A 1963 report8 of a film editor chewing on photographic film to achieve an aversive dose of silver described the development of argyria, a blue-grey coloration of the skin, mucosa, and occasionally viscera. Argyria accompanies silver ingestion in large doses, described as 0.9 g9 to 25 g,8 at which point the body cannot clear the metal completely; otherwise, silver poses little apparent health risk at low doses. This safety has been demonstrated in a study by Jensen, et al.tO on serum silver levels, as well as levels in skin biopsy samples by autometallography in users of a silver acetate chewing gum (fabmint). Reports of argyria from improper doses of silver acetate lozenges used for smoking cessation also indicated no systemic toxicity.ll,t2 Given the new availability of silver acetate in an oral spray, a randomized, placebo-controlled pilot study was instituted to find out whether the spray was efficacious in increasing quit rates among smokers motivated to stop smoking. Methods Given the probable efficacy of any single-component aversive technique, the spray was tested within the context of minimal behavioral change instruction. Subjects Subjects were recruited by advertisements in newspapers, by fliers in physicians' offices, and by word of mouth. The study was conducted during an 18-month period at a family practice office in a socially and ethnically integrated urban neighborhood. Participants were included if they smoked at least one pack per day for 5 years, were 18 years old or older, had no silver allergy, were not pregnant or nursing, and reported a desire to stop smoking. At the introductory visit the program was described, including randomization and placebo use, and a refundable deposit of $25 was collected as an incentive to increase completion of the experimental protocol.
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