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?"
- 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…)
Refer, you say? How does this work at the DOC?