Quit smoking cheaply

In the September 29 edition of the New England Journal of Medicine, British and Polish scientists published one of the first new studies of an anti-smoking addiction treatment drug, cytisine, which has been used for decades in the former Soviet Union. The study shows that not only is the drug effective as a treatment to counter the effects of nicotine addiction, it is significantly cheaper than other current nicotine patches, pills and other options currently on the market. Commercially, cytisine is now produced by a pharmaceutical company in Bulgaria, and is available in many eastern European countries. To learn more about the new study, Deutsche Welle spoke with the lead author, Robert West, a professor of health psychology at the University College London.

Deutsche Welle: How would you summarize your research into this drug, cytisine?

Robert West: We started the research program because there was evidence emerging from eastern Europe that a drug that they've been using for more than 40 years to help them stop smoking might have actually have some significant efficacy, but there wasn't adequate data to know for sure. And if we were ever going to get it licensed in the West or across the globe, we would need a really strong pivotal trial. So that's what we did. Our interest in the drug was not necessarily because it would be more effective than what we go, but because it would be much, much cheaper.

So why is it so much cheaper?

It's very easy to extract the active chemical, which is called cytisine. You can get it from a lot of plants, but the most common one is from the seeds of the labernum plant, and some people might know about that because they are toxic. But of course, in a drug, you would have it much, much lower doses than if you were to chew the seed. So it's easy to extract and it's out of patent, so anyone in theory can do the process to make it. The company that currently produces it, which is in Bulgaria, is called Sopharma. They already produce it at very low cost, so there wouldn't necessarily be a huge incentive for someone else to step in.

According to an article in the Associated Press, generic versions of cytasine cost as little as $5-$17 per month compared with $100 for an eight-week supply of nicotine patches or $300 for a 12-week supply of Pfizer's Shantix pill. Are those figures about right?

Yes, the cost of cytasine, or the brand name is Tabex, varies from country to country. And of course, there are Internet suppliers that will charge what some may consider to be over the odds for it, but still it's a bit cheaper. So if you look around you'll see various different prices for it. I wouldn't necessarily recommend people going to the Internet for drugs, that's not the way to go. Clearly, there are all sorts of risks and things attached to that. But the legitimate suppliers in Russia charge the equivalent of $6 for it, and in Poland, it's up to $15. But as you can see, it's a tenth or less of the cost of the other licensed products.

Which countries is it actually available in?

It's available in many countries in the former Soviet bloc; Russia, Bulgaria - where it's made - and Poland, because there's an eminent epidemiologist who was the driving force behind this study. He had the idea that we should really pursue this. Because of him and his colleagues it's quite widely used in Poland. I think it's also widely used in other countries in the former Soviet Union. It was withdrawn from some countries when they joined the European Union and they would need to have the kind of data from the study that we produced to get licensing approval because the early data were not quite strong enough.

How does this drug work? You compared this to some of the other treatments like nicotine patches? How does this drug work biochemically and physiologically-speaking?

It works very similarly to the drug Champex in Europe and Chantex in the United States, and the chemical name for that is varenicline. Both of these are what are known as "partial agonists" and they target a particular nicotine receptor in the brain that we've found from a range of studies is important for nicotine dependence.

By only targeting the receptor or having this partial agonist effect, you get to control the craving without actually having any positive rewarding effect, so you will get craving relief but won't get any positive effect. The other thing is that if you were to have a cigarette, this chemical is sitting on the receptors so that nicotine can't get on them, so you get less satisfaction from the cigarette if you do happen to have a relapse.

So the pleasure that one would get from having a cigarette would be blocked by either of these drugs?

That's right, the pleasure and satisfaction and the craving that you get when you haven't smoked for awhile, are substantially reduced.

So now that you've shown that this drug is effective, and I would presume you would argue that more people should have access to it, what's the next step? It sounds like this drug has only been restricted for use in a small part of the world but probably would be useful in other parts of the world.

That's right. I think my main interest is in countries like China and India and many low-to-middle income countries where the smokers themselves would have to pay for any treatment. In Britain, the National Health Service will largely pick up the tab if you want help with stopping smoking and that's true with other countries. But in low-and-middle income countries, what we're looking for is a treatment that can help you stop and can cost less than it costs to smoke.

Interview: Cyrus Farivar
Editor: Stuart Tiffen