Stubbing out a habit

Anthony Tarducci has tried to quit smoking many times over the last 25 years. He's gone cold turkey, slapped on the patch, even taken antidepressants. Nothing worked.

On June 23 he tried again, this time with a powerful new aid: Chantix - the antismoking medicine that was approved for sale in the United States 18 months ago.

Today, the 45-year-old South Philadelphian considers himself an ex-smoker, and he credits the drug with enabling him to kick his more-than-a-pack-a-day habit.

"What I found with everything else I tried was I still had that urge, I still had that craving," says Tarducci. "When I was on Chantix I never had any of that. I just didn't want to smoke anymore."

And that, in a nutshell, is the difference between Chantix and other antismoking pharmaceuticals.

The others substitute a cigarette's nicotine - the component that makes it physically addictive as well as pleasurable - with their own. Smokers can then quit the habit while getting their nicotine-induced pleasure elsewhere.

Chantix, on the other hand, was designed to give pleasure without nicotine.

The Pfizer drug, whose scientific name is varenicline, appears to work in two ways: It blocks nicotine from binding to receptors in the brain that trigger the release of dopamine, a chemical neurotransmitter that generates feelings of pleasure. At the same time, Chantix stimulates the brain to release some dopamine, which reduces symptoms of withdrawal.

But Chantix is still far from a sure thing. Less than half of smokers manage to stay off cigarettes during the typical 12-week prescription. Even fewer, just one in four, remain smoke-free after a year.

Robert Murray is one who didn't make it.

At first he was able to cut four cigarettes a day from his pack-and-a-half habit. He soon found himself back where he started, and dropped the medication.

After two heart attacks, the 49-year-old Roxborough resident is plenty motivated to quit. He knows his health problems are related to the 35-year habit, and he worries about not being around for his kids and grandkids.

So he's planning to try again with a Chantix-boosted New Year's resolution - after all, the drug worked better than anything else he's tried.

Head-to-head comparisons have found it gets significantly better results than other antismoking aids. Researchers reported in the Journal of the American Medical Association last year that 23 percent of Chantix users still weren't smoking 12 months later vs. 15 percent of those who relied on a commonly used antidepressant, burpropion, and fewer who quit cold turkey.

"Chantix is the most effective FDA-approved treatment for smoking," says Freda Patterson, a project director at the University of Pennsylvania's Transdisciplinary Tobacco Use Research Center. "Still, only a fraction of smokers looking to quit do so effectively."

The reason, as she and other scientists have known for years, is that "smoking is a behavioral as well as a biological addiction."

So while Chantix seems effective at blocking the biological impulse, many smokers still can't break habits that they have integrated into their lives over decades - lighting up automatically after meals, for example, when stressed.

Changing her routine has been the challenge for Vienna Leoncavallo, who started smoking in her teens.

After using Chantix for six weeks so far, the 57-year-old Bella Vista resident says she no longer feels the need to smoke. Yet she's still smoking.

"With me, it is totally the habit," she says. "I just can't get rid of those two little cigarettes with my morning coffee."

Even so, Leoncavallo is pleased with the results of using Chantix, and doesn't mind shelling out the $125 for a 30-day supply of shrink-wrapped tablets.

"They are not cheap," she says, "but they are cheaper than cigarettes."

The manufacturers' instructions for Chantix suggest that patients not quit during the first week, while the dose is ramped up. After that they should try, and ideally stay off forever.

"You should take it for at least three months," says Sandra Weibel, a pulmonary and critical-care doctor at Thomas Jefferson University Hospital. "In the studies they suggest that if you take it longer your chance of a relapse is less."

Weibel says "the biggest hurdle with Chantix these days is that it is often not covered by insurance."

Aetna and Independence Blue Cross, the region's two largest health insurers, don't cover any smoking-cessation drugs under standard policies, although both allow employers to add the benefit for an extra charge.

Paul N. Urick, vice president of pharmacy services at Blue Cross, says the evidence points toward giving people the tools they need to break ingrained habits.

"We are always interested in what is most effective to help people," Urick says. "So far, smoking-cessation programs is the best thing and that is what we are getting behind." Blue Cross provides partial reimbursement for such efforts through its healthy lifestyles program.

Even without the boost of insurance coverage, sales of Chantix are brisk. More than six million prescriptions were filled during its first 13 months on the market, generating sales of $576 million, according to IMS Health, a health-care information company in Plymouth Meeting.

This despite the drug's common side effects: nausea, constipation, gas, vomiting, and, for some users, sleep disturbances that include strange or particularly vivid dreams.

Tarducci, the South Philadelphia success story, has experienced some nausea and a few "crazy dreams" that he attributes not to Chantix but to the absence of his pack-and-a-half-a-day fix.

Breaking the habit was worth the price in any case, he says, recalling how he has felt more and more of an outcast over the years as the stigma of smoking has grown.

Yet a week after he quit, Tarducci wanted a cigarette. He went to the store.

"But when I got to the cashier and asked for a pack, I decided 'no, I really can't do this' and left," he says. "If I hadn't really wanted to quit, I don't think I could have walked away."

But just to be sure, and on his doctor's recommendation, Tarducci is continuing to take Chantix to help him get through the holiday stress, smoke-free.

With or without Chantix, successfully quitting a longtime habit usually requires planning and support.

Some suggestions:

Get ready: Set a date. Get rid of all cigarettes and ashtrays. Learn where smoke-free environments are enforced. Don't allow smoking in your home.

Find support: Get help from your doctor. Tell friends and family that you plan to quit, and ask for their help. Join a smoking-cessation program.

Find a new habit: Distract yourself from the urge to smoke. Change your routine. Plan something enjoyable to do. Drink plenty of water. Reduce stress.

Prepare yourself to avoid relapse or bad situations: Avoid alcohol. Visit smoke-free environments. Stay out of smoke-filled bars, restaurants and other locations. Exercise and eat a healthy diet. Think positive.

SOURCE: Pennsylvania Medical Society

Additional guidance, an animation of how Chantix works, plus lists of free smoking-cessation programs around the region: http://go.philly.com/health

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