Nicotine Replacement Therapy: Administration and Overview

1. Nicotine Replacement Therapy: Administration and Overview Barbara Hart, MPA and Claudia Lechuga, MS Bronx BREATHES T: (718)430-2601 E: bhart@aecom.yu.edu / clechuga@aecom.yu.edu www.bronxbreathes.org June 15, 2009

2. Smoker Assessment • History of usage • Previous quit attempts • Withdrawal/abstinence symptoms • Motivational level for quit attempt • Current social environment • Stressors • Triggers • Biological/medical assessment • Family and friend support/sabotage

3. Previous Quit Attempts • Dates • Age • Method used to quit • Medications or counseling used (if any) • Duration of that method • Problems and successes experienced • Reason for relapse • Withdrawal/Abstinence Symptoms

4. Current Quit Attempt • Motivational Level • Confidence • Main reason for considering/wanting to stop • Concerns about quitting • Weight gain concerns

5. Use of NRT Reasons for using NRT Reasons for NOT using NRT Medical conditions requiring caution/physician input i.e. recent MI, pregnancy, current arrythmia Age Under 18s require physician/parental input Specific issues Allergy to patches Personal aversion to medication Questionable efficacy i.e. those smoking less than 10pd • Doubles the success rate • Treats nicotine withdrawal • Helps patient feel more comfortable • Safe • Patient receiving same drug (nicotine) in a less addictive form over a relatively short period

6. Tobacco Cessation Medications Nicotine Replacement Non-nicotine medication Bupropion ^ (Zyban/Wellburtrin) Varenicline ^ (Chantix) • Patch * • Gum * • Lozenge * • Oral Inhaler ^ • Nasal Spray ^ * Available OTC ^ prescription only

7. Nicotine Delivery Comparison

8. Medication Overview

9. Use and Efficacy of combination therapy • Multiple patch therapy (42 vs 21mg) • 20% increased abstinence • No significant increased sleep disturbances • (Dale 1995; Jorenby 1995) • Patch + Gum • Kornitzer 1995; Puska 1995 • Early better rates • 7% increase at 6 months • Not sustained at 1 year • No increase in adverse events • 2008 OHS Guidelines Meta-analysis • Path + Gum/Spray OR = 1.9 • Compared to patch alone (OR=1) • Fiore 2008 • Abstinence rates • Nicotine Patch = 23.4% • Nicotine Gum = 19.0% • Long term Patch + Gum = 36.5%

10. Important Points about NRT • Nicotine is the addictive part of tobacco smoke but NOT the most dangerous part • People do NOT generally become addicted to medication • People DON’T use enough medication or stop TOO EARLY • Medications are SAFE and EFFECTIVE • Plan on minimum of 2 months of medication • Combinations • Work better than single medications • Use Long acting + Short acting

11. NRT Kits Available Moderate Smokers Heavy Smokers • Smoke 10-20 per day • Includes: • Novartis Step 1 • 28 count 21 mg patches • Smoke 20+ per day • Includes: • Nicorelief Gum • 110 pieces of 4mg gum • Novartis Step 1 • 28 count of 21mg patches

12. NRT Enrollment Forms • Necessary for each course distributed • Full information required • Fax or email back to Bronx BREATHES

13. NRT Enrollment Forms (cont’d 1)

14. NRT Enrollment Forms (cont’d 1)

15. NRT Enrollment Forms (cont’d 1)