Nicotine replacement therapy - why so expensive?

[billg]

Hey I was just thinking about this the other day and could possibly figure out the answer via googling, but thought it would be more social if I asked the question here - why are nicotine replacement therapies (i.e. nicotine patches, nicotine gum etc.) so expensive?

 

Particularly with regard to nicotine gum - although I don't know much about gum manufacturing, it seems odd to me that nicotine gum is so expensive compared to ordinary gum. Does adding nicotine make the gum that much more expensive to make? Is it due to extra manufacturing processes or the cost of pure nicotine itself? Or is it due to government taxes on the product to make it less likely to create a new drug-dependent group, even at the expense of risking the health of cigarette smokers who could potentially benefit from the products?

 

Surely there would be significant benefit to national/global health if everyone smoking cigarettes were on far less harmful nicotine gum instead - so why not subsidise it? Perhaps it's because the worlds governments get more money off cigarette taxes than they do off the health costs anyway, though I don't know (that's a very pessimistic view that I hope isn't the case). In any case, please let me know if you have any ideas of data about costs and benefits of nicotine replacement therapy, and why it is so expensive, I'd be fascinated to hear them.

[CraigD]

why are nicotine replacement therapies (i.e. nicotine patches, nicotine gum etc.) so expensive?

Like most non-generic pharmaceuticals, Nicorette and similar drugs sell, in markets that don’t regulate their cost, for many times the cost of their research, development, and manufacture. In the absence of government regulation limiting the price charged by their manufacturers, this price is determined by the law of supply and demand, which dictates that they cost the maximum that the market (the consumer) is willing to pay. Since people wanting to quit smoking will pay a lot, demand is high, so so is price.

Does adding nicotine make the gum that much more expensive to make? Is it due to extra manufacturing processes or the cost of pure nicotine itself?Or is it due to government taxes on the product to make it less likely to create a new drug-dependent group, even at the expense of risking the health of cigarette smokers who could potentially benefit from the products?

No.

Surely there would be significant benefit to national/global health if everyone smoking cigarettes were on far less harmful nicotine gum instead - so why not subsidise it?

From a clinical perspective, it’s important to note that people who attempt to quit smoking using cessation aids like nicotine gum but without the supervision of a trained counselor, support group, etc., are, according to gathered statistics, unlikely to succeed. The clinical efficacy of these drugs was established (as they are drugs, in the US, it was required that their efficacy be demonstrated before they were approved for sale) only in supervised smoking treatment plans. So a government program to reduce smoking by subsidizing these drugs only would likely have little success in reducing the number of smokers.

 

In the US, the making of some nicotine replacement drugs over-the-counter was controversial. I’m part of a health organization that fought unsuccessfully to prevent their approval for OTC sale. The reasoning for this opposition was primarily threefold:

• As mentioned above, there’s no evidence these drugs work outside of a supervised setting, which keeping them prescription-only would have promoted
  
• The are not without risk. About 2 of every 10,000 people who use them will overdose, often by both taking them and smoking, requiring clinical or ER treatment
  
• The increased market made available by OTC sales allowed manufacturers to increase the cost of these drugs to large wholesale purchasers. When Nicorette went OTC, our cost roughly tripled, making it necessary for us to pass the cost on to our patients. In practical terms, the cost to one of our patients of a box of nicotine gum or patches went from about $5 to about $30 (vs. a typical OTC cost of about $200). This presents a disincentive to our patients, potentially reducing the likelihood of them successfully quitting smoking.
  

[Michaelangelica]

Hey I was just thinking about this the other day and could possibly figure out the answer via googling, but thought it would be more social if I asked the question here - why are nicotine replacement therapies (i.e. nicotine patches, nicotine gum etc.) so expensive?

Because addictive drugs are expensive?

Because they can be.

 

I know at least one person now addicted to nicotine gum

 

I am surprised that lobaline is not used (Originally part of the original American Indian Smoking Mix from the herb Lobelia inflata). I am told it gives the same jag to the adrenals and is not addictive.

[leuv21]

Maybe drugs like nicorette patches look so expensive because i sincerely think that it is put forward in a commercial way towards the society and has no regulation because smoking has been decided from one's own free will and there is no real legal issue to regulate the price. Maybe people should try to move towards the natural ways of healing like crave rx which are more effective and cost less.

[Nix]

Maybe drugs like nicorette patches look so expensive because i sincerely think that it is put forward in a commercial way towards the society and has no regulation because smoking has been decided from one's own free will and there is no real legal issue to regulate the price. Maybe people should try to move towards the natural ways of healing like crave rx which are more effective and cost less.

