To the Editor We enjoyed reading the article by Cunningham et al1 in a recent issue of JAMA Internal Medicine that demonstrated an effect of mailing smokers nicotine replacement therapy (NRT) without behavioral support on 6-month abstinence from smoking.1 One important reason for performing this trial, as noted by the authors, was that “population survey data comparing those who used NRT (obtained over-the-counter) during a quit attempt and those who did not use NRT has found no association between use of NRT and an increase in success rates.”1(p185) This statement refers to a cross-sectional study and a prospective cohort study we recently performed in England.2,3 However, Cunningham et al did not register the crucial distinction we made in these 2 studies between NRT bought over-the-counter and used without behavioral support and NRT received on prescription (NRT Rx) and used with brief advice from the prescribing physician. Compared with unaided quitting, NRT bought over-the-counter was indeed not effective whereas NRT Rx was (cross-sectional study,2 odds ratio [OR], 1.62; 95% CI, 1.33-1.94; and prospective cohort study,3 OR, 1.55; 95% CI, 1.11-2.16).
Kotz D, Brown J, West R. Questioning Nicotine Replacement Therapy Without Behavioral Support. JAMA Intern Med. 2016;176(6):863-864. doi:10.1001/jamainternmed.2016.1559