Nicotine preloading: effectiveness and meachanisms

There currently exist several effective pharmacotherapies that can help smokers quit. Even with a high degree of efficacy compared to placebo however, most patients treated with the standard treatment regimens do not achieve long-term smoking cessation and there remains a considerable scope for improvement. Both nicotine replacement treatments and varenicline have been shown to reduce urges to smoke and enjoyment of smoking and this opens a possibility that providing such treatments for a period of time PRIOR to stopping smoking may enhance treatment efficacy. The current use of these medications relies on their effects on alleviating post-cessation withdrawal discomfort. Using them while still smoking (pre-loading) could utilise this other effect that they can have on lowering the subjective reward that accompanies smoking and thus weakening the association of smoking with enjoyment. This in turn could in theory enhance smoking cessation and treatment efficacy. Several early tests of this hypothesis were inconclusive. This symposium will report for the first time the results from the largest study of nicotine pre-loading to date, as well as from a new study that included both NRT and varenicline. The presentations will cover treatment efficacy as well as the results of testing the hypothetical active ingredients of any effects. The concluding panel discussion with the presenters and the invited discussant will focus on directions for future research.

JUSTIFICATION: Using cessation medication prior to quit day is rarely used in clinical practice and there is equivocal evidence on whether it is effective. This symposium will present new data on effectiveness and mechanisms of action.