 

hi!!

im all for more natural medicines (im currently employed to research a plant product with medicinal uses), but its hard to find an ad for them that doesnt make misleading or vague claims. crave rx suggests that nicotine is the primary poison in cigarettes, but the scientific community is undecided. whats known is that there are hundreds of other poisonous chemicals in cigarettes, and nicotine itself has been found to trigger angiogenesis. whilst this has alarming results with pre-existing tumours, it has beneficial results in wound healing, ischaemia, and is also suggested to help prevent neurodegenerative disorders like parkinsons and alzheimers. having a strong family history of bowel and bladder cancer (smoking induced) and parkinsons and alzheimers, im more than excited for the potential and damage of nicotine to be sorted out. i also smoke although im not saying i do it to prevent parkinsons!! (personal opinion given the choice id take cancer any day). and its true about quitting, support from friends and family and a decision within yourself is more important than a stop smoking aid. i have no problem with crave rx, its a nifty idea, but id prefer its claims were simply about its potential, and not about nicotine.

perhaps if a therapeutic, prescription based use for nicotine was patented and produced, the price of nicotine replacement therapy's for smoking cessation would have to be decreased?

[CraigD]

Maybe people should try to move towards the natural ways of healing like crave rx which are more effective and cost less.

Before the claim that a particular remedy is more effective than another can be accepted, more evidence than a retailer’s claim that a US$35 / .05 litre, 1-month supply of the tincture in question contains ingredients “which have been clinically proven to reduce the craving for nicotine due to their balancing effect on the brain chemicals known to be associated with addiction”. As Nix notes, accurately IMHO

im all for more natural medicines (im currently employed to research a plant product with medicinal uses), but its hard to find an ad for them that doesnt make misleading or vague claims. crave rx suggests that nicotine is the primary poison in cigarettes, but the scientific community is undecided.

I’ve known many people who successfully quit smoking with the aid of nicotine-replacement drugs, traditional herbs and herbal remedies, and without aids of any kind. Of the herbal remedies, the one’s in my anecdotal experience most effective are tobacco replacements, such as coltsfoot leaf and various other leaves, often including clove dust or oil, smoked as cigarettes. I suspect this is because these less pharmaceutically active substances are good replacements for the highly ritualistic, physical habit of smoking.

 

It bears repeating that nearly every well-controlled study of smoking cessation aids and therapies, both those involving nicotine replacement and those not, show that participation in a supervised program is more important than the particular aids and approaches used.

 

It’s also worth noting that, although the products sold by companies specializing in herbal remedies are often less expensive than those of “big pharma” companies, many of these companies are large, and enjoy even higher profits. When using herbs, I think it best to learn as much as practical about them, rather than naively relying on the authority of commercial enterprises.

[InfiniteNow]

Not totally thread specific, but potentially useful to those who are actually attempting smoking cessation...

 

I smoked for a lot of years. Started in middle school and continued off and on (mostly on) into college. When quitting the final time, I did exercise... Not just random exercise, but specific and pointed. Every time I wanted a cigarette, I made myself do 60 push-ups instead.

 

I tell you what. After finishing the push-ups I sure didn't want a cigarette anymore, and I was in much better as a result.

 

Also, drink water. Replace smoking with something you enjoy so you don't sense the void. Plan for what you will do when you do have a craving later (especially if you know you'll be at a party or out to dinner or some other challenging urge inducing situation). If I have a craving at the holiday party, I will go into the bathroom, sip some water, and then go get a piece of that wonderful fruitcake instead. If I have another craving, I'll reach into my bag for some (insert food/gum/etc. of choice).

 

NRT helps with the physiological addiction, but that goes away in approximately 72 hours. After that, all of the nicotine has metabolized and the rest is mentail... retraining yourself to think as a non-smoker.

[Edella]

.

 

NRT helps with the physiological addiction, but that goes away in approximately 72 hours. After that, all of the nicotine has metabolized and the rest is mentail... retraining yourself to think as a non-smoker.

Thinking as a non-smoker is the hard part! I've "quit" four times with the help of the patch, and then started again after about six months, thinking I can now be a "casual smoker!" Wrong. You would think I would learn after making the same mistake over and over.

 

I never smoked until I joined the Army. I soon realized having cigarettes when you hear "Smoke 'em if you got 'em " was a sure break and non-smokers were assigned to detail.

 

Back on topic, I have noticed generic brands of "the patch" are now cheaper than some brands of cigarettes in Minnesota. Maybe that should be incentive to do it right this time. Just thinking about it makes me want to smoke.