New tobacco report guides pharmacists’ role in smoking cessation
From Tom: This week we are featuring a guest blog from RADM Ty Bingham, chief pharmacy officer at the U.S. Public Health Service—with whom we are closely aligned. I want to thank RADM Bingham for sharing the latest on a new U.S. Surgeon General report and the ways pharmacists can take an active role in tackling this public health issue. As pharmacists get energized around this issue, know that APhA is here to support these efforts. APhA’s tobacco cessation resources are curated at pharmacist.com/tobaccocessation, and just last week APhA advocated for CMS to remove barriers enabling patient access to pharmacists’ smoking cessation services. We have even more resources to be released in the coming months, including profiles of sustainable pharmacist-provided cessation services, new education programs, and a framework for cessation service delivery.
On January 23, 2020, VADM Jerome M. Adams, U.S. Surgeon General released Smoking Cessation: A Report of the Surgeon General. This is the 34th Surgeon General’s report on tobacco, and the first on smoking cessation in 30 years. The report expands on the findings of the 1990 Surgeon General’s report on smoking cessation, reaching several new conclusions regarding the health benefits of smoking cessation. The report also reviews the evidence on the effectiveness of clinical, health system, and population-based policy interventions on smoking cessation.
The health burden of tobacco use continues to plague our nation. While the percentage of U.S. adults who smoke cigarettes is at an all-time low, 14% of U.S. adults were still current smokers in 2018. That means that 34 million of our family members, friends, and neighbors who make up this group remain at risk for smoking-related disease and death. Moreover, marked disparities in smoking persist across population groups, including those of lower socioeconomic status and those with behavioral health conditions. The situation is compounded by the fact that the tobacco product landscape has also evolved over time. In recent years, an array of new tobacco products has entered the marketplace, and many individuals are using multiple tobacco products. These developments may have a range of implications, including accelerating or impeding cessation efforts among adult smokers and slowing or reversing the decrease in cigarette smoking prevalence among youth and young adults.
As a health care provider currently serving as our nation’s Chief Pharmacy Officer, tobacco use causes me great concern. Smoking is the leading preventable cause of disease, disability, and death in our country. The best means of prevention is to never start smoking, but for those who currently smoke, quitting is a protective measure to take. While quitting smoking is not easy, it is possible. This is especially the case with support from loved ones and when the individual wanting to quit smoking is also connected with counseling and proven cessation medications that are safe and effective.
In February of last year, our family gathered to mourn the death of my wife’s youngest sister. She was a joy to all who knew her, but I continue to wonder if I could have done more to help her to stop smoking. She had smoked for most of her life and we lost her unexpectedly at age 53 with advanced cancer. This serves as a heavy reminder of my responsibility as a health professional to protect, promote, and advance the health and safety of our nation. I know there are many throughout our nation who can relate personally to our situation and my heart goes out to you and your families. It is my hope that our pharmacist community will fully engage in helping those who are struggling to overcome addictions of any kind.
Health care professionals, including pharmacists, can and should play a pivotal role throughout the continuum of cessation treatment. They can help individuals who smoke quit by making treatment of tobacco use and dependence a routine part of care. More specifically, health care professionals can assist individuals by advising them to quit, offering counseling, providing medications approved by FDA for cessation, providing referrals to resources like state quitlines, and following up with continued support to prevent the relapses that are so common on the path to successful quitting. As detailed within the report, while counseling and cessation medications are effective alone, using them together can more than double an individual’s chances of successfully quitting. Also, with regard to cessation medication use, evidence shows using combinations of short- and longer-acting nicotine replacement therapy (NRT) can be more effective than using a single form of NRT on its own.
Given our expertise in pharmacology, as well as potentially more frequent touchpoints and face-to-face opportunities with patients relative to other members of the health care team, we as pharmacists should see ourselves as uniquely situated to assist and support quitting for individuals who smoke. Certain policies, such as state regulations and/or collaborative practice agreements, may allow pharmacists to prescribe cessation medication, which improves patient access to these effective treatments. Pharmacists also can assist by helping patients decide which medications to use and educating patients on their proper use.
These are just a few of the strategies that can contribute toward building and sustaining a more comprehensive support system for individuals who want to quit smoking. The closing chapter of this 34th Surgeon General’s report on tobacco issues a charge for us as a nation to continue our progress to decrease smoking in our country. We are reminded that more work remains, but we have the experience and wherewithal to do it. This charge is particularly relevant to pharmacists as we do our part to protect and promote the health of the American public.