, Japan in 1991.

Dr. Niphadkar is associated with different societies as a member of these associations like Association of Physicians of India, Indian College of Allergy and Immunology, Indian Chest Society, India Medical Association. He is also actively involved with various associations which were doing social work for asthmatics like Asthma & bronchitis Association of India.

He was also instrumental in organizing various asthma camps during his medical career. He also created special films and VCDs which revolves on his topic of interest – Asthma and Allergy. Dr. Niphadkar has also arranged lots of seminars and symposia on asthma and allergy like First International Symposium on Asthma and Allergy in Collaboration with case Western University- Cleveland, Ohio in 1984 and 1986. He is also associated with some of the top industries as a consultant. In this article, he explains why and how smokers can kick this addictive habit that is endangering the health of the society at large.

Smoking remains the number one cause of preventable disease and death in India. Yet a shocking 74 million people across India are hooked on the habit. Despite the grave consequences of smoking which smokers are well aware of, why do people continue to smoke? Could it be the addiction to nicotine?
Nicotine is 5 to 10 times more addictive than cocaine and morphine. As a result the quitter experiences strong withdrawal symptoms, which is hard to combat with will power alone. The situation gets more complicated when the psychological addiction to the drug outweighs the physiological addiction. This explains why despite the fact that 70% of smokers desire to quit and another 46% are strongly motivated to quit, quitting successfully remains a challenge to many smokers.

Letting go of the smoking habit successfully requires support in many ways. From peer or family support to counseling and more recently the availability of smoking cessation therapy. Nicotine addiction is a chronic, relapsing condition that presents physical and psychological barriers to quitting smoking. The fact that less than 7% of smokers who attempt to quit on their own remain smoke-free for one year after quitting smoking underlines the difficulty in getting rid of the addiction.

There are currently a range of products or devises to aid smoking cessation. These include Nicotine Replacement Therapy (NRT) such as Nicotine Patch, Gum, Lozenge, Inhaler and Nasal Spray. NRT aids in combating the strong withdrawal symptoms a quitter experiences as he weans himself from smoking. Through this method, the nicotine delivered by the cigarette is replaced with nicotine delivered through the skin, the nose or by oral consumption. Although NRT tackles the craving to smoke, the smoker can’t get rid of his dependence on nicotine to make him feel good. Also, alarmingly, there have been cases of misuse of NRT by smokers for heightened sense of pleasure induced by the higher concentration of nicotine in addition to smoking.

Apart from the physiological dependence, nicotine induces powerful psychological and habitual dependence in a smoker. Since smoking is psychologically linked to enjoyable activities such as watching TV, driving, enjoying a good meal, the urge to have a cigarette can be particularly strong when engaging in these activities. Most of the smoking cessation solutions, look at the problem of nicotine addiction very myopically; concentrating only on the physiological dependence on nicotine.

The latest smoking cessation treatment, Champix, from Pfizer seems to have come closest in approaching the problem in a holistic manner. Varenicline, the base molecule of Champix, acts as a partial agonist and works in combination with behavioral therapy to take care of the urges which a quitter goes through when he/she stops smoking. Champix is non-nicotine based and, more importantly, is researched to be twice as effective as Buproprion. Studies have suggested it is four times more effective than will power alone to combat nicotine addiction. Varenicline is the only molecule so far specifically designed to help quit smoking. It has already been released in States, U.K. and eight other countries as a prescribed drug and within 19 months of launch over 5 million prescriptions of Champix have been given worldwide.

For an aspiring quitter it pays to remember that an average smoker who is motivated to quit makes at least 6-9 attempts in his life to quit smoking. Hence it is important to stay put when the going gets tough and not reprimand oneself too much if a slip up happens. It is natural. Please approach your nearest trusted medical practitioner and seek guidance to quit smoking. With the help of modern medicine it is getting lot easier to get rid of the fatal addiction.
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