Nicotine Replacement Therapy for Young People
About NRT
Nicotine Replacement Therapy is important for a successful quit journey. In North Carolina, the tobacco treatment standard of care is in two parts: behavioral interventions and pharmacotherapy. Although NRT is approved for people 18 and older, the American Academy of Pediatrics recommends off-label forms of NRT for people younger than 18. Young people who are trying to quit should always talk to their health care provider before starting NRTs to avoid prescription drug interactions or making any medical conditions worse.
Read the AAP's guidance for nicotine replacement therapy and adolescent patients.
Guidelines for Accessing NRTs
- Patients receiving support under North Carolina Medicaid Direct and patients who are MCO enrollees are eligible for NRTs with a prescription. There is no age restriction for NRT medication.
- Per the North Carolina Board of Pharmacy Protocols, immunizing pharmacists may prescribe a patient NRT without a prescription from a primary care provider.
- For those younger than 18, immunizing pharmacists may still prescribe NRTs with consent from the patients’ parents or legal guardians.
- For all patients, pharmacists must notify the patients' PCP within 72 hours of dispensing the prescription for NRTs. If patient do not have a PCP, the pharmacist must offer resources regarding support in finding a PCP in their area.
What Kinds of NRTs Are Available?
There are three kinds of NRTs that young people can use: nicotine transdermal patch, nicotine gum and nicotine lozenge.
Types of Nicotine Replacement Therapy
Nicotine transdermal patches work when nicotine in the patch is absorbed through the skin and enters the bloodstream. This helps make the withdrawal symptoms less severe. The patches contain less nicotine as the person quitting tobacco weans off it.
How to Use
- Apply the patch to clean skin on the upper body and change the patch every 24 hours.
- Eight-to-12-week treatment regime: use a lower strength patch after each dose.
Dosage
Nicotine transdermal patches are available in doses of 21 mg, 14 mg and 7 mg.
Nicotine gum works when nicotine in the gum is absorbed through the mouth and into the bloodstream. This helps make the withdrawal symptoms less severe. People using this method chew the gum less frequently as they wean off nicotine.
How to Use
The "chew and park" method is recommended for use:
- Place the gum in your mouth and chew until you feel a tingling sensation.
- Stop chewing and “park” the gum between cheek and gums.
- After about a minute, start chewing the gum again, until you feel a tingling sensation again.
- Stop chewing and “park” the gum again.
- Repeat this for about 30 minutes.
Twelve-week treatment regiment:
- Chew one piece every one- to two hours for the first six weeks.
- Chew one piece every two- to four hours for three additional weeks.
- Chew one piece every four- to eight hours for three additional weeks.
Dosage
Nicotine gum is available in 4 mg and 2 mg doses.
Nicotine lozenges work when nicotine in the lozenge is absorbed through the mouth into the bloodstream. This helps make the withdrawal symptoms less severe. People using this method use the lozenges less frequently as they wean off nicotine.
How to Use
The "dissolving method" is recommended for use:
- Place the lozenge in your mouth, occasionally moving from side-to-side in your mouth.
- Allow the lozenge to slowly dissolve. Do not chew or swallow the lozenge.
- Do not use more than one lozenge at a time.
Twelve-week treatment regimen:
- Use one lozenge every one- to two hours for the first six weeks.
- Use one lozenge every two- to four hours for three additional weeks.
- Use one lozenge every four- to eight hours for three additional weeks.
Dosage
Nicotine lozenges are available in 4 mg and 2 mg doses.