US Pharm. 2017;42(7):1.

Everyone knows that smoking causes a myriad of serious health issues, from cancer to emphysema, yet people still have a tough time breaking the habit. This is due in part to the addictive nature of nicotine, which is quite possibly as addictive as opioids. As a result, nearly 17% of adults are still lighting up. For the CDC to realize its objective of reducing smoking among adults in the United States to 16%, help from some other source is needed. Armed with the latest treatment methodologies, pharmacists—the most accessible healthcare professional—should take an aggressive position in helping their patients kick the habit.

How should this happen? As Cortney Mospan, PharmD, BCACP, BCGP, and Angelo Boss, PharmD Candidate 2018, write in this issue’s cover article, “Smoking-Cessation Services in Community Pharmacies,” pharmacists should inquire about patients’ tobacco use at every visit, cautioning, “It is important to phrase the question so that both smokeless tobacco use and occasional use can be identified.” Even though it is not routinely practiced in retail pharmacies, the authors add, pharmacists should document tobacco use in the patient’s profile. And during the prescription-verification process, community pharmacists can utilize this information to highlight intervention opportunities.

Pharmacists, the authors note, should realize that not all patients who inquire about smoking cessation or who have a prescription for a smoking-cessation product are amenable to stopping. “Behavioral interventions should be performed,” they write, “to identify the patient’s stage of quitting in order to determine the next step.”

Smoking is so addictive, the authors write, that it is estimated that a smoker requires eight to 11 cessation attempts, and a Gallup poll reported that smokers average about six quit attempts before achieving success. To help nudge up the success rate, pharmacists have a variety of first-line agents at their disposal, although treatment guidelines do not recommend one therapy over another. In any case, the authors recommend that pharmacists consider a long-acting therapy that lessens withdrawal in tandem with a short-acting modality to ameliorate breakthrough cravings.

There is evidence that nonpharmacologic interventions also work. Last month, the American Cancer Society released the results of a clinical study that looked into the effectiveness of frequent, tailored e-mails with quitting tips, motivational messages, and social support, and these modalities had smoking-cessation rates similar to those for the most effective medications. The mean abstinence rate was highest for smokers in the study receiving 27 tailored cessation e-mails (34%), followed by those receiving three or four e-mails with links to booklets (30.8%), and receiving a single, noncustomized e-mail (25.8%).

In addition to the standard pharmacologic therapies at pharmacists’ disposal, regular personal contact could have a similar positive impact on smokers in their attempts to quit.

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