Patch

The patch was developed well over a decade ago to provide a safe way of introducing nicotine to the brain. The cigarette smoke contains nicotine and is an instant way of gratifying the addictive need for that drug. Unfortunately the smoke itself is very deadly containing cyanide. Carbon monoxide, over ten proven cancer-causing chemicals and a number of other substances that are associated with major disease. Nicotine itself is relatively harmless and provides a number of very gratifying purposes, e.g. relaxation, anti-stress, and even ability to concentrate more on boring tasks, as well as for some aiding a bowel movement.

Nicotine as a chemical cannot be absorbed through the stomach, nor through the small or large intestines, just like insulin and other some drugs have to be administered through other than pill form. Nicotine in the cigarette is quickly absorbed through the lungs, however this is not acceptable due to the smoke as noted above. However the nicotine can be safely absorbed through the skin. This led to the development of the patch which is designed to slowly introduce nicotine into the blood stream over a twenty-four hour period.

Use of the patch is very much like using methadone for heroin addicts. You must get all of your nicotine from the patch and none at all from cigarettes. It is not to ever be used as a "helper" to stop smoking gradually. The patch when properly dosed will immediately take the place of the nicotine dependency. Do not combine the patch with cigarettes.

Many of our patients have come with the sad story of absolute failure in using the patch. "Doc, I did just what they told me and it didn't help at all, I just kept needing to smoke cigarettes and I never could stop". The reasons for failure are generally understood by us. The most common are:

• Incorrect dosage- The amount of nicotine in the patch (usually 21, 14, or 7 mg. a day) is designed to replace all the nicotine that your brain demands from the cigarettes. However, the daily amount of nicotine varies considerably from person to person. This has to be calculated on an individual basis.
  
  Some cigarettes have 0.1 mg. per cigarette while others are as high as 2.0. Some people smoke 10 cigarettes a day and a few go as high as 90. You can see therefore that the amount of nicotine can vary tremendously from as little as 1 mg. in 24 hours to 180 mg. in 24 hours. This tremendous variation requires that the amount of patch nicotine must be regulated to meet your needs. You might be getting too much nicotine in your patch or you might be getting too little.
  
  
• Side effects of the patch- The most common annoyance is irritation of the skin. One must be careful to relocate the new patch every 24 hours. Sometimes one brand of patch will have an adhesive that annoys. This should be changed by prescription if necessary. Some people are kept awake or have excessive dreams. In that case the patch might be removed by bedtime and a new one replaced in the morning.
  
  
• Extra control needed- Cigarette smokers are used to reaching for the pack when needed. Obviously this cannot be done with good results in treatment. However, additional nicotine that can be voluntarily administered for the moment is available with nicotine chewing gum. Proper prescription can help those who have to be in charge of the additional nicotine needed for special occasions.
  
  
• Extra stress problems- The nicotine patch although it is correctly dosed for the 24-hour period may not be enough to help with extra stress factors such as confrontations at work, pre-exam anxiety, domestic arguments, etc.. Here extra treatment can be very useful such as hypnosis, relaxation therapy, and a very new approach: biofeedback stress reduction.
  

When appropriately used the patch is a superb way of controlling nicotine deprivation and the availability of nicotine in the brain helps the highly addicted smoker avoid the "first cigarette before the feet hit the floor" pattern.