Comment on the John Hughes, MD blog

At SRNT last week (February 22, 2019) I presented data that parallels John's Blog. Almost 25 years ago, Sachs & Benowitz et al. reported on a study where they took smokers and measured their cotinine levels while smoking normally.  They then assigned those subjects to nicotine patch replacement in quartiles from 0% replacement to 100% replacement or more.  Not surprisingly, those with the highest nicotine replacement attained the highest levels of continuous abstinence from 100% at week 2 to 80% at week 6 (See graph below). These results are consistent with the study data reported by John. At SRNT, I presented the IntelliQuit mobile app which leverages an FDA cleared, CLIA waived technology that inexpensively quantitatively measures the tobacco dependents' cotinine levels at point of care (medical office, hospital, etc) within 15 minutes.  One of my hopes is that in-office rapid cotinine (actually Total Nicotine Equivalents {TNEs}) will demonstrate to clinicians everywhere that high dose NRTs (>100%) is safe and greatly increases quit rates.    While many of our non-specialist colleagues may feel uncomfortable treating the tobacco dependent, we hope that every health care provider (MDs, DOs, NPs, PAs, etc.) will more fully embrace the concept of titrating tobacco treatment medications. Matt  Matthew P. Bars, MS, CTTS, NCTTP