THE LAST TIME John Stone tried to quit smoking he found himself in a cafe saying to a smoker, "I'm either going to kill you or you're going to give me a cigarette."
This time, rather than with threats, the interior designer is trying to end his 1 1/2 -pack-a-day habit with help from a patch, which, when applied to the skin, allows nicotine gradually to enter the bloodstream.
"It kills the physical craving for the nicotine," Mr. Stone said on Day 24 without lighting up. "The habit is there -- the craving for having something between your fingers or in your mouth is still there . . . but this really helps."
Doctors and pharmacists have been fielding dozens of calls from smokers like Mr. Stone who have seen advertisements, including promotions during Sunday's Super Bowl programming, for the newest weapons in the battle to quit smoking. These would-be non-smokers want to try two prescription products that just entered the market: Nicoderm, made by Marion Merrell Dow (makers of Nicorette gum), and Habitrol, manufactured by Ciba-Geigy.
"There's a tremendous clamoring for the patches," says Dr. Donald R. Jasinski, chief of the center for chemical dependence at Francis Scott Key Medical Center. "Some physicians' phones are ringing off the hook with people asking for them."
Both products are patches that smokers apply daily to the skin anywhere on the upper body. As the weeks wear on, the amount of nicotine that seeps into the bloodstream is decreased. "The recommended course for Nicoderm is 10 weeks, and there are three different strengths. You decrease strengths so that it's easier to just walk away [from cigarettes]," said Tom Heapes, manager of product communications for Marion Merrell Dow. For Habitrol, treatment typically lasts about three months.
The patches, said Dr. Jasinski who conducted a study of Habitrol, relieve physical symptoms of withdrawal from cigarettes which can include irritability, frustration, nervousness, increased appetite and difficulty in concentrating.
"The withdrawal peaks at about the second to third day and persists for about 4 weeks. So you transfer [the smokers] to the patch and you keep them on it for several weeks then you wean them off," he said.
The average cost for the patches is $3 to $4 a day "which is comparable to a two-pack-a-day smoker," said Mr. Heapes of Marion Merrell Dow.
And although it is too early for consumers to say they've quit smoking while using the patches, according to one study of Nicoderm, published in the Journal of the American Medical Association, one in four patients using the patch was still a non-smoker after six months, compared to one in nine of those patients using a placebo.
However, there's a catch, say doctors. While alleviating physical symptoms of addiction to nicotine, the patches don't address the psychological addiction to cigarettes, said Dr. Jasinski. "The major concern that I have -- and a number of others in the medical community -- is that a lot of people will go in and doctors will just give them a prescription and they'll get the drug. . . just giving people the patch is not a magic bullet."
"Statistics show that if you have some kind of support for the behavior changes you can double the quit rate. For example, if smokers do something besides wearing the patch -- which could include joining a group or practice relaxation or something," said Doug Arbesfeld, manager of communications for Ciba-Geigy in Summit, N.J. Subsequently, the makers of Habitrol include a motivational and relaxation tape with the patches.
"The patches are only an adjunct, they have to be part of an overall program," said Dr. Tony Hsai, director of the Chesapeake Health Plan Medical Stop-smoking Clinic at Mercy Hospital. At his clinic, "patients are motivated and then they are given the patch and then they are taught behavior modification."
Thus far, for Mr. Stone, the alleviation of physical symptoms and the convenience of the patch are a big draw. "Once you put it on in the morning you forget you have it," he says. "You can shower, swim, anything."
For Judy Sussman of Hunt Valley, using a patch that can be easily hidden under clothing was far more appealing than chomping on nicotine gum. "You have to learn how to chew it," she said of Nicorette. "You can't chew too fast. You have to chew a lot. And I think chewing gum is one of the most unattractive things you can do."
But despite her initial enthusiasm for Nicoderm, Ms. Sussman discontinued its use after two days: She had extraordinary dreams all night long, she said. "I just took it off. I called the pharmacist, and when you pull out the fine writing in the package they do list dreaming."
According to Mr. Heapes of Merrell Marion Dow, there have been few reports of adverse reactions to the patches. "The biggest thing we have heard is a few reports of adhesion problems when the patch refused to stick," he said.
Interest in the patches continues to grow at local drugstores such as Tuxedo Pharmacy on Roland Avenue. In the past three weeks, six or seven people have asked their doctors to prescribe the drugs to them, said pharmacist Arnold Davidov. Most of them had tried to quit smoking using many other methods including nicotine gum and hypnosis.
At Rite Aid drugstores located throughout the East, the patches are "flying out the door," said Suzanne Mead, vice president of corporate communications.
Despite enthusiasm shown by would-be non-smokers, those in the medical field are adding a note of caution. "The patch alone has not been shown to be a magic cure," said Frances Stillman, director of the health resource program at the center of health promotion at Johns Hopkins. "If people think that, then they aren't going to use it as a valuable adjunct to other supportive programs."