The Chantix Experience

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Smoking is one of the most difficult addictions to quit. It commonly appears in rankings of addiction potential in the top five, sometimes in the top spot, depending on the criteria used.

So when a “cure” is offered up, it’s a big deal. But, as usual, there’s much more to the story...

About Chantix

Chantix (varenicline) was approved by the FDA in May of 2006 as a non-nicotine prescription medicine to help smokers quit. This was a new approach, with total abstinence and nicotine replacement therapy the only options at the time. The way Chantix works is described by the manufacturer this way:

There are receptors for nicotine in your brain ... [Chantix] targets nicotine receptors in the brain, attaches to them, and blocks nicotine from reaching them. By activating these nicotine receptors, it is also believed that Chantix causes less dopamine – compared to nicotine – to be released.

The important bit is that varenicline blocks the effects of nicotine – smoking (or any other way of getting nicotine) stops working altogether. As long as Chantix is around, there’s no satisfaction or enjoyment to be gained from smoking. It sounds ideal. And for many, it does work.

Estimates vary, but studies have shown a 44 percent success rate with supportive therapy, contrasted with about an 18 percent success with therapy alone. These rates are measured at 12 weeks, a significant milestone, since most smokers who try to quit will relapse within the first week.

Problems arise

By 2009, there were more than 2,700 lawsuits filed nationwide by people who complained of psychological problems, including suicides or suicide attempts, while on Chantix. The allegation was that doctors and patients had not been properly warned about the dangers of taking the drug. By last month (March of 2013) about 80 percent of the lawsuits had been settled with manufacturer Pfizer shelling out $273 million to do so. Other suits remain in litigation.

Chantix now has a warning on the main page of their website (www.chantix.com) that says, in part:

Important Safety Information: Some people have had changes in behavior, hostility, agitation, depressed mood, suicidal thoughts or actions while using CHANTIX to help them quit smoking ... If you, your family, or caregiver notice agitation, hostility, depression, or changes in behavior, thinking, or mood that are not typical for you, or you develop suicidal thoughts or actions, anxiety, panic, aggression, anger, mania, abnormal sensations, hallucinations, paranoia, or confusion, stop taking CHANTIX and call your doctor right away.

What it was like for me

I’ve been a smoker for the last 10 years. I picked the habit up in the military (along with the ability to swear non-stop for a solid minute). Looking back, it started as a way to combat boredom. Since then, smoking has become a way of life. I tried Chantix last year. It didn’t work out.

It is very hard to describe just what happens when your brain chemistry is jarred so fundamentally that you lose your sense of self. The words in the warning above do not capture it well. They are too abstract, too sterile. “Changes in behavior, thinking or mood” just doesn’t suffice. I’ll try to do better.

Imagine what it might be like to lose all connection with food. You still have the urge and the habit to eat, but food doesn’t satisfy or taste like food. All enjoyment disappears from the activity. You still attempt it, but it seems pointless. That’s a start.

What I found out about myself while on Chantix was scary in a way that nothing has ever scared me before. It was as if whatever made me “me” had been taken out, shuffled around a bit and put back in with some pieces missing. The smoking habit was so ingrained that without it, I was literally a stranger to myself.

The fear came partially from the realization that I was so fundamentally hooked to nicotine, but along with this was the fear that came from understanding how fragile the “who I was” was.

We assume, or at least I did, that whatever it is that makes up who I am is permanent. I get older, a little slower, somewhat wiser… but in the end, I’m still me. Not on Chantix. On Chantix I lost my own self, and not in a good way.

The drug works. Cigarettes taste like cardboard – not bad, but not good either. Puffing away does nothing to satisfy, even temporarily. It’s very strange. You do all the stuff associated with smoking – putting a cigarette to your lips, holding the lighter up and lighting the cigarette, drawing that first puff to get it lit properly – and then nothing. It feels stupid.

I didn’t get hostile. I didn’t get suicidal. But I certainly understood how what I was feeling (the bizarre, not-me feeling) could result in some pretty radical behaviors.

I’d done my homework. I knew about partial antagonists and how dopaminergic neurons would be stimulated less by Chantix than nicotine. In the end, it didn’t matter. The experience transcended the science. I went off the drug after only a couple of days. No lawsuit required, no permanent damage, and I still smoke.

So what?

One failure does not give much evidence either way. But for me, it highlighted an aspect of addiction I hadn’t considered before. When we offer a drug that blocks the effects of the preferred addictive substance, it’s still a huge challenge for the addict.

Suboxone and methadone, replacement therapies for heroin, have a serious dropout rate – addicts go back to heroin, and one wonders why. I think the answer is partly because, while the body chemistry adds up, the fundamental changes to someone’s mode of living, or even way of being, are just too much to handle.

I also learned there is no easy cure for nicotine addiction. All routes to quitting will be hard for me. Perhaps, in my next attempt, I will understand my foe a little better and not take it so lightly. Forewarned may very well be forearmed.

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