A few words of caution about varenicline (Chantix and Champix). Never in the history of cessation products have we seen such a wide array of serious side effects, including death.
And here's the problem. We can't accurately predict who will and won't sustain harm. What can be asserted with confidence is that varenicline is not the magic cure, or nearly as effective in real-world use, as Pfizer marketing suggests.
Three studies pitted varenicline against NRT: Aubin 2008, Tsukahara 2010 and Dhelaria 2012. In each, varenicline failed to show statistical significance over NRT when looking at the percentage of quitters within each group who were still not smoking at 24 weeks.
The Aubin study notes that two varenicline users experienced severe depression, with suicidal ideation causing one to be hospitalized 11 days after ending use. It found that among 376 Chantix users and 370 patch users that the likelihood of a Chantix users experiencing vomiting was 5.5 times greater, that decreased sense of taste was 5.3 times greater, abdominal pain x5, disturbances in attention x4.5, nausea x4, flatulence x4, constipation x3, headaches x2, dizziness x2, diarrhea x2, with 2.3 times as many Chantix users complaining of fatigue.
Does it make sense to assume significantly increased risks, including risk of death, without a significant increase in your odds of success?
England's "Stop Smoking Services" (NHS SSS) may offer the most comprehensive government sponsored cessation services of any nation. Services include free individual or group counseling and support.
A 2008 study analyzed NHS SSS program performance. It found that at four weeks after starting varenicline use (Champix in the UK) that 63% of users were still not smoking as compared to 48% using nicotine replacement products (NRT) such as the nicotine patch, gum or lozenge, and 51% who stopped smoking without use of any product.
While at first blush it appears that varenicline has the lead, keep in mind that these are four-week results and that both varenicline and NRT users still face another 4-8 weeks of "treatment" before trying to adjust to living and functioning with natural brain dopamine stimulation.
The only long-term English evidence is from an April 2005 study that examined one-year success rates. That study did not include varenicline as it wasn't yet on the market. It found that while 25.5% of those who attempted to stop without using any pharma product were still smoke-free at one year, only 15.2% of NRT users and 14.4% of bupropion (Zyban) users were still not smoking.
I strongly suspect that varenicline one-year rates are likely slightly better than NRT (due to pill swallowing being easier than hourly chewing or daily patching) but significantly worse than cold turkey.
Don't expect any researcher to ever include a copy of FFN-TJH or Joel's book as part of any fair, open-label study pitting cold turkey against varenicline or NRT. Doing so would produce a cold turkey victory that would destroy the industry's golden goose. Also, any researcher bold enough to conduct such a study would never receive pharma industry study funding again.
Joel's poll suggestion - Joel has also written extensively on pharma industry cessation products. He was warning about nicotine gum's ability to foster relapse or become a crutch, as early as 1984.
He encourages those contemplating using industry products to take their own poll of all successful long-term ex-users who have remained nicotine-free for at least a year. He encourages us to believe our own survey findings.
Joel reminds us that smoking declined from 42% to 23% over the past 40 years, but that the drop-off stalled in the 1990s. He finds it curious because that's when pharma industry NRT started experiencing widespread use.
"Nicotine gum was first approved for use in America in 1984, by prescription only. In 1991 and 1992, four patches were approved for prescription use. In 1996 all controls broke loose as the gum and two of the four patches went over-the-counter and Zyban (bupropion) was just coming into the fray."
"Lets hope not too many miracle products for smoking cessation get introduced in the future as it may result in skyrocketing smoking rates," suggests Joel.
Why delay and extend withdrawal and neuronal re-sensitization for weeks or months? Keep in mind that a 7mg. nicotine patch delivers the nicotine equivalent of smoking seven cigarettes a day.
In the end, all drug addicts who successfully recover must give-up their drug. In fact, all who successfully arrest their dependency eventually go cold turkey.
It is then and there that the rule for staying free becomes the same for all ... no nicotine just one day at a time.