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Smoking cessation in New Zealand

Smoking cessation in New Zealand. Hayden McRobbie MB ChB ( Otago ) PhD (London) Faculty of Health and Environmental Sciences, Auckland University of Technology Wolfson Institute of Preventive Medicine, Queen Mary University of London. Smoking in people aged 15–64.

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Smoking cessation in New Zealand

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  1. Smoking cessation in New Zealand Hayden McRobbieMB ChB (Otago) PhD (London) Faculty of Health and Environmental Sciences, Auckland University of Technology Wolfson Institute of Preventive Medicine, Queen Mary University of London

  2. Smoking in people aged 15–64 Source: 2009 New Zealand Tobacco Use Survey

  3. Do smokers want to smoke? • 4 in 5 smokers said that they would not smoke if they had their life over again • Females were significantly more likely than males to say this • 3 in 5 had tried to quit in the last 5 years Source: 2009 New Zealand Tobacco Use Survey

  4. What are we up against? • The addictive nature of tobacco • The tobacco industry • Optimism and over confidence of smokers • “It won’t happen to me” • “I’ll be able to give up when the time comes”

  5. Tension, Triggers, Treatment • Tension and triggers • Maximising smokefree norms • Raise the price of tobacco • Restrict the supply • Regulate tobacco • Remove temptations to smoke • Continue with fear arousing messages • Populate the smokers’ world with QUIT NOW messages • Provide evidence based treatment

  6. Policy and treatment • ITC project: in first year after recruitment • Odds of quitting for a month Reid et al 2010 Nicotine & Tobacco Research 12 (supl 1) S20-S33

  7. Stop smoking services • Do not have a large effect on smoking prevalence Offer a life saving treatment for those smokers who want to use it

  8. NZ Smoking Cessation Guidelines • Screen for tobacco use • Brief advice to quit smoking • Offer help to quit • Behavioural support • Face-to-face and telephone cessation support • Setting a quit date and providing multi-session behavioural support • Medication • Nicotine replacement therapy • Bupropion & Nortriptyline • Varenicline

  9. Put simply… • A - ask whether a person smokes • B - give brief advice to quit to all people who smoke and • C – make an offer of, and provide or refer for cessation treatment

  10. Treatment of Tobacco Use

  11. Treatment Works Data from Cochrane reviews; bars represent 95% CIs based on risk ratios versus placebo (for medications) or brief advice/no treatment (for BehSup) Slide courtesy of Prof Robert West, UCL, London

  12. Smoking Cessation in NZ Individual Counselling Frontline Healthcare Professionals • Pregnancy services • DHB services Options Proactive Telephone Counselling Group Counselling Web and text based support

  13. Pharmacotherapy ✔ Bupropion Subsidised ✔ ✖ User pays Options Nicotine Replacement Varenicline ✔ ✔ Patch Gum Lozenge Microtab Inhaler ✔ ✔ Nortriptyline ✖ ✔ ✖

  14. NRT • Roughly doubles the chances of quitting long-term • Safe to use in ALL people who smoke • Patch, gum and lozenge fully subsidised • Combination therapy recommended • Available on prescription or via a QuitCard Stead, L. F., Perera, R., Bullen, C., Mant, D. & Lancaster, T. (2008) Nicotine replacement therapy for smoking cessation, Cochrane Database Syst Rev, CD000146.

  15. Quit Card Providers • Registered Healthcare Professionals can become quit card providers by doing a 30 minute online training module • www.smokingcessationabc.org.nz • Face-to-face training for other healthcare workers

  16. Varenicline (Champix) • Partial agonist of nicotinic acetylcholine receptors • At least doubles chances of quitting • Able to be used my most smokers, BUT need to fulfill special authority criteria • Prescription only • Nausea and vivid dreams are common side effects Cahill, K., Stead, L. F. & Lancaster, T. (2008) Nicotine receptor partial agonists for smoking cessation, Cochrane Database Syst Rev, CD006103

  17. Champix available on prescription • Special authority • The patient is part of, or is about to enroll in, a comprehensive support and counseling smoking cessation programme, which includes prescriber or nurse monitoring AND • The patient is not pregnant AND • The patient has tried but failed to quit smoking after at least two separate trials of nicotine replacement therapy, at least one of which included the patient receiving comprehensive advice on the optimal use of nicotine replacement therapy OR • The patient has tried but failed to quit smoking using bupropion or nortriptyline

  18. Nortriptyline • Tricyclic antidepressant • Doubles chances of quitting • Not suitable for some smokers • Prescription only • Dry mouth, blurred vision are common side effects

  19. Zyban • Atypical antidepressant • Roughly doubles the chances of quitting • Number of contraindications, cautions, and drug interactions to consider • Prescription only • Side effects: headache, dry mouth, insomnia, seizure (rare)

  20. Is the ABC approach working?

  21. Smokers ‘ABC’d’ in past year Source: 2009 New Zealand Tobacco Use Survey

  22. The Tobacco Health Target • “Eighty percent of smokers will be provided with advice and help to quit by July 2010; 90 percent by 2011; and 95 percent by July 2012.”

  23. Health Target Results – 2009/10 New Zealand District Health Boards Percent provided with advice and/or help to quit

  24. What are smokers doing?

  25. Tried to quit in the last year Source: 2009 New Zealand Tobacco Use Survey

  26. Going cold turkey? • No – almost 40% of recent quit attempts involved advice or smoking cessation products • Quitline • NRT

  27. Cessation Support Source: 2009 New Zealand Tobacco Use Survey

  28. Where are they getting their NRT? Source: 2009 New Zealand Tobacco Use Survey

  29. Where to from here? • A range of support that best fits the person (and the health care system) • Need to maximize access • Priority populations • Go to where the people are • People want choice and the service that fits THEM • Innovative, effective, and safe ways to manage tobacco dependence

  30. Quality of treatment services • Its not just about throughput, outcome is also important • Service user feedback and input • Monitoring and improvement (as opposed to evaluation)

  31. Novel approaches • ‘Drop-In’ clinics • Halls, shopping centres • Outside working hours • No appointments, multi-session, • Potential use of ‘lay’ community members to • Promote and ‘sign post treatment • Provide support

  32. Different Routes to Quitting • UK NHS Stop Smoking Service is considering implementing different options for smokers • Abrupt quitting (status quo) • Rapid reduction to quit • Slow reduction to quit • Harm reduction

  33. Conclusions • Smoking cessation treatment is part of a comprehensive tobacco control strategy • For many smokers, smoking cessation will be life-saving • ‘ABC’ is part of ‘core practice’ for healthcare professionals • New Zealand has a good range of options for smokers who wish to quit, but we need to improve utilisation of these

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