If one of your new year's resolutions is to quit smoking, perhaps you've noticed ads for the growing number of clinics that offer stop-smoking shots. The injections, which contain powerful drugs that are supposed to quell cravings for nicotine, are touted as highly effective. But many addiction experts say the treatments are unproven and can cause serious side effects.

The shots typically include the drugs atropine and scopolamine. Both belong to a group of medications known as anticholinergics, which block a chemical that is responsible for certain nervous-system activities. Normally they are used with anesthesia during surgery and as a treatment for Parkinson's disease, motion sickness and certain gastrointestinal problems, among other things. The drugs aren't approved as stop-smoking treatments, but doctors are free to use them for this purpose.

Before getting the shots, patients undergo a medical exam to rule out problems that may disqualify them. They then typically receive three injections -- one in the arm or hip, followed by two behind the ear. The process takes 60 to 90 minutes.

Contrary to what the ads may imply, though, the treatment doesn't end there. For two weeks, the person has to take tablets containing atropine and wear a scopolamine patch behind the ear. At most clinics the treatment also includes educational materials or counseling on how to change behaviors associated with smoking. The cost for everything ranges from $350 to $500, which insurance sometimes partially covers.

Proponents say the shots and medications work by blocking nicotine receptors in the body, preventing people from experiencing withdrawal symptoms when they stop smoking. But not all addiction experts buy that idea, saying that only very high doses of atropine (far above those that anyone uses) may possibly have this effect.

Though some clinics boast of success rates of over 80%, this refers only to the first month or two. There's little solid research on the long-term effectiveness of injections. The only published study, which dates to 1986 and didn't include a comparison group, found about 40% of people who received shots weren't smoking after a year. Success rates for other methods are considerably lower.

Side effects of the treatment, which are temporary, can include dry mouth, dizziness, confusion, blurry vision and difficulty urinating. Excessive doses of anticholinergic drugs can lead to hallucinations, strokes, heart attacks and comas. The treatment isn't appropriate for people who have heart rhythm or prostate problems, take multiple mood-altering drugs, or are pregnant.

Given the side effects and risks, shots are best used only after other quit-smoking methods have failed. Before signing up, ask about the clinic's long-term success rates, and request to speak with other patients who have had the treatment. Make sure the clinic offers counseling and support, which are often crucial for success. Don't expect shots, by themselves, to be a quick fix.

By ROBERT J. DAVIS

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