March 23, 2020
The US Surgeon General’s office in January released its first report on smoking cessation in 30 years. The new report outlines the latest evidence on quitting smoking, which has continued to accrue since the Surgeon General’s revelatory 1964 report on smoking and health that linked the habit to a host of diseases.
Fifty-six years after the dire diagnosis, how well is America is doing with smoking? The good news: Since 1965, cigarette smoking has dropped 67 percent. Some reports estimate eight million lives have been extended by that decline. The bad news: Smoking remains the leading cause of preventable disease, disability, and death in the United States. An estimated 480,000 Americans die from smoking each year, accounting for nearly 1 in 5 deaths. Around 16 million Americans live with a smoking-related disease and 34 million American adults still smoke cigarettes daily.
With decades of demonstrable evidence of tobacco’s harmful effects, why do so many people continue to smoke? Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol, according to the Centers for Disease Control and Prevention. More people in America are addicted to nicotine than to any other drug. The new report found that more than two-thirds of US adult cigarette smokers report interest in quitting. The majority try to quit each year, but only 10 percent succeed.
This presents an opportunity for patients’ most accessible healthcare provider to help achieve their goal. Evidence from the report shows that “partners throughout the public health community are extremely effective at preventing and reducing tobacco use.” Today, only 23 percent of independent community pharmacies off er smoking cessation programs, according to the 2019 NCPA Digest. That low participation rate isn’t only a blow to the public; it’s also a missed opportunity for pharmacy business.
Through the sale of cessation prescriptions and front-end products, you can earn revenue from a needed service. According to some pharmacy sources, you make about $23 in profit on varenicline, for example, and up to 80 percent margins on nicotine suckers. CVS charges $59 for a smoking cessation assessment and $49 for a follow-up, revealing what some patients are willing to invest in the service. Many employers will pay for their employees to enroll in pharmacy cessation programs. Moreover, cessation counseling and resources increase patient loyalty, and smoking cessation programs bring new people through your doors who may become lifelong patients. “We know what works to prevent and reduce tobacco use, including how to best help smokers quit for good.”
More than 50 years of data have given us “more knowledge on quitting smoking than ever before,” the report says. It’s enough data for the Surgeon General to claim that “we know what works to prevent and reduce tobacco use, including how to best help smokers quit for good.”
The report provides these strategies for effective cessation, all of which pharmacies can implement in one way or another. The simplest and most effective thing pharmacies can do is help patients take and adhere to their nicotine-replacement medication. Research shows that the FDA-approved medications actually work. Although pharmacists in most states can’t prescribe cessation medications, some allow full prescriptive authority and others allow collaborative practice agreements with physicians granting the authority. The chance of success increases when multiple therapies are used, which means recommending appropriate OTC products like patches or lozenges can go a long way in helping patients kick their habit.
Another effective technique is behavioral counseling, which can be provided in person or over the phone, one-on-one or in a group. Pharmacists can also refer patients to the National Cancer Institute’s quitline (1-800-QUIT-NOW) where they can talk confidentially with a trained counselor and receive additional resources. Combining medication and counseling makes the most potent recipe for cessation, the report said, even doubling one’s chances of successfully quitting. Text message cessation support and online web support can also be helpful.
One of the most surprising findings, the Surgeon General said, is how many people aren’t being advised by healthcare providers to quit smoking. Four out of every nine adult cigarette smokers who saw a health professional during the past year did not receive advice to quit, the report said. Pharmacies should make it a routine policy to ask patients if they smoke and advise them personally on the advantages of quitting. Smokers may not realize that quitting can extend their life expectancy by 10 years and reduce the risk for many adverse health effects, including poor reproductive health outcomes, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer.
Pharmacies can implement these cessation strategies in a variety of ways, whether on a personal, case-by-case basis or through a full program with structured one-on-one or group meetings. Two community pharmacies in Oklahoma off er a 12-week program with 6 weeks of hourlong group meetings followed by 6 weeks of one-on-one meetings in person or over the phone. A clinical pharmacist in Massachusetts offers recurring workshops every week for two hours that patients can attend at their convenience.
The American Pharmacists Association recommends incorporating cessation into the appointment-based model and provides a detailed sample schedule for doing so. It also provides a continuing education course on cessation and other materials at pharmacist.com/tobaccocessation. The National Community Pharmacists Association also provides resources specifically geared to community pharmacies, such as an example four-week curriculum, printable materials, and sample bag stuffers. On the CDC website, pharmacists can find a collection of resources, such as handouts for patients, downloadable posters, frequently asked questions for health care providers, a video on how to conduct a tobacco intervention, and additional resources for referring patients.
This article was published in our quarterly print magazine, which covers relevant topics in greater depth featuring leading experts in the industry. Subscribe to receive the quarterly print issue in your mailbox. All registered independent pharmacies in the U.S. are eligible to receive a free subscription.
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