Introduction

Roughly one-fourth of American adults smoke, and each of them faces increased risk of death or illness from cardiac and respiratory diseases, including cancer. But they also face the likelihood that they will fail in their attempt to quit smoking—relapse occurs in more than half of all quitting attempts within 6 months. Success is more likely for smokers who use medications to help them quit. However, pharmacological treatment is currently limited to nicotine replacement therapy, which delivers nicotine by a skin patch, gum, or inhaler instead of a cigarette, and the use of bupropion, an antidepressant that has been found to help some smokers overcome the craving associated with nicotine withdrawal.

Development of effective pharmacological treatments to help smokers quit is a complicated, expensive, and slow process. It begins with scientific research to identify the molecular mechanisms of nicotine’s effects in the brain and continues through development of candidate medications that must be extensively tested in animal and human trials, meet regulatory requirements for safety and effectiveness, and be carefully monitored after being approved for use. Even after a medication has been approved, it can be truly successful only if it is widely available, easily administered, and affordable.

In an effort to encourage collaborative efforts and stimulate innovations that may speed up the development process, the National Institute on Drug Abuse (NIDA), along with the National Cancer Institute and the National Institute on Alcohol Abuse and Alcoholism, sponsored a symposium on drug discovery, development, and delivery as part of the 2003 Annual Meeting of the Society for Research on Nicotine and Tobacco. The symposium consisted of three components, featuring examples of collaborative efforts in the discovery of targets for potential medications, the development of medications based on a platform of existing targets, and the delivery and adoption of medications.

During the Discovery section of the program, speakers addressed the most recent findings in the field of nicotinic receptor biology and CNS neurochemical systems—such as GABA and glutamate—that play a role in nicotine effects in the brain. The Development section of the program provided a background on the drug development process, presentations on emerging medications, such as antidepressants and nicotine vaccines, and an overview of medications in late-phase development. Presentations on Delivery focused on strategies for developing widespread access and use of medications within the health care system and beyond.