A prospective study of off-label use of, abuse of, and dependence on nicotine inhaler

Objective: To determine the incidence of off-label use of, abuse of, and dependence on prescription nicotine inhaler. Design: Prospective telephone and internet interviews for six months. Participants: 535 new inhaler users. Main outcome: Structured interview about off-label use ( that is, use of inhaler for non-cessation reasons or concurrent use of inhaler and cigarettes) and Diagnostic and statistical manual, fourth edition ( DSM-IV) and International classification of diseases, 10th edition ( ICD-10) criteria for abuse and dependence Results: Although many used inhaler and cigarettes concurrently at some time ( 43-55%), few used inhaler for non-cessation reasons ( 4-9%) and few persisted in off label use ( 8-16%; 95% confidence interval ( CI) 5% to 19%). No participant met ICD-10 criteria for harmful use/abuse ( 95% CI 0% to 3.3%). Eight subjects ( 1.4%) appeared to meet DSM-IV or ICD-10 criteria for dependence on inhaler, but none were found dependent in a clinical expert interview ( 95% CI 0% to 3.3%). Conclusions: Although transient concurrent use of inhaler and cigarettes often occurs, use for noncessation reasons, abuse and dependence are rare.