Tobacco Dependence Can Be Treated

“The World Health Organization estimates that, around the globe, 1.3 billion smokers purchase 10 million cigarettes every minute, and that every 8 seconds somebody dies from a tobacco-related disease,” Canadian Medical Association Journal (June 15, 2008).

Smoking is the single most preventable cause of death and disability. This has been said over and over again for many years. But smokers continue to smoke and each year we find new generation of smokers take up the habit. They get addicted and dependent on the tobacco to an extent that they find it difficult to give up the habit. In consequence they pay a price in terms of health and suffering. Not to mention the amount of money they spend to buy cigarettes and then to buy medications to treat complications of chronic smoking.

June 15 issue of the Canadian Medical Association Journal (CMAJ) has articles that review the “effective treatment for the ultimate vector of this epidemic: tobacco dependence.”

There are several effective medications available for the treatment of tobacco dependence but the problem is a failure of “dissemination of interventions from clinical trials to the broad population of tobacco users.”

Authors of one article in the CMAJ identified 69 well-designed randomized controlled trials which looked at the effectiveness of medications to help tobacco abstinence at six months and 12 months. The authors observed that varenicline (Champix), bupropion (Zyban) and 4 types of nicotine replacement therapy (nasal spray, patch, gum and tablet) roughly doubled the odds of smoking abstinence compared with placebo.

What about the nicotine inhaler?

Nicotine inhaler appeared to double the odds of abstinence as well, but the results were not statistically significant. Nicotine is also available as lozenges and nicotine sublingual tablets which dissolve under the tongue. Even in the US, 2008 guidelines on this subject agree with the above findings. The authors of the commentary in the CMAJ asks, “So why are we not doing a better job controlling the tobacco epidemic?”

The authors say that the answer is simple. It resides in our inability to disseminate effective interventions from the clinical research setting to the population. The authors give several reasons for this failure. At the physician and clinical level there is a primary emphasis on medically urgent issues, lack of time and support, inadequate training and low self-confidence among providers, and low rates of reimbursement for tobacco-treatment services.

At the population level, the authors say there is a lack of political will to restrict tobacco companies and to promote and disseminate the most effective tobacco control policies (e.g., smoke-free indoor air policies and higher tobacco taxes). Sometimes the politicians give low priority to anti-smoking programs and divert funds to other ventures.

One survey has shown that smokers in general will be receptive to receiving free nicotine replacement therapy and would use it to quit smoking. The question remains, how are we going to make the treatment accessible and affordable so we can prevent death and disability from tobacco-related illnesses? The all powerful multinational tobacco industry will not do it for us. The responsibility is in the hands of the government and the clinicians to target and encourage smokers to seek help. And the smokers should know there is help, if only they would ask.

Remember, every eight seconds somebody dies from a tobacco-related disease.

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