To the Editor: Growing revenue from the sale of products for nicotine-replacement therapy (NRT), such as nicotine patches, has fuelled media interest in the likelihood that “reformed smokers” are “getting hooked on nicotine replacement”.1 While there may be anecdotal evidence of long-term use, there are no current population-based data to indicate whether this is the case in Australia.

Overseas data suggest long-term use of NRT is low.2,3 For example, a United States study found the median duration of patch use decreased from 30 days to 21 days following over-the-counter NRT availability.2 Another study found that more than 75% of NRT purchases were for 1 month, while only 5% of smokers purchased NRT for more than 3 consecutive months and less than 1% of purchases continued to 24 months.3 An Australian survey conducted in 2000 suggested that most NRT use (61%) was short-term, lasting less than 2 weeks.4

More recently, our 2004 telephone survey of smoking-related perceptions and practices included an item on length of NRT use. The survey involved households selected at random from the New South Wales electronic white pages, with quotas applied to the sample based on NSW census proportions. The study was approved by the University of Newcastle Human Research Ethics Committee.

Of the 3503 participants (response rate, 43%), all 539 current smokers and 1013 former smokers were asked about NRT use. Those who had made their most recent quit attempt in the previous 2 years reported on their NRT use during that quit attempt. Of the 138 who had used NRT on their most recent quit attempt, only three (2%) used an NRT product for 12 weeks (the recommended length of use). Only four NRT users (3%) reported using the product for more than 3 months, and none reported using NRT for more than 6 months.

It appears that fears of widespread addiction to NRT products are probably unfounded. In fact, lack of compliance with use recommendations, resulting in inappropriately short episodes of use, is probably a bigger problem, and one that may help explain the disappointing effectiveness of NRT under “real world” over-the-counter conditions.5 Data on frequent repeated short-term use of NRT products would be useful to round out the picture on NRT use in the over-the-counter environment.