There are two basic, principal issues.
If you look at even the third edition of the American guidelines on how to treat smoking addiction, there are two basic principles: pharmacotherapy and counselling Very often, if people really want to stop smoking and have made many attempts in the past and have had lots of difficulty stopping, you should use these two approaches. But again, I'm a bit disappointed and discouraged to see how.... It's so easy to use a standard recipe for everybody, but this is why it's so unsuccessful at the moment: they don't adapt.
For example, the main cause of failure, in my experience.... I've been doing this for quite a few years now, as you know. I have been involved in the tobacco business since 1975 and am one of the founding members of the Canadian Council on Smoking and Health. In our experience, the main cause of failure of nicotine replacement therapy, for example, is that people don't start at a high enough dose of nicotine replacement.
Even nowadays, smokers remove their patch to light up a cigarette. If they cannot resist lighting up a cigarette while they're wearing the patch, there's only one reason: it's that they're not getting enough nicotine. People are not using combined therapy. The patch will provide the smoker with a constant concentration of nicotine, but it will never provide the kick that the brain is asking for when the smoker lights up a cigarette.
We've been trying to approach some medications that will deliver nicotine much more quickly. We started with the gum, then went to the lozenges. But nicotine is absorbed by the mouth and goes through the venous system, not the arterial system, which goes right the brain when people light up a cigarette.
And then you have the inhaler. There is one inhaler at the moment that is providing the patient a fairly high concentration of nicotine and fairly quickly—less quickly than the tobacco cigarette, but again, much better than the gums and the lozenges or the other forms of inhaler.
As you know, the nasal spray of nicotine is not available in Canada, but it has been used in Europe and in the United States.
What comes closest to the tobacco cigarette, in terms of delivering nicotine to the brain, is the electronic cigarette.
This is very important, because the smoker needs to have that kick to be satisfied and to remain in his comfort zone.
I don't know whether that answered all your questions.