They are flooding the market in various shapes — chewing gums, lozenges, gel cubes and patches. And they are promising to help smokers and tobacco chewers kick the nicotine habit. With a leading international smoking cessation brand having now been launched in India, the question, though, is how effective and safe these products are.

Indians are among the heaviest smokers in the world. Points out Dr Monika Arora, head of Health Promotion and Tobacco Control, People Foundation of India, an organisation that conducts anti-tobacco campaigns, “While tobacco claims 4.9 million deaths annually across the globe, 1 million deaths are from India alone. This alarming figure reflects the enormity of tobacco usage among Indians. It’s also the reason these anti-tobacco products are becoming popular in the country.”

Beating nicotine addiction is not an easy task. Nicotine fools the brain into releasing the chemical dopamine, which gives a false sense of well being. Soon the body wants more and more nicotine, leading to addiction. Apart from a range of cancers that it can cause, a recent study published in the journal Chemical Research in Toxicology suggests that smoking can lead to genetic damage within minutes of the smoke reaching the lungs.

So how do these anti-tobacco products help you kick the potentially lethal tobacco habit? Most of them, including the recently launched Nicorette by Johnson & Johnson or Elder Pharmaceuticals’ nicotine replacement pastilles, contain trace amounts of nicotine. When a smoker suddenly quits smoking, he experiences withdrawal symptoms that can lead to severe nicotine cravings. But if nicotine is supplied at a moderate rate daily through these products, a certain nicotine level is maintained in the bloodstream and this takes care of an addict’s tobacco cravings. Then gradually, as the nicotine level in the bloodstream is further reduced, the addict no longer needs the product to help him along on the road to a life without tobacco.

Anti-tobacco products come in different nicotine strengths such as 1mg, 2mg and 3mg. Depending on the degree of nicotine intake, doctors prescribe the one that is suitable for you. Most brands claim that a chain smoker (who has 20-40 cigarettes a day) needs to take a 3mg product twice a day for about three months. Those who puff less frequently can do with a smaller dose.

However, some doctors believe that dosing a person with small amounts of nicotine may not be the ideal way to quit smoking. As Dr Somnath Bhadra, state council member of the Indian Medical Association, points out, “Using small doses of nicotine through anti-tobacco products to beat the usage of greater amounts of nicotine present in cigarettes or gutkha makes no sense. One cannot beat one alkaloid usage with another.”

Needless to say, anti-smoking cessation brand managers claim otherwise. “We don’t trade one addiction for another,” says an official at Johnson & Johnson. “Our product, which comes in the form of lozenges and chewing gums, provide a controlled amount of nicotine to the system at a slower, less intense pace than cigarettes. And it’s a therapeutic form of nicotine, without any of the harmful toxins contained in cigarette smoke like carcinogens or carbon monoxide. It is also used for a short period and gradually reduced over the course of time until the body no longer needs it,” adds the official who refused to be named.

There is some evidence to suggest that these products do help to an extent. A study published in the Indian Journal of Cancer shows that the continuous abstinence rate in the counselling-only group (that is, those given only psychological help and no anti-tobacco products) at one, three, six and 12 months was 17 per cent, 17 per cent, 16 per cent and 15 per cent, respectively. On the other hand, in the combination therapy group (behavioural therapy + medication), these rates were 60 per cent, 58 per cent, 54 per cent and 53 per cent, respectively. In other words, the abstinence rates were significantly higher in the group treated with tobacco replacement products and counselling.

However, some say that for these products to be really effective, they must not pass through the gastro-intestinal tract. Says Dr Kanchan Gurtu, a Calcutta-based physician, “It is better to use anti-tobacco patches that are directly absorbed into the bloodstream through the skin or those that can be absorbed in the mouth. Saliva and gastric juices reduce the effectiveness of these products, thus increasing the duration of the cessation programme.”

Keeping this in mind, some companies like Elder Pharma have come up with anti-tobacco jelly cubes and pastilles, which do not pass into the gastro-intestinal tract. “The cubes — which come in strengths of 1mg, 2mg and 3mg — have to be kept for three to four minutes between the cheek and the teeth. This helps the product to avoid saliva and gastric juices,” reveals Ajit Mhatre, marketing manager, Elder Pharma.

Other tobacco replacement products in the market include herbal patches such as Zero Nicotine which contains ingredients that are supposed to be natural substitutes for nicotine.

Experts say that whatever the tobacco replacement product, manufacturers should try and make consumers aware of their properties. As consumer activist Sanjukta Palit says, “All tobacco cessation brands must come up with literature that reveals the fact that there are trace amounts of nicotine in them. This will help consumers understand the product instead of being fooled into believing that they are magic pills that will enable them to quit smoking or using tobacco in no time at all.”

Doctors like Gurtu suggest that companies should offer counselling services to consumers who wish to use their products to quit smoking. Some brands have, in fact, already begun such services. For example, Johnson & Johnson launched the Committed Quitters Club to help people deal with the psychological aspect of nicotine addiction. It provides a customised quit plan to help a consumer determine when, where and why he or she is tempted to smoke and how he or she can kick the habit.

Though many of these products may help a person quit smoking, experts point out that physical de-addiction alone is not enough. “What’s needed is psychological counselling of tobacco users, specially those who are poor and cannot afford to buy these relatively expensive products,” says Arora. A three-month de-addiction programme costs around Rs 4,000. “How can poor people afford them?”

At the end of the day, there’s nothing to beat exercising one’s own will power to quit smoking. If you are unable to do that, perhaps a tobacco replacement product could come to your aid.