Adding anti-depressant drug to smoking cessation therapy fails to help prisoners stop smoking

Who is surprised? What struck me about this story was that the drug in question, Nortryptiline, 'is not FDA-approved for smoking cessation but often is used for that purpose'. That it does not work for smoking cessation is not terribly surprising, as no interventions seem to have a long term success rate of more than about 5 per cent.

We know that the prison population is given drugs for smoking cessation that are not approved for this purpose. Are the prisoners informed that the drugs they are on are not licensed for this purpose?

Cautionary notes on Nortriptyline are as follows:

Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant such as nortriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. 

This is shocking – a non-approved drug being used for behaviour modification purposes in a captive population.

In fact the leader of the research reported in this article, which concluded that the drug did not help smoking cessation in the long term, seems to think that the prison population is not captive enough: 'One thinks that you have a captive audience" in prison studies, she said. "However, half of the prisoners were either transferred to another prison within the study or released into the community.' Fluidity in the prison makes follow-up harder – surely this is hazardous for a drug which might induce suicidal tendencies.

Bear in mind that Glaxosmithklein received record fines recently for (among other things) improper marketing of drugs – selling them for non-approved uses. Why is it legal to do this in New York prisons? Looks like, as far as smoking cessation goes, anything goes – especially when a population already has limited choices.