[Problems of abuse of and dependence on Nicotine Replacement Therapy (NRT)]

Smoking addiction consists in co-existence of pharmacological nicotine dependence and behavioral dependence. The most commonly used nicotine dependence pharmacotherapy is the Nicotine Replacement Therapy (NRT). At first, NRT preparations in many countries have been available on prescription only. Gradual introduction of NRT into over-the-counter sale involved the possibility of abuse. As a consequence, patients could become dependent on nicotine contained in the preparations, which are meant to be therapeutic. The analysis of results of current studies indicates that a small fraction of NRT patients (0.4-17%) uses it for a time longer than recommended. Thorough research assessing particular dependence symptoms do not, however, reveal such symptoms as: pleasure or satisfaction connected with taking the NRT preparations, subjective sense of dependence, difficulty in ceasing using NRT or occurrence of withdrawal symptoms. Thus, it has been suggested that NRT dependence occurs extremely rare is often times confused with chronic use. On the other hand, numerous studies show increased effectiveness of prolonged Nicotine Replacement Therapy, especially in heavy smokers. It is believed that a prolonged therapy using one NRT preparation does not pose any threat of severe side effects, just like simultaneous using of two NRT preparations or using NRT while continuing smoking. Conclusions drawn from current studies are reflected in the state-of-the-art guidelines concerning NRT use.