“Isn’t quitting cold turkey too dangerous?”

From Freedom from Nicotine post on Oct 26 06 12:34 PM 

Seven months ago the following question was emailed to me at the AskJoel board:

Hi, I have been told before that “cold turkey” stop smoking can actually bring out medical problems in your body because it shocks it and that the weaning method was actually safer. Have you seen any research to back this up? It terrifies me that this could be true but not stopping is just as scarey….

Thank you.

Lana”

John and I assembled numerous replies that I am attaching below. A new study that was just released shows just how much of a misconception many people have about this topic–apparently including a lot of cardiologists who have been giving NRT to critically ill patients. I was actually quite surprised to find out that this was a common practive now a days. It was my understanding when I worked in hospital based settings that no caridac patient would be given patches or any NRT while in Intensive Care. I don’t know when this practice changed but given the known vasoconstriction risks of nicotine I am surprised that this practice has been going on now for the past five to ten years.

First, here is today’s article. I will attach the original comments from the AskJoel board after this:

Nicotine patches may
boost intensive care risk

Nicotine given to intensive care patients to ease their withdrawal from cigarettes may put them at a greater risk of death than going “cold turkey”, researchers say.

A preliminary study of more than 200 smokers placed in intensive care suggests they are better off simply enduring withdrawal symptoms than receiving nicotine replacement therapy (NRT).

Nicotine replacement therapy has become common in hospitals’ intensive care units (ICUs) in the last five to 10 years. The drug reduces withdrawal symptoms, such as headache and irritability, among smokers in these units, who are too sick to go to an area where they can smoke.

Bekele Afessa at the Mayo Clinic College of Medicine in Rochester, Minnesota, US, and colleagues expected to find that patients comforted by (NRT) fare better than smokers who do not receive it.

Heart power

The team examined the intensive care records of 224 smokers, half of which received NRT, mostly via skin patches.

Surprisingly, they found that 18 of the patients on NRT died, compared with just three of the smokers that did not receive nicotine. Also, the average duration of an ICU stay for patients given nicotine was 24.4 hours, about 2 hours longer than their cold-turkey counterparts.

“We have to be aware that we may be doing some harm [by giving patients NRT],” Afessa warns.

He notes that many of the patients in the study had been admitted to the ICU because they had gone into sepsis due to an infection. Sepsis can cause the body to release myocardial depressant factor, a molecule that reduces the pumping power of the heart.

Nicotine may further weaken the hearts of these patients by causing the coronary artery feeding the heart, to narrow, he suggests. This would reduce the amount of oxygen being pumped to other organs in the body. Many of the ICU patients in the trial died of multiple organ failure.

Wake-up call

Nicotine is known to cause a narrowing of the coronary artery in chronic smokers, but remains unknown whether short-term doses of the drug can have the same effect.

Experts say the results of the new study should encourage more research on how NRT affects hospital patients. “This is a wake-up call that we really need to study this,” says Mark Rosen, president of the American College of Chest Physicians.

He adds, however, that a large prospective study is necessary to establish whether nicotine definitely causes an increased risk of death among patients.

Afessa presented the findings at the annual meeting of the American College of Chest Physicians (ACCP) in Salt Lake City, Utah, US, on Wednesday.

© Copyright Reed Business Information Ltd.

Source Link: http://www.newscientist.com/article/dn10380-nicotine-patches-may-boost-intensive-care-risk.html

Additional commentary from same string:

As far as I know there has never been any credible research done that had proved that quitting cold turkey was too dangerous. I actually haven’t even had the question posed to me for many years.

There was a time when I used to get the question quite frequently. In my early years of doing programs I would hear it from people who told me that they had personal physicians who would tell them that quitting was just too much of a shock to their system and not worth the risk. It was often advice given to pregnant women by their obstetricians.

What must be understood about this information is was what the level of total misunderstanding there was by the physicians at the time, as well as by the entire medical and scientific community. It was at a time that there was a good chance that if a woman were to ask her physician if smoking was harmful to her baby, that the physician could have reached into his shirt pocket, pulled out a cigarette, took a few puffs while in deep contemplation and came back with the answer that smoking didn’t really pose any real risk. The same kind of conversation could have been held between a man and his cardiologist or any person with almost any medical condition talking to his or her doctor. Back in the 1950’s over half of the doctors in our country smoked.

What we know now about the dangers of smoking as it relates to many conditions makes it totally obvious to almost any health care professional in any field that smoking is deadly, even though in the past the lack of solid information caused the wrong advice to be standard fare.

We now have decades of experience with millions and millions of people successfully quitting smoking, the vast majority of them doing so by going cold turkey. It should be obvious to almost any one now that the dangers of quitting smoking is not what smokers need to be concerned with, it is the dangers they face if they do not quit smoking.

On a personal note, I have personally run over 4,500 people through cold turkey smoking programs for almost 30 years now. Out of those 4,500 people I only had two people who died during the two week period of the clinic. One was a younger man, probably in his thirties with severe heart disease and diabetes who was forced into the program by his wife and doctor because it was clear to both of them that he was in real danger of dying if he didn’t quit smoking. Unfortunately, while the man’s wife and doctor were both convinced that he was in immediate danger, the man himself didn’t accept the risk for in fact, he did not quit smoking during that clinic. He was cheating throughout the program and his wife was not ever sure he had reduced his smoking at all from the first day of the program. He died on the fifth or sixth day.

The other death was from a man who was also in really bad shape, having just had major cardiac surgery, was still having ongoing problems with chronic heart failure and had a terrible prognosis coming in. His doctor had told him that he was a walking time bomb and he meant it in very literal terms. He died about ten days into the program. He had quit and had eased up in the withdrawal, was in fact very proud of the fact that he had quit and was happy with his decision to do so. I actually went to his funeral. His wife was very happy to see me there, and excitedly introduced me to a number of their family members and friends, explaining how I was the person who helped her husband to quit smoking. They were all very proud of the man and felt that he really was trying to give himself a fighting chance to live. That seemed very important to his loved ones at that time.

Other than these two cases, I have never encountered a person who had died during the quitting process, which is quite remarkable considering the state of health that many people who come to clinics are in.

Again, don’t waste your energy on the fear of quitting. It is a baseless fear. If you spend time doing any real research on the effects of not quitting though, the fear that you will feel will be totally warranted for the magnitude of risk posed by smoking is tremendous. The good news is that all of the risks posed by smoking can be minimized by simply making and sticking to a personal commitment to never take another puff.

Also added that day:

Lana, I’m confident that every quitter survery you’ll find asserts that almost all successful long-term quitters quit smoking could turkey (80 to 90%). Again in 2006 almost all successful long-term quitters will again be cold turkey quitters. Contrary to being dangerous, a Jaunary, 2006 study published in the British Medical Journal asserts that your odds of success are 260% greater for those quitting without any planning. Clearly any form of weaning program involves advance planning. John

“Catastrophic” pathways to smoking cessation: findings from national survey.

British Medical Journal (BMJ) 2006 Feb 25;332(7539):458-60. Epub 2006 Jan 27.

West R – University College London, London WC1E 6BT. robert.west@ucl.ac.uk

OBJECTIVE: To assess the extent to which the prevailing model of smoking cessation (that smokers typically prepare their attempts to stop smoking in advance and that doing so increases their chances of success) is correct.

DESIGN: Cross sectional household survey.

SETTING: England.

PARTICIPANTS: 918 smokers who reported having made at least one quit attempt and 996 ex-smokers aged 16 and over.

MAIN OUTCOME MEASURES: Whether the most recent quit attempt was planned in advance and whether quit attempts made at least six months before resulted in at least six months’ abstinence.

RESULTS: 48.6% of smokers reported that their most recent quit attempt was put into effect immediately the decision to quit was made. Unplanned quit attempts were more likely to succeed for at least six months: among respondents who had made a quit attempt between six months and five years previously the odds of success were 2.6 times higher (95% confidence interval 1.9 to 3.6) in unplanned attempts than in planned attempts; in quit attempts made 6-12 months previously the corresponding figure was 2.5 (1.4 to 4.7). The differences remained after controlling for age, sex, and socioeconomic group.

CONCLUSIONS: A model of the process of change based on “catastrophe theory” is proposed, in which smokers have varying levels of motivational “tension” to stop and then “triggers” in the environment result in a switch in motivational state. If that switch involves immediate renunciation of cigarettes, this can signal a more complete transformation than if it involves a plan to quit at some future point.

PMID: 16443610 [PubMed – in process]

Online Source Link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=16443610&dopt=Abstract