Over $170 billion in health care spending is attributed to smoking.
A new Surgeon General report emphasizes that smoking cessation is critical to improve health outcomes, and pharmacists can play an important role.
Approximately 34 million Americans currently smoke cigarettes, and most adults have been smokers since adolescence. Over $170 billion in health care spending is attributed to smoking.
Smoking Cessation: A Report of the Surgeon General is the 34th tobacco-related Surgeon General’s report published since 1964. Jerome M. Adams, MD, MPH, the Surgeon General, discussed in the report that cigarette smoking in the United States has significantly decreased to an all-time low of 14%. However, more work can be done, especially since 16 million Americans are living with a smoking-related disease.
Pharmacists, and other health care professionals can make a positive impact by encouraging smoking cessation.
The Surgeon General report offered important evidence-based information regarding smoking cessation. Smoking cessation reduces the risk of premature death, and can add approximately 10 years to life expectancy. Additionally, smoking cessation reduces the risk of adverse health complications including reproductive health issues, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer.
More than 3 of 5 US adults that have ever smoked cigarettes have quit. However, each year, less than 1/3 of smokers that have made an attempt to quit use FDA approved smoking cessation medications or behavioral counseling for support. Pharmacists can play an important role in counseling patients on safe and effective smoking cessation pharmacologic treatment options.
Currently, there are 7 first line therapies, including 5 nicotine replacement therapy (NRT) medications (nicotine patch, gum, lozenge, nasal spray, and oral inhaler) and 2 non-nicotine oral medications: bupropion and varenicline. The nicotine patch, gum, and lozenges are available over-the-counter. Evidence has shown that combination pharmacotherapy with dual regimens of NRT (nicotine patch with any other NRT form) is more effective than monotherapy. Combination treatment with behavioral therapy and pharmacotherapy is considered the “gold standard” of smoking cessation.
Quitline counseling, short text message services about smoking cessation, and web or Internet-based interventions also increase smoking cessation. E-cigarette use has increased among adolescents and has resulted lung injury. There is a lack of evidence to support the use of e-cigarettes for smoking cessation, and future studies are needed.
Advice from health care professionals on smoking cessation has increased since 2000. However, 4 of 9 adult cigarette smokers who had a consult with a health care professional during the past year did not receive advice to quit. This further emphasizes the need for pharmacists as part of an interdisciplinary team for smoking cessation.
Pharmacists can help to identify interactions between patients’ drug regimen, disease states, and smoking to encourage cessation right at the point-of-care. The report also discussed that pharmacist-based smoking cessation programs are effective and also result in healthcare savings.
U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. CDC website. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf. Accessed January 24, 2020.