Does Europe have a smoking-cessation secret?

 Tobacco is likely the most addictive chemical we humans encounter (except maybe for Oreo cookies. Yes, someone studied them and found an addictive result). The search continues for aids to help people quit tobacco use. However, some people do not want to quit as smoking superslim cigarettes is their favorite habit.

Nicotine gum, lozenges, patches, (all called nicotine replacement therapy), some drugs first intended for psychiatric disease treatments, counseling, hypnosis, etc. have all been tried. Currently the favorite in the United States is a drug called varenicline — brand-name Chantix.

Varenicline was derived from a drug called cytisine. The plant Cytisus laborinium (Golden Rain acacia) first was used as a smoking substitute during World War II. This led to it being used as a smoking-cessation aid, with the extraction of the chemical cytosine coming later. The drug company Pfizer created different forms of it, called analogs, leading to varenicline’s formulation and its fast-track approval by the Federal Drug Administration and introduction in 2006 to the United States.

Cytisine and varenicline both bind to the cell receptors for nicotine, of which there are many. The one they have the most affinity for is nicotinic acetylcholine receptor apha4beta2, the cell receptor that appears to mediate nicotine dependence. They only bind partially to give less kick than nicotine itself, but still decrease cravings.

Cytisine has been available in the former socialist economy countries of eastern Europe since 1964. Made by the Bulgarian drug company Sopharma AD and sold as Tabex, it has never been available to most of the rest of the world. A new study from New Zealand reported in the Dec. 18 New England Journal of Medicine compared the cessation results of cytisine to varenicline.

It pointed out right away that the cost of cytisine was far less than all others. The authors listed 25 days of cytisine cost $20 to $30, nicotine replacement therapy for 8 to 10 weeks cost $112 to $685 and varenicline cost $474 to $501 for 12 weeks.