The combination of nicotine replacement therapy and varenicline is often the most effective, but pharmacists can help patients find the best approach.
Discussing smoking cessation with patients can be difficult.
Often patients respond with statements such as “It’s the only pleasure I have” or “I only smoke a few cigarettes a day.” Having a toolkit of talking points can engage patients in quitting efforts or at least start the thinking process.
Here are 7 facts that can help convince your patients to quit smoking.
1. The earlier patients try to quit smoking, the more likely they are to succeed. Smoking is a pediatric disease. Most people start smoking during adolescence.1.2 For older patients, this means they started before the dangers of smoking were fully known and widely publicized. Older smokers generally have a more severe addiction, a propensity to blame smoking-related health problems on aging, and a belief that the harmful effects of smoking are reversible.1.2 Dispelling myths is essential.
2. Smoking is expensive. In the United States, the average cost of a pack of cigarettes is around $7, depending on the state. A person who smokes 1 pack a day will pay around $2,555 per year to smoke.3 Ask patients what they would do with the money they would save by not smoking.3
3. Many smokers don’t understand that nicotine isn’t the only dangerous ingredient in cigarettes.4 Cigarettes are very effective toxin release devices and can contain arsenic, carbon monoxide, formaldehyde, hydrogen cyanide, polycyclic aromatic hydrocarbons and thiosulfates. All of these substances generate free radicals.4
4. Nicotine increases norepinephrine levels, which creates a calming effect.5.6 Here too, cigarettes are extremely effective. Seconds after switching on, patients will feel calmer and less anxious.6 The average smoker needs 20 or more cigarettes a day to maintain the pleasurable effects of smoking.5
5. About 70% of smokers want to quit,7 but they think it will be too hard or it’s too late. Simply asking patients if they would like to talk about quitting smoking may not result in immediate agreement, but may encourage them to come back later.
6. People who quit smoking can sometimes reduce their intake of pills. Smoking affects the metabolism of many drugs. Table 18 lists drugs that may interact with smoking. Primarily, smoking interacts with CYP1A2 substrates.
7. The right smoking cessation product increases the chances of success. There is no better way to quit smoking. Each individual must consider the comorbidities, convenience, cost, and severity of their addiction. In line Table 29-13 lists smoking cessation products and the pros and cons of each. Some patients may need to use 2 smoking cessation products for best results.
Smoking cessation is difficult and abstinence rates are around 25% at 1 year, even with treatment.13 The combination of nicotine replacement therapy and varenicline is often the most effective, but pharmacists can help patients find the best approach and provide ongoing support.
About the Author
brownie Yes. Wick, MBA, HPR, FACPis the Associate Director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy at Storrs.
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2. Committee on Environmental Health, Committee on Substance Abuse, Committee on Adolescence, Committee on the Native American Child. From the American Academy of Pediatrics: Policy Statement on Tobacco Use: A Pediatric Disease. Pediatrics. 2009;124(5):1474-1487. doi:10.1542/peds.2009-2114
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11. How to use bupropion SR. CDC. Updated May 24, 2021. Accessed March 20, 2022. https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/quit-smoking-medications/how-to-use-quit-smoking- medicines/ how-to-use-bupropion-sr.html
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