Silver acetate oral spray for smoking cessation: results of a double-blind trial

Silver acetate is a pharmaceutical ingredient used in some over-the-counter products to deter smoking. Silver acetate is a heavy metal salt that produces an unpleasant taste when mixed with cigarette smoke and has been used in lozenges and chewing gum. A new formulation involves a proprietary method of dissolving silver in a palatable oral spray, allowing for intermittent administration. The study examined the effectiveness of the spray in increasing quit rates among long-term smokers who reported that they were eager to quit. Silver acetate treatment is a disgusting technique, not an alternative like nicotine gum or withdrawal blockers like clonidine. Aversive conditioning occurs when an aversive stimulus (such as a harmful taste) is systematically and repeatedly paired with a behavior the subject wishes to eliminate (such as smoking). 1 Other aversive conditioning response methods used in smoking cessation include rapid smoking and holding the smoke. 

In general, aversion techniques are not effective when used alone in long-term treatment, 2 but they may have some usefulness when combined with other behavioral interventions. Four placebo-controlled, double-blind studies investigated the effectiveness of silver acetate in smoking cessation. Rosenberg3 tested the effects of lozenges and silver acetate on 60 smokers who smoked an average of 18 cigarettes a day. At the end of the 2 weeks, 11 of the 30 people in the experimental group and 5 of the 30 people in the placebo group had quit smoking through verbal reports alone. Arvidsson, 4, studied 50 smokers and noted that the difference in the number of cigarettes reported between the silver acetate group and the placebo group was 10.6 and 18.4, respectively. In a large, double-blind study of 1,000 participants, SchmidtS found that 31 percent of the silver acetate group and 25 percent of the placebo group dropped out by self-report. According to self-reports in smoking cessation studies, the number of subjects who do quit smoking is exaggerated. A study by the British Thoracic Society Committee found that 27% of people who claimed to have completely quit smoking had biochemical evidence of smoking. Studies without biochemical indicators can be unreliable.