|  Last year 1.6 million smokers quit smoking on No Smoking Day
and more than a million others used the day to find out about the help
available
for when they do decide to stop. “This year we expect to break
all records and help two million smokers to stop smoking on No Smoking
Day,” Sarah Watson, campaign officer for the charity No Smoking
Day, says. “Pharmacists are a key element in providing these smokers
with
support.”
Pharmacists’ role
Pharmacists should support smokers in any way that they think is appropriate,
Miriam Armstrong, chief executive of PharmacyHealthLink, says. “Whether
it is to refer the smoker to their local NHS stop smoking service
or to provide them with nicotine replacement therapy over the counter,
they are ideally placed to provide support.
“Tobacco smoking still remains the single greatest cause of preventable
illness and premature death in the UK, with more than 100,000 people
a year dying from its effects. And currently a third of smokers attempt
to stop each year with 70 per cent saying that they would like to stop,” she
says. “No Smoking Day is a great opportunity for pharmacists to
help smokers focus on their habit.”
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Smoking: latest statistics
In 2003 the average male smoker in the UK smoked
15 cigarettes a day compared with the average female smoker who
smoked 13, according to latest official figures published by
the Office for National Statistics in January.
Twenty-six per cent of the adult population smoked in 2003, with more
men smoking than women — 28 per cent compared with 24 per cent,
its report “Focus on health” shows. The biggest groups of
smokers, were men aged 20 to 34 years (38 per cent) and women between
20 and 24 years of age (34 per cent).
There was a continued decline in older smokers with just 14 per cent
of women and 16 per cent of men over 60 years smoking. But older smokers
aged between 50 and 59 years smoked the most, with men getting through
18 cigarettes a day and women getting through 15.
The report also reveals from a separate survey that at least 26 per cent
of girls aged 15 years, and 16 per cent of boys the same age smoked regularly
in 2004.
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Web resources
A number of useful resources related to smoking
cessation and No Smoking Day are available on the internet:
No Smoking Day The No Smoking
Day website provides information about No Smoking Day 2006 (8
March), the history of the day and its successes, facts about
smoking and the benefits of quitting, free-of-charge leaflets
to download and information sheets, as well as an online catalogue
of materials that can be used for stop smoking events
www.nosmokingday.org.uk
PharmacyHealthLink PharmacyHealthLink
has published guidelines on providing NRT to patients and the
template for the supply of both NRT and bupropion under patient
group direction can be downloaded from the charity’s website
www.pharmacyhealthlink.org.uk
PJ Online PJ Online features
a page devoted to information, links and articles about smoking
and No Smoking Day
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Award-winning pharmacy smoking
cessation scheme
A community pharmacy-based smoking cessation scheme
received one of the NHS Alliance Acorn Awards, it was announced
last week.
Ashton, Leigh and Wigan Primary Care Trust’s scheme was named runner-up
in the clinical engagement category.
Over 120 community pharmacists in the PCT have been trained to provide
nicotine replacement therapy and the scheme has achieved a 62 per cent
four-week quit rate among the 3,200 patients have used the service in
the last year.
The NHS Alliance Acorn Awards celebrate success and innovation at the
frontline of primary care and the NHS. The winners and runners-up were
presented with their awards by the Prince of Wales last week.
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This year’s theme is “Serious about stopping … you
can do it”. The campaign image uses a question mark (right) made
of ash and cigarette butts to remind smokers of the everyday reasons
why they want to stop smoking, Ms Watson explains. “It asks smokers
if they are serious about stopping and then lets them know that they
can do it with the help and support that is available on No Smoking Day
and all year round. The best thing pharmacists can do to prepare for
No Smoking Day this year is, she says, to
access the campaign’s website at:
www.nosmokingday.org.uk
The site features resources that can be downloaded free of charge, leaflets
in a variety of languages, information sheets and smoker diaries, as
well as an online catalogue of materials that pharmacists can purchase
to help them set up events to help smokers who are serious about stopping.
The last order date for the materials is 28 February 2006. Rethinking quitting
It may be, however, that pharmacists can play a much bigger part in
helping smokers quit than received wisdom has previously suggested, since
recent
research has found that smokers’ quits attempts are much more
impulsive than has been thought. A national survey published
online in the BMJ last month (27 January), showed
that almost half of attempts to stop were made without prior planning,
and that
the unplanned attempts succeeded for longer.
Nearly two thirds (65.4 per cent) of unplanned attempts lasted at least
six months compared with 42.3 per cent of planned attempts to stop smoking
made between six months and five years before the survey.
This may mean
we need a serious rethink in terms of understanding how smokers quit,
Robert West, of the Cancer Research UK Health Behaviour
Unit at University College London and one of the authors of the study,
argues.
“We used to think that people would set a date, plan and then try to quit,
but quitting without planning is the norm — people are much more
responsive to the immediate triggers than we’d previously thought.
But that’s not necessarily a bad thing from a pharmacist’s
point of view, since it means that pharmacists can help smokers by just
offering advice and information about new treatments, without necessarily
entering into an in-depth debate about smoking.”
If the pharmacist comes across as knowledgeable and professional, smokers
will be attracted to that and willing to listen, he adds. “So,
in that situation, the best way that pharmacists can help smokers is
by being ready to ‘sell’ the best ways of quitting and that
means the NHS stop smoking services and nicotine products.
“If a smoker says ‘I’ve tried this or that nicotine product
before and it didn’t work for me’, the pharmacist can offer
new flavours or formulations,” he adds. And if someone comes in
to buy a cough medicine, the pharmacist can politely ask whether he or
she smokes and has tried any of the products available to help smokers
quit. “Pharmacists really need to be prepared to sell the concept
of stopping and what can be done, as well as being enthusiastic about
the help on offer,” he says. Recent developments
Advances in the licensing of NRT products are also expanding the box
of tools pharmacists can offer smokers. At the end of 2005 the Medicines
and Healthcare products Regulatory Agency agreed to extend NRT licences
to pregnant women, those aged 12–17 years and those suffering
from heart disease. And in September 2005 the MHRA approved a new indication
for two NRT products — Nicorette gum and inhalators — which
can be used by smokers to ‘cut-down’ on their smoking before
attempting to stop completely.
“Reducing to stop” has been found to be helpful in the short
term, Ms Armstrong explains. “The rationale is that using NRT boosts
nicotine levels and makes it easier for the smoker to smoke fewer cigarettes,
therefore inhaling fewer toxins. Reducing their reliance on cigarettes
for nicotine intake appears to help many smokers to stop smoking completely.”
However, unfounded safety concerns still prevent many of those it could
help quit from asking for information about it, Terry Maguire, PharmacyHealthLinks’s
vice chairman, says. “Sadly about half of smokers still remain
convinced that NRT is dangerous to use and are unwilling to try it so
pharmacists have a major role in informing the public that NRT is relatively
safe.”
Professor West adds: “The key misconceptions people have about
NRT are that nicotine causes cancer — which it doesn’t — and
that nicotine products are as addictive as cigarettes, which they aren’t.
“A knowledgeable pharmacist should be able to explain that and help
smokers understand that nicotine products release nicotine much more slowly
than
cigarettes and so are far less addictive.” Legislation
Smokers planning to quit may also be helped by plans ro reduce the
number of places where they are legally allowed to smoke.
On 26 March, the ban on smoking in enclosed public places comes into
force in Scotland and the Welsh Assembly Government has said it plans
to ban smoking in enclosed public places in Wales.
On 14 February there will be a free vote in Parliament on how far the
ban on smoking in public places in England, as outlined in the Health
Bill, should extend. Members of Parliament will be able to vote on three
options of where the ban should extend to: licensed premises but not
membership clubs, licensed premises and membership clubs or non-food-serving
pubs and membership clubs.
The Government has also added a clause to the Health Bill which will — following
a consultation on raising the age of buying tobacco products — allow
ministers to take swift action to raise the age from 16 to 18 years of
age.
This latter measure, however, is unlikely to reduce smoking levels, Ms
Watson argues. “There is no real evidence that increasing the age
at which people can buy cigarettes will affect young people starting
to smoke,” she says.
“Almost all smokers start before the age of 16 and the majority of young
smokers get their cigarettes from those who are old enough to buy them,
or from parents, supplies or sources other than shops.”
People start smoking because it is an expression of freedom and being
grown up, she says. “Raising the age reinforces this perception
and while it might appear to be a strong counter tobacco policy, the
real impact is unlikely to have any tangible health gain. The Government
needs to focus on the real and proven ways of reducing tobacco use, such
as smoke-free public places.” Guidance
An imminent policy change that is likely to affect pharmacists involved
in helping smokers quit is the National Institute for Health and Clinical
Excellence’s consultation on “brief interventions and referral
for smoking cessation in primary care and other settings”.
This ongoing consultation — designed for those working in PCTs,
primary care, pharmacies and dental practices — will focus on pregnant
smokers and disadvantaged groups in particular.
The provisional guidance states that “health professionals, such
as pharmacists should, where practicable, recommend smokers to use the
NHS stop smoking service”.
It also recommends that smoking cessation advice and support should be
made available to all smokers in community, primary and secondary care
settings and that pharmacists with suitable training should offer a prescription
of NRT to smokers in lieu of a referral to stop smoking services where
appropriate. The deadline for comments on the document is February 21.
When the full guidance is published at the end of March, NICE will produce
implementation advice, slide sets and costing and audit tools to support
implementation — these tools will, NICE says, be available on its
website by the end of April. Future advances
Progress continues to be made in the development of nicotine vaccines
and a drug designed to block nicotine’s action.
Last year, in two double-blind placebo-controlled studies of varenicline
(Champix; Pfizer), a selective nicotinic acetylcholine receptor partial
agonist, 44 per cent of varenicline-treated patients had stopped smoking
by the end of the 12-week treatment period, compared with 30 per cent
of patients in each study treated with bupropion and 18 per cent of those
taking placebo (PJ, 10 December, p716).
Further results of studies involving a vaccine to treat nicotine addiction
being developed by Cytos Biotechnology and Nabi Biopharmaceuticals (CYT002-NicQb)
were announced last week. Researchers have now identified a dose that
will induce sufficiently high levels of antibodies for the vaccine to
be effective in most individuals. Last year, research showed that 42
per cent of patients given the vaccine were still not smoking after a
year, compared with 21 per cent of those given placebo (P=0.012).
When such products come to market they may be able to provide that little
bit more help that those who are ready to give up smoking need to quit
for good. In the meantime, pharmacists can offer advice and information
about treatments and be enthusiastic about selling the concept of quitting
and how pharmacists themselves can help smokers who are serious about
giving up. |
The
Pharmaceutical Journal