Patch Puts Out Burning Desire to Light Up a Smoke

Arlene Gonsalves took her first puff at age 14. This fall, 27 years later, she finally kicked the smoking habit.

The reason? A tiny patch she wore on her chest for a month. This stick-on drug-delivery system put a substance called clonidine into her bloodstream, warding off the withdrawal symptoms that had sent her running for a smoke when she had tried to quit “millions of times” before.

“It’s been like nothing I’ve ever done before,” Gonsalves said of the treatment program two months ago that ended her three-pack-a-day habit.

For 10 years, before she tried the patch at a clinic run by a San Diego psychiatrist, Gonsalves, a real estate agent who lives in Vista, tried every stop-smoking method she could find. A commercial clinic, hypnosis and an American Cancer Society program were among them.

Withdrawal Too Difficult

But like others who might participate in today’s Great American Smokeout--when the American Cancer Society urges smokers to abstain for at least that day--Gonsalves found withdrawal too difficult.

“The reason I would always go back is that it was just so unpleasant not to have that nicotine going into my body,” she said. “I was a nervous wreck. I was always fidgeting. I was anxious, always on edge. So that’s why I would constantly reach for the cigarettes, even though I really wanted to quit.”

Gonsalves’ use of a clonidine patch to get her past withdrawal put her among only a few smokers nationwide who have used this method, which is still in the research stages.

After leading a novel study of the method last year, while he was chief psychiatric resident at UC San Diego, Dr. Steven A. Ornish broke more ground by setting up the nation’s first clinic offering transdermal clonidine to smokers.

So far, the $245 program has drawn only about two dozen participants, but Ornish is optimistic about the method’s future as an alternative to nicorette chewing gum. The nicotine-containing gum is the primary method doctors use for patients who need help with symptoms of cigarette withdrawal.

Ornish noted that he recently was asked to talk about transdermal clonidine at the American Psychiatric Assn.’s annual meeting.

Clonidine, a blood-pressure medicine that has been around for years, has shown promise in the last decade in alleviating withdrawal symptoms in morphine and heroin addicts and in cigarette smokers. Skin patches have recently been marketed for

use in patients with high blood pressure. Another study in 1985 tested skin patches for delivering nicotine itself to smokers.

Ornish’s study was the first to pull all those elements together, as he and others began the current wave of research investigating clonidine as a stop-smoking aid.

In the technique, a postage-stamp-size patch containing the drug is placed on the skin. A patch delivers the drug continuously for about a week, then is replaced by another. The drug enters the skin through the patch’s semipermeable membrane, much as with skin patches used to counteract seasickness. The delivery system eliminates the problem of forgotten pills and seems to result in a more even level of the drug in the bloodstream, Ornish said.

His study of 40 smokers, done with Dr. Sidney Zisook and Lou Ann McAdams at UCSD, found that clonidine alleviated craving, anxiety, irritability and restlessness. The participants were studied for a week.

Ornish’s clinic also has the smokers attend support group meetings once a week to help with the social and psychological consequences of quitting smoking.

But because the use of clonidine is still in the investigative stages, Ornish’s quick action to offer the drug to smokers is not without controversy.

Gum Is Still Top Choice

Nicorette chewing gum remains the treatment of choice for helping smokers past withdrawal symptoms, said Dr. Steven R. Cummings, a UC San Francisco Medical Center researcher who in September published a study of how the gum is used by doctors.

“There are zero studies of long-term success with clonidine, and there are a number of studies showing long-term success with nicorette gum,” Cummings said.

“We don’t know much about it,” he said of clonidine, noting that it has distinct side effects: lowered blood pressure and, in some people, drowsiness.

“And we don’t know what happens after people stop taking it,” Cummings said. “If they stop it and go back to smoking, what happens to their blood pressure?”

Given such questions, opening a clinic “seems early,” he said, but added, “It at least has some scientific basis.”

Dr. Allan Adler, medical director at Alvarado Parkway Institute, said his main concern about commercial stop-smoking programs is that they may not offer the social and psychological support necessary for smokers to stay off cigarettes.

“There’s no simplistic solution,” Adler said. “Any program that just passes out clonidine isn’t doing any good at all.”

For Arlene Gonsalves, clonidine had only minor side effects and made a major difference in her battle against smoking.

“It’s so good because it takes away all the craving, all the anxiety that you feel when you quit,” she said. “It’s just a real peaceful way to do it.”