By Peter Lake
Nicotine skin patches are now available on the Australian market. Intended for people who want to stop smoking, the patches come with a kit which includes information booklets and a behaviour change contract to be countersigned by a doctor.
Pharmacists have been targeted as patch promoters and provided with customer leaflets in plastic dispensers. These leaflets carefully avoid any direct mention of the patches themselves in order to comply with regulations which prohibit the advertising of prescription drugs to the public.
The advent of nicotine patches seems to have caught Australian doctors on the hop. So far, there have been no reviews of their safety or effectiveness in any of the local medical journals, and even prescribing information has been hard to come by.
In a variation on the usual drug company marketing strategy, many doctors have been consulted ahead of the drug detailers in some cases, by patients asking for patch prescriptions. People soon discover that the patches are expensive — between $360 and $450 for a 12-week course, depending on the brand chosen.
Because nicotine patches are available only on prescription, an unknown number of people will be visiting their doctors for initial supply and ongoing counselling.
This promises to be a big money spinner for the drug companies. In the US during 1992, more than 5 million people were nicotine patch users, and sales exceeded $1 billion. If the patches prove to be as popular in Australia, the additional Medicare outlays for visits to doctors could be considerable, given that almost a third of Australian adults smoke and many would like to give up.
How useful are nicotine patches?
Considering their expense, the answer to this question
is very important for people who are considering using them. Drawing together all the available evidence so far, a recent editorial in the well-respected British Medical Journal concluded that patches "work about as well as nicotine chewing gum in motivated patients in the setting of general practice or specialised smoking cessation centres. In hospital patients with smoking related diseases, they seem to confer little if any benefit over advice and support alone."
In fact, only three studies have ever been done on nicotine patches in general practice (i.e. using the local doctor as the person providing counselling and support), and the results are not impressive. They show that with support and encouragement from a local doctor, between one in five and one in 10 motivated smokers can expect to be abstinent.
[Dr Lake is treasurer of the Doctors Reform Society in South Australia.]