Nov. 19--Chantix is one of the most successful smoking cessation products ever introduced, in part because it partially ties up nicotine receptors in the reward areas of the brain. But even its inventor said the pill can't help people who aren't committed to quitting.
Jotham W. Coe, a research fellow at Pfizer Global Research and Development, spoke Wednesday during Grand Rounds at Medical College of Georgia before students and faculty from the School of Nursing, School of Graduate Studies and the University of Georgia College of Pharmacy.
Smoking works by nicotine activating neurons in the reward area to release dopamine, Dr. Coe said.
"It makes you feel good," he said. "When dopamine is released, it is basically telling you, whatever you did, do it again."
That reinforces the behavior and, when dopamine levels drop, helps create the urge to smoke again.
When the smoking ends "you feel lousy," Dr. Coe said, and suffer from such withdrawal symptoms as irritability, depression and sleep problems. Nicotine replacement therapy, such as the patch or gum, helps create a low level of dopamine reaction to keep those symptoms at bay. The problem is, it is still possible to smoke while using them and get an extra reward, which leads some to smoke again. Chantix ties up that receptor, creating the same low level dopamine response, but prevents nicotine from creating an additional reward if the person smokes, Dr. Coe said.
"I think of it as a 40-watt light bulb," he said, explaining that it gives off some light but also occupies the nicotine socket.
Chantix has shown a good level of success -- a 12-week course produces long-term quit rates of nearly 30 percent, Dr. Coe said. An analysis published in 2008 of six clinical trials found a regimen was three times more effective than trying to quit without drugs. The MCG smoking cessation clinic, which uses a six-week course, has had 130 patients use it and 104 were able to quit, about a 78 percent success rate, said Director Janie Heath.
"It really is the best thing since I've been practicing to help patients quit," said Dr. Heath, a 15-year veteran.
But much is up to the patient and going into it with the right attitude, said Dr. Coe, who smoked 21/2 packs a day before he quit 18 years ago.
"The way I view quitting smoking is it is a re-establishment of your self-image and your behavior in the absence of smoking," he said. "You are retraining yourself. You essentially have to experience almost all of the conditions where you normally would have smoked.
"And what comes with that is pride, trust and strength and belief in yourself. That doesn't come from a pill. That comes from experience. A pill helps you get through those experiences. It's rewarding to see it really work, to see it work quite a bit."
Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.
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