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DOC Dispatch: August 31, 2017
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How can we help patients quit?
 
First and foremost, we should talk to them about it!

  • 70% of people who smoke and who visit their doctor at least once a year, want to quit smoking. 
  • Less than half of them report that their doctor advised them to quit.
  • And only a quarter of them report getting evidence based treatment to help them quit. 
  • More than 40% of adult smokers attempt to quit each year. 
    • Cold turkey?  5% success rate at 6 months
    • Success can increase to 10% just with advice from a medical provider
    • Quitline referral alone?  12% success rate at 6 months
    • Counseling + FDA-approved medications are 3X more likely to work
Meds?  What meds?
  • Nicotine Replacement Therapy (NRT), which includes nicotine gum, patches, lozenges, nasal spray, inhaler
    • Recommended NRT dose will vary depending on the level of tobacco use
    • NRT provides a spike of nicotine that can help manage triggers and urges
  • Bupropion (Wellbutrin, Zyban)
    • Originally developed as an antidepressant, so it may be good to use when there is also depression
    • Helps keep dopamine levels from dropping during withdrawal, and reduces some of the withdrawal effects
  • Varenicline (Chantix)
    • Studies found that Chantix does NOT increase suicidal ideation or attempts
    • Binds with nicotine receptors, so tobacco use isn't as satisfying

And you mentioned counseling…

  • Motivational Interviewing (MI), coping skills training and mindfulness are very helpful during smoking cessation
How do I start the conversation?
  • Ask "Have you ever smoked cigarettes or used other tobacco products?"
    • "If so, how much and how often?"
  • Advise
    • Brief support statements
    • Ex.  "Stopping all tobacco use is one of the most important things you can do for your health."  OR "You may be less dependent on your inhalers when you stop smoking."
  • Refer (stay tuned…)

Coming next:
Refer, you say?  How does this work at the DOC?

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