Duke University Medical Center researchers recently found that using a nicotine patch before quitting smoking can double success rates. They say their findings should be printed on nicotine patch labeling. Currently, the nicotine patch is only recommended for use after the quit date, explained Jed Rose, director of the Duke Center for Nicotine and Smoking Research and lead author of the study. This resulted from concerns that using a patch while smoking could lead to nicotine overdose. However, the new study found that concurrent use of a nicotine patch and cigarettes appears to be safe. "People who use the patch before quitting are likely to spontaneously reduce the number of cigarettes they smoke because the patch satisfies their need for nicotine and makes the act of smoking less enjoyable," Rose said. He added that it also decreases withdrawal symptoms. "Yet people are afraid to try a pre-cessation patch because the current labeling recommends users not smoke while on treatment," Rose said. "That's why our study is so important. It reinforces the findings of previous studies, which show the value of pre-cessation patch therapy, and demonstrates that using a pre-cessation nicotine patch can make a significant difference in a person's ability to quit." Despite the known health risks, nearly 25 percent of the population continues to smoke cigarettes. In addition, up to 90 percent of smokes who use nicotine replacement therapy relapse within a year. In an effort to find a successful smoking cessation method, Rose and his colleagues randomized 400 people who smoked an average of slightly more than one pack per day. They were placed in four groups who used either a nicotine or placebo patch for two weeks prior to quitting smoking. They were further randomized to smoking their regular brand of cigarettes or low-tar-and-nicotine cigarette. Following the quit date, all groups received standard nicotine patch treatment at reduced dosages for 10 weeks. Of the pre-cessation nicotine patch users, 22 percent of people abstained from smoking for at least 10 weeks, compared to 11 percent in the placebo groups. Although those who smoked their usual brand fared no better or wore than those who smoked a low-nicotine cigarette, Rose said switching to a low-tar-and-nicotine cigarette may circumvent any potential safety or tolerability issues that could occur in some smokers. Rose also said he believes that similar pre-cessation intervention may work for other drugs used for smoking cessation, but that more research is needed. Rose said the use of the pre-cessation patch is significant because it helps researchers predict people\u2019s subsequent success. "People on the patch are more likely to reduce the number of cigarettes they smoke. We found that is a potent predictor of subsequent abstinence. Smokers who did not reduce their smoking on the patch were less likely to succeed,\u201d Rose said. Rose continued, "By monitoring pre-cessation patch smoking levels, we may be able to rescue people who aren't going to succeed. If the smoker is not spontaneously decreasing the number of cigarettes they are smoking, we may be able to find a different treatment that will work for them rather than letting them stay on an ineffective treatment and fail."