The Pharmaceutical Journal Vol 267 No 7158 p121-123
28 July 2001

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Smoking cessation

Be professionally flexible

From Mr A. B. McCoig, MRPharmS

I was interested to obtain the article published in the June issue of Primary Care Pharmacy concerning the adopted protocol for the treatment of tobacco dependence, which was mentioned in the PJ (June 30, p875). I use the words “tobacco dependence” as opposed to smoking cessation because in my role as a smoking cessation co-ordinator I am constantly reminded of the fact that all smokers are addicted to nicotine.

My health authority adopts a code of practice similar to that outlined by Alison McCormick and this appears to be a nation-wide policy as a result of the intention to tackle smoking as a priority in health improvement programmes. However, having accepted the policy as “best practice” I now have to say as a result of my experiences in counselling tobacco-dependent patients, that a more flexible approach may be more appropriate in some cases.

Many people present themselves to me (or are referred on from a local surgery) as motivated and committed to change their lifestyle based on a smoking habit. Most have already tried some form of nicotine replacement therapy and need considerable persuasion that another structured attempt using similar therapy will be in their best interests. For most, I can usually win them over to a more disciplined approach to using nicotine replacement therapy with support counselling over a four-week period. There are those, however, who reject the whole idea of using yet more nicotine to overcome their dependence on this powerfully addictive substance. They frequently admit to having had more than one quit attempt using nicotine gum or patches although they also accept that they have not had the benefit of close professional support and monitoring. For these clients, the appropriate use of amfebutamone as a first line treatment in the clinic setting can be a more successful option. There is also the added incentive that the use of amfebutamone is the “final option” at least in drug terms and that fact can often make the client more determined to quit. This also avoids the need to “fail” with NRT before beginning a course of amfebutamone.

Each client should be assessed individually not only for their motivation score but also for their past history with purchased NRT. I have had many successes with both forms of therapy but I am no longer prepared to accept the current protocol as written in tablets of stone. A degree of professional flexibility should be applied to each and every individual struggling with one of society’s most dangerous addictions.

Andrew McCoig
Smoking Cessation Adviser
Croydon Health Authority
and
Secretary
Croydon Local Pharmaceutical Committee

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