Nicotine patches and the subjective effects of cigarette smoking: a pilot study.

Twenty-five per cent of the North American population smoke cigarettes regularly. Twelve smokers (aged 19 to 55 years, Fagerström test score 3 to 10) participated in a double-blind, placebo controlled, counterbalanced study to determine the extent to which subjective effects of smoking are altered by nicotine delivered by transdermal patches. Subjects wore a placebo or 21 mg nicotine patch while abstaining from smoking for 48 h. Nicotine-mediated objective and subjective effects were measured at baseline, and after smoking a regular and a low yield cigarette at four different study sessions. Subjective effects were assessed using validated computerized questionnaires such as the Profile of Mood States and Visual Analogue Scales. Nonsmoking compliance was determined by measuring expired air carbon monoxide and saliva cotinine concentrations. Significant within-session differences were found in subjective effects at baseline and after smoking. No differences in subjective effects were found between patch treatments before smoking. Nicotine withdrawal symptoms such as craving, irritability, tension, frustration, anxiety and restlessness were significantly increased in both patch conditions after 48 h of smoking abstinence. Smoking markedly ameliorated nicotine withdrawal symptoms. Systolic blood pressure increased after smoking in both patch conditions (P=0.01). Visual Analogue Scale scores for cravings, nicotine effects, good effects and 'high' consistently increased after smoking during either patch condition. Thus, wearing a nicotine patch did not seem to modify the subjective effects of smoking compared with placebo in this preliminary study.