The Cravings Market: Who Benefits from Nicotine Replacement Therapies?

Gums, lozenges, patches...there’s an array of brand names, flavors and packaging that makes cutting your nicotine habit that much more of an accessory. Marketed as a quit aid that’s easy to take and is commonly found in any subprime grocery store, nicotine replacement therapies (NRTs) have become available to the public market as the easiest way to wean yourself off smoking—an ever more desirable goal for many Americans. But recent studies suggest that these so-called therapies are just another way for tobacco and pharmaceutical industries to increase profits, and at the expense of poor communities that do not have access to alternative therapies.

The Centers for Disease Control and Prevention reports that 7 out of 10 smokers are looking to quit smoking completely. And the abundance of over-the-counter NRTs has provided many with the packaged means to quit. Though while the public market sees e-cigarettes and nicotine patches as the most accessible way to quit smoking, studies show that NRTs are less effective than people are misled to believe; moreover, the tobacco industry has had a strong hand in pioneering these products. Meanwhile ineffective NRTs have become the main means for working class and poor people to approach quitting. The smoking rate among Americans without a high school diploma is 40%, more than twice the national average.

A recent study published in the American Journal of Public Health offers new reason to question the efficacy of burgeoning NRT treatments. Citing previously unpublished tobacco industry documents, coined the "Tobacco Papers," a team from the UCSF Center for Tobacco Control Research and Education revealed that the tobacco market has found business incentives in NRTs for decades. As the UCSF paper argues, “the tobacco industry opposed NRT when it first appeared in the 1980s but by 2016 was marketing its own NRT products.” An investment that exemplifies the industry’s power over individuals with nicotine addiction — often those from poor communities.   

According to Science Daily, nicotine replacement therapies were introduced in 1984 as a prescription medication and prescribed as a supplement to behavioral therapy, one of the more successful approaches to quitting smoking. Though as the UCSF research team found, while tobacco industries approached NRTs with enlightened trepidation, largely due to their studied success when paired with behavioral therapies, the industry’s perspective transformed as companies found physicians inappropriately administering NRTs, meaning as treatments lost their efficacy.

In truth, the tobacco industry has manipulated the NRT market since the 1950s. As UCSF researchers found, industry interest in the "craving relief market" existed before the advent of e-cigarettes and their antecedents: lozenges, gums and patches. The industry’s research into the smokeless market was merely stunted due to fear it would garner FDA attention and therefore regulation. As one document from Phillip Morris concluded: “Without some degree of psychological therapy, many experts warn that the nicotine patch is powerless,” a statement that led the industry to invest in the unregulated proliferation of NRTs. By 1996 the public could buy NRTs without a prescription or therapy due to changes in FDA regulation. A decision that only made it easier for the stressed-out and working poor to access quit aids, without the necessary and beneficial co-treatments.

As AlterNet recently reported, quitting smoking is largely a matter of dealing with stress triggers, which often keep long-time smokers in a cycle of cravings. Having financial access to behavioral therapies dramatically improves an individual’s chances of successfully quitting, and poorer communities cannot afford the same counsel. As the UCSF research concluded, quit aids and NRTs are relatively ineffective if they are not combined with behavioral therapy programs.

A quick look at Medi-Cal’s "No-Butts" Program shows how behavioral support is now limited to a 1-800 call number. Instead the program emphasizes a questionable list of patches, gums and other nicotine supplements to  address a smoking addiction. As another UCSF study showed, financial ties between pharmaceutical and tobacco companies have long spirited competition and collaboration. Like in 2009, when Reynolds American, the country’s second largest tobacco company, bought Niconovum, a Swedish company that produced smoking cessation products. These kinds of mergings make it irresponsible for the healthcare industry to repudiate these compromised quit aids at all, especially without proper complementary treatments and support.

A study published by the BMJ estimates that the number of attempts made to quit smoking are grossly underestimated. Their findings suggest that “a current smoker tries to quit on average 30 times or more before successfully quitting for 1 year or longer.” This is profoundly more than the 6 times often cited by health care agencies. With a large percentage of the population looking to quit, one wonders if it’s desire that’s impeding cigarette consumption, or the trouble of managing the circulation of stressful life triggers. If there is any population vulnerable to health ramifications of stress, it’s poor communities that do not have equal access to corporatized healthcare, including behavioral therapy programs.

In order for smoking addiction programs to be effective, public access to low-cost and free behavioral therapy programs should be reestablished. As it stands, the deregulation of NRT’s, alongside the lack of behavioral therapies, has only allowed the NRT market to successfully propel tobacco dependency and its lucrative subsidiaries. Once again, the poorest communities are the most vulnerable to the market’s pull; and meanwhile, tobacco industry gains are all patched up.


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