Confessions Of A Nicotine Patch Wearer

Faithful readers of this section may remember a rather touchy-feely piece on hypnotism that ran about 18 months ago. I, the subject, was supposed to go into trances and kick my 23-year smoking habit. I went into trances. I did not kick the habit.

This summer, my disgusted editor ordered me to get a prescription for a nicotine patch. I'm wearing one now, on my left deltoid. It looks like an oversize Band-Aid, except "nicotine/21 MG/24 HR" is printed on it in brown block type. I put on a fresh one every day. Choosing a new site isn't as stimulating as my morning cigarette used to be, but I try to enjoy the ritual.

Nicotine patches hit the drugstores with a bang in December, 1991. Initially, so many smokers tried them that manufacturers couldn't keep up with demand. Consumer fervor cooled last spring, when Sturdy Memorial Hospital in Attleboro, Mass., reported treating five patch-wearers for heart attacks: They smoked while wearing their patches, and nicotine overdose pushed their blood pressure dangerously high. Subsequently, addicts found that using patches didn't detox them overnight. "People need to understand that slapping a patch on your arm is not a solution," says Jerie Jordan, editor of the American Cancer Society's World Smoking & Health magazine.

BAD DREAMS. But these sticky little things help a lot. The four types currently on the market all work much the same way: They deliver nicotine, the addictive substance in cigarettes, to the bloodstream transdermally, while the wearer learns to live smoke-free. A smoker's life is a series of peaks and valleys, controlled by the number of cigarettes smoked. The patch smooths these out, eliminating the acute physical craving that follows a nicotine "fast."

Ciba-Geigy's Habitrol (the one I use) and Marion Merrell Dow's Nicoderm are virtually identical. Worn round the clock, they come in three dosages and are designed to wean heavy smokers gradually, over two to three months. American Cyanamid's ProStep, also a 24-hour patch, comes in just two dosages, requiring a fairly sharp withdrawal from 22 mg of nicotine a day to 11 mg after several weeks. A month's supply of patches costs from $123 for 30 21-mg Habitrols to $90 for 11-mg ProSteps.

The most widely reported side effects are skin irritation and sleep disturbances ranging from insomnia to nightmares. Many patch users report a slight tingling or itching sensation when they first apply a patch to virgin territory, but unless you have unusually sensitive skin, these symptoms subside quickly.

Sleep disturbances are another story. My dreams are marathons of subconscious violence and sexual misadventure, from which I awake exhausted. In part to address such problems, Warner-Lambert introduced Nicotrol, a patch that's worn only during the day. The drawback, of course, is that heavy smokers waking up after a long nicotine fast are more likely to cheat, as it takes a couple of hours for a fresh patch to begin drug delivery.

NO FOOLING. Smoking-cessation experts stress the patch is most effective when supplemented by behavior-modification therapy or a self-help program. And the patch is worthless if not used correctly. Wearing one at work because colleagues go ballistic at a whiff of tobacco, only to strip it off in the evening, won't help you quit. "It's like any other prescription medication--you shouldn't fool around with it," says Hildy Dillon, manager of the American Lung Assn.'s Smoking or Health program.

I should know. After a cigaretteless month, the patch slipped off my damp skin during a high-energy rock 'n' roll concert. Sure enough, three hours later I was smoking again. Since then, I have cheated, going on and off the patch--and guiltily sneaking smokes--depending on my level of sanity. When my editor reads this, he'll probably make me write a first-person story on liquid diets.

But I haven't lost the battle against my addiction. "Most smokers have to make at least two or three serious quit attempts before they actually succeed," says the ala's Dillon. Each relapse, the experts tell me, is part of the quitting process. If only I could stay in a trance until it's all over.

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