Smoking Cessation
Smoking is the single leading preventable cause of early death in New Zealand. Half of all long-term smokers die of a smoking related illness, losing an average of 15 years of life.
https://www.beehive.govt.nz/release/tobacco-excise-rise-part-wider-programme
Contents
Pharmacists in Canterbury can contribute to the goals of Smokefree 2025 by:
Referring people wanting to quit to cessation support at Te Hā – Waitaha Stop Smoking Canterbury. See Appendix A for details.
Prescribing and giving advice around funded Nicotine Replacement Therapy (NRT) and the impact of stopping smoking on some medications. See Appendix B.
Giving advice on oral funded prescription medications such as varenicline, bupropion and nortriptyline. Please see Smoking Cessation