ROP in Smoking Cessation Program

Role of Pharmacist in Smoking Cessation Program

By, CHAN PL

Nicotine is a highly addictive drug and can causes dependence, as evident in tobacco smokers.  Nicotine addiction is a complex disorder that requires treatment directed at both the biological and the behavioral aspects of the disease. Many smokers believe that smoking is simply a bad habit, as a result of weakness in character and an inability to change one’s behavior. However research has shown that nicotine addiction is a chronic brain disease resulting from an alteration in brain chemistry. It is a complex process involving the interplay of many factors (pharmacologic, environmental, and physiologic) that influence an individual’s decision to use tobacco. The pharmacologic and behavioral processes that determine nicotine addiction are similar to those that determine addiction to drugs such as heroin and cocaine. Hence, healthcare professionals, namely pharmacists, must treat nicotine use and dependence as a serious medical condition.

Why Pharmacist? Pharmacists can play an active role because they are easily accessible, approachable, knowledgeable and able to offer advice in smoking cessation. Studies have shown that patients who received a tobacco cessation intervention from a non-physician clinician or physician clinician were 1.7 and 2.2 times likely to quit (at 5 or more months post cessation), respectively, compared with patients who did not received such intervention (Fiore et al., 2008; p.88). Similarly, the number of clinicians that assist with quitting is related to success rates. An analysis of 37 studies determined that patients who received a tobacco cessation intervention from two or more clinicians were more than twice as likely to quit (for 5 or more months) than patients who received no assistance from a clinician (Fiore et al., 2008).

Pharmacist’s Role  Tobacco dependence requires two-prong approaches for maximal treatment effectiveness. (a) Physiological dependence (addiction to nicotine) can be treated with approved medication for smoking cessation, and (b) Behavioral habit can be treated through behavioral change programs, such as individualized counseling and group or online cessation programs. Pharmacist is there to provide a combination of pharmacotherapy and behavioral counseling in treating patients who smoke.

“Do you smoke or use tobacco?” Pharmacist should start screening for tobacco use by asking each client or customer. Evidence shows that screening for tobacco use significantly increases clinician intervention. Smoker should be strongly urged to quit at every encounter. Advice should be clear, personalized, supportive and non-judgmental.

Identify Potential Benefits:  If a smoker is willing to quit, pharmacist will assist patient to indicate why quitting is personally relevant. Patient will be asked to identify potential negative consequences to smoking and potential benefits to quitting.

Identify Potential Barriers:  For smokers who have tried to make a quit attempt and have failed previous attempts, pharmacist should advice them not to give up.  The reason is simply because most people repeatedly failed in their attempts before they can succeed. Pharmacist should continuously motivated patients to quit, help patient to identify barriers to quitting and address the barriers. If a smoker is unmotivated to quit, pharmacist will repeatedly giving motivation at every visit. A motivational counseling will be more successful if the pharmacist is empathetic, promotes patient autonomy, supports the patient’s self efficacy and avoids arguments.

Smoking Cessation Aid:  Patient on action stage, where they wish to quit within the next 30 days should be assisted in quitting. Smokers can talk to their pharmacists about the medications available for smoking cessation e.g. Nicotine Replacement Therapy (NRT) and Varenicline. Smokers who are given pharmacotherapy intervention will be advised on administration, dosage, nicotine withdrawal symptoms and possible adverse reaction.  Pharmacist is also available to give further counseling on tobacco-related illnesses and Drug Interactions with Smoking. Combined counseling and medication is more effective than when either intervention is used alone. Person-to-person treatment delivered at least 4 or more sessions appear especially effective in increasing abstinence rates.

Follow Up:  It does not stop there as patient on pharmacotherapy intervention will soon be arranged a follow-up after the quit date. Patient should be congratulated if they succeed and strongly encouraged to remain abstinent. If patient smoked, pharmacists will review circumstances and encourage recommitment to complete abstinence. Patients will be encouraged to discuss on the problems encountered and challenges that may occur in the future. On the follow-up visits, pharmacist will assess pharmacotherapy use and problems. If required, pharmacist can consider use or referral for more intensive treatment.  In patients who have recently quit smoking, the pharmacist should reinforce the patient’s decision to quit, review the benefits of quitting and help the patient with any residual problems arising from quitting. Smoking relapse usually occurs within the first 3 months of quitting and can occur months or years after the quit date. Therefore pharmacist need to continuously be involved in relapse prevention interventions.

In summary, nicotine addiction is a form a chronic brain disease. Tobacco use is a complex disorder involving the interplay of the nicotine pharmacology, environmental factors and physiologic factors. Treatment of tobacco use and dependence requires a two-prong approach for maximal treatment effectiveness. Pharmacists are effective providers of smoking cessation program. Greater utilization of pharmacist in tobacco cessation efforts will have significant impact on smoking rates, prevention of tobacco-related illnesses and overall improvement in public health.