Breaking free: Guide to kicking the unhealthy habit

Cigarette smoking has long been a deeply ingrained habit in Malaysia, often associated with social settings such as coffee shops and roadside eateries. Despite the presence of “No Smoking” signs in certain areas, compliance had historically been inconsistent. However, in recent years, the landscape has shifted following the implementation of stricter tobacco control laws. While the prevalence of traditional cigarette use has shown a decline, the emergence and increasing popularity of electronic cigarettes (e-cigarettes) and vapes present a new public health concern.

Why is it time to quit smoking for good?

Smoking poses a significant threat to both public health and the economy. In Malaysia, approximately 20,000 deaths annually are attributed to smoking-related illnesses. Tobacco use harms nearly every organ in the body and is a major cause of lung cancer and chronic obstructive pulmonary disease (COPD). It also contributes to coronary heart disease, stroke, and numerous other cancers and chronic health conditions.

Exposure to secondhand smoke is also harmful at any level, as it increases the risk of heart disease, lung cancer, and other serious illnesses. Secondhand smoke, also known as passive smoke, consists of the smoke exhaled by smokers and the smoke released from the burning end of a cigarette. Children and other vulnerable groups are especially affected, with exposure linked to respiratory infections, ear infections, asthma attacks, and sudden infant death syndrome (SIDS).

In addition to its health consequences, smoking imposes a heavy financial burden on the nation. A significant portion of the national gross domestic product is allocated to healthcare expenses for treating diseases related to smoking. This situation highlights the need for coordinated efforts aimed at preventing smoking initiation, particularly among the younger population, and providing effective support for individuals who wish to quit smoking.

The benefits of nicotine replacement therapy (NRT)

Whether in the form of traditional cigarettes or e-cigarettes, smoking products contain nicotine, which is a highly addictive substance that reinforces the habit and makes quitting especially difficult. According to the Global Adult Tobacco Survey (GATS) 2023, 59.7 per cent of smokers in Malaysia have expressed a desire to quit smoking. However, many face challenges such as nicotine dependence and limited access to support services. Therefore, it is crucial to increase public awareness about the treatment options and support systems that are available to help individuals overcome addiction and successfully quit smoking.

Nicotine is the key addictive component in smoking products; meanwhile, the other toxic substances found in traditional cigarettes are responsible for the health issues and deaths linked to smoking. Nicotine works by stimulating receptors in the brain, which triggers the release of dopamine hormone.

Photo for illustration purposes only.

Nicotine Replacement Therapy (NRT) is an effective treatment designed to assist individuals in quitting smoking by providing controlled amounts of nicotine without exposing the body to the harmful substances present in cigarettes. This helps alleviate withdrawal symptoms and reduce cravings, gradually decreasing physical dependence on cigarettes.

Over time, the dosage of NRT is reduced, allowing the body to adjust and ultimately quit nicotine use entirely. There is strong evidence supporting the effectiveness of NRT in helping individuals quit smoking, and it is widely recommended by clinical guidelines as a first-line treatment for those seeking pharmacological support.

The Health Ministry (MOH) reclassified NRT products, such as gum and patches, from the 'Group C poison' category under the First Schedule of the Poisons Act 1952 to the non-poison group. These changes have made these products more accessible, allowing for widespread over-the-counter sales in pharmacies across Malaysia.

The appropriate ways to use NRT products

Each NRT product should be used with specific instructions to maximize its effectiveness and minimize potential side effects.

Nicotine gum

Nicotine gum is designed to release nicotine gradually while being chewed, helping to manage cravings effectively. Nicotine gum should be used for up to 12 weeks, with a maximum of 24 pieces per day. Nicotine gum should be chewed slowly until a peppery or mint taste or tingling sensation is felt. The gum should then be held between the cheek and gum until the tingling sensation fades. This chew-park cycle should be repeated for up to 30 minutes. To ensure proper absorption of nicotine, it is advisable to avoid eating or drinking anything except plain water for 15 minutes before and during the use of the gum. Common side effects of nicotine gum may include mouth soreness, hiccups, dyspepsia, and jaw aches which are usually mild and temporary.

Nicotine patches

Nicotine patches are transdermal devices designed to release nicotine steadily throughout the day, helping individuals manage cravings and reduce dependence. Nicotine patches should be applied once daily to clean, dry, and non-hairy skin, such as the upper arm, hip, back, or chest. The patch should be pressed firmly for approximately 10 seconds to ensure proper adhesion. To prevent skin irritation, it is advisable to rotate the application sites with each new patch and avoid applying the patches on the same spot.

Nicotine mouth sprays

Nicotine mouth sprays deliver nicotine directly to the mouth lining for quick relief of cravings, making them a fast-acting option for those looking to curb their nicotine urges. When cravings emerge or when an individual would typically smoke, one or two sprays should be used. The maximum recommended usage is four sprays per hour to avoid excessive nicotine intake.

Nicotine lozenges

Nicotine lozenges are available in two strengths, with 2 mg for smokers who consume fewer than 20 cigarettes per day, and 4 mg for those who smoke more than 20 cigarettes daily. The maximum duration for using nicotine lozenges is 24 weeks. It is important not to chew or swallow the lozenge, and one should also refrain from eating or drinking while it is in the mouth to ensure proper absorption. Common side effects may include nausea, vomiting, dry mouth, and oral discomfort.

Advice for smokers before using NRT products

Before starting any nicotine replacement therapy (NRT), it is highly recommended to consult healthcare professionals, such as doctors or pharmacists. They can help to assess the suitability of NRT by identifying any allergies or health conditions that may interfere with its use. They will also guide smokers in selecting the most appropriate form of NRT (patches, gum, sprays, or lozenges) and the correct dosage based on their smoking habits and lifestyle. In many cases, combining long-acting NRT (like patches) with short-acting options (such as gum or sprays) can be more effective in managing cravings.

Healthcare professionals such as doctors and pharmacists can provide detailed instructions on the proper use of the chosen NRT product to ensure maximum effectiveness. They will monitor progress through regular follow-ups, help manage any side effects, and adjust the treatment plan as needed. These will subsequently increase the chances of long-term success.

Individuals who wish to quit smoking are also encouraged to seek help from the Smoking Cessation Services available at most MOH healthcare facilities. In addition, similar support is provided through the mQuit programme, which is offered by selected private healthcare facilities.

In conclusion, quitting smoking is a challenging but achievable goal. With the right support and treatment, individuals can break free from nicotine addiction. The combination of effective NRT, guidance from healthcare professionals, and a commitment to making lasting lifestyle changes can significantly improve the chances of success.

If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Jolene Tay Luen Ling is a pharmacist. The views expressed in this article are her own and do not necessarily reflect those of Sinar Daily.