Silver acetate for smoking cessation: Cochrane systematic review

Abstract

Background

Silver acetate produces an unpleasant taste when combined with cigarettes, thereby producing an aversive stimulus. It has been marketed in various forms with the aim of extinguishing the urge to smoke, by pairing the urge with an unpleasant stimulus.

Objectives

The aim of this review was to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation.

Search methods

We searched the Cochrane Tobacco Addiction Group specialised trials register. Most recent search was in July 2012.

Selection criteria

We included randomised trials of silver acetate for smoking cessation with reports of smoking status at least six months after the beginning of treatment.

Data collection and analysis

We extracted data in duplicate on the type of subjects, the dose and form of silver acetate, the outcome measures, method of randomisation, and completeness of follow-up.

The main outcome measure was biochemically validated abstinence from smoking after at least six months follow-up in patients smoking at baseline. Subjects lost to follow-up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed effects model.

Main results

Two studies provided long-term follow-up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The pooled risk ratio for quitting for silver acetate vs placebo was 1.04 (95% confidence interval 0.69 to 1.57).

Authors' conclusions

Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation. The confidence intervals for the ratio are quite wide. However, the upper limit of the confidence intervals for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%. Any effect of this agent is therefore likely to be smaller than nicotine replacement therapy. The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus.

Author(s)

Lancaster Tim, Stead Lindsay F

Summary

Does silver acetate help people stop smoking

Silver acetate products (gum, lozenge, and spray) produce an unpleasant metallic taste when combined with cigarettes, so they are used as a form of aversion therapy for smoking. However, the review of trials found little evidence to show that silver acetate helps smokers quit. Any beneficial effect of silver acetate is likely to be very small, and less than the effect already proven for nicotine replacement therapy.

Reviewer's Conclusions

Implications for practice

Although a possible small effect of silver acetate in promoting smoking cessation has not been disproved, any such effect is likely to be very small, and less than that proven for nicotine replacement therapy. There is therefore little role for silver acetate for promoting smoking cessation in the clinical setting.

Implications for research

Further research on silver acetate for smoking cessation is unlikely to be helpful.

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