The Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline on Smoking Cessation states that “All physicians should strongly advise every patient who smokes to quit.” Randomized clinical trials have shown that physician advice to quit smoking by itself improves cessation rates by 30%.<sup>63 US Department of Health and Human Services   Clinical Practice Guideline, Number 18: Smoking Cessation Washington DC: US Government Printing Office (1996).  AHCPR Publication No. 96–0692..

Cliquez ici pour aller à la section Références</sup> Physicians can further aid smokers by recommending nicotine replacement therapy (NRT) to their patients to aid in their quit attempts.<sup>63 US Department of Health and Human Services   Clinical Practice Guideline, Number 18: Smoking Cessation Washington DC: US Government Printing Office (1996).  AHCPR Publication No. 96–0692..

Cliquez ici pour aller à la section Références</sup> NRT has been shown to be efficacious in helping smokers quit. In fact, the data to support the efficacy of NRT are strong enough that the AHCPR recommends the following to physicians: “Patients should be encouraged to use nicotine replacement therapy (patch or gum) for smoking cessation, except in the presence of special circumstances (e.g., cardiovascular disease, pregnancy).” The public health impact of treating smokers is enormous. It has been estimated that 400,000 premature deaths in the United States each year are attributable to cigarette smoking<sup>40 McGinnis J.M., Foege W.H. Actual causes of death in the United States JAMA 1993 ;  270 : 2207

Cliquez ici pour aller à la section Références</sup> and that up to one half of all smokers die prematurely from tobacco-related disease.<sup>47 Peto R., Lopez A.D., Boreham J. , et al.   Mortality from smoking in developed countries 1950–2000 Oxford: Oxford University Press (1994). 

Cliquez ici pour aller à la section Références</sup> Cigarette smoking has been shown to cause myriad diseases and disorders that cost smokers their health and their lives and that cost society approximately $100 billion annually.<sup>9 Centers for Disease Control Medical-care expenditures attributable to cigarette smoking—United States, 1993 MMWR 1994 ;  43 : 469

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Cigarettes are to lung cancer what contaminated heroin needles are to HIV and hepatitis; in both cases, the role of the highly addictive drug (nicotine or heroin) is to sustain repetitive use.<sup>21 Henningfield J.E., Clayton R., Pollin W. Involvement of tobacco in alcoholism and illicit drug use Br J Addict 1990 ;  85 : 279

Cliquez ici pour aller à la section Références</sup> That is, the death and disease caused by cigarette smoking is not primarily due to nicotine, but rather the huge number of carcinogens and other toxins produced by the burning and inhalation of tobacco. With one third to one half of occasional users graduating to maladaptive use and physical dependence, cigarettes are one of the most addictive drugs known.<sup>16 Giovino G.A., Henningfield J.E., Tomar S.L. , et al. Epidemiology of tobacco use and dependence Epidemiol Rev 1995 ;  17 : 48

Cliquez ici pour aller à la section Références, 22 Henningfield J.E., Cohen C., Slade J.D. Is nicotine more addictive than cocaine? Br J Addict 1991 ;  86 : 565

Cliquez ici pour aller à la section Références</sup> The main cause of death from nicotine and heroin dependence is the contaminated drug delivery system (and not the drug itself), therefore, an important treatment modality for tobacco and heroin dependence is to provide a medication with a favorable risk-to-benefit ratio to replace the drug of abuse, that is, oral methadone for heroin or nicotine medications for tobacco. The vast majority of smokers in the United States report that they would like to quit; however, only about 3% of smokers who quit abruptly on their own (cold turkey) remain abstinent for longer than 6 months.<sup>32 Hughes J.R., Gulliver S.B., Fenwick J.W., Valliere W.A., Cruser K., Pepper S., Shea P., Solomon L.J., Flynn B.S. Smoking cessation among self-quitters Health Psychol 1992 ;  11 : 331  [cross-ref]

Cliquez ici pour aller à la section Références</sup> It has been repeatedly shown that NRT is an effective aid in the treatment of tobacco abstinence.<sup>63 US Department of Health and Human Services   Clinical Practice Guideline, Number 18: Smoking Cessation Washington DC: US Government Printing Office (1996).  AHCPR Publication No. 96–0692..

Cliquez ici pour aller à la section Références</sup> This article summarizes the scientific rationale for nicotine replacement medication, describes the clinical features of each of the currently available medications, and offers recommendations as to how nicotine replacement medications might be used in the future to treat tobacco dependence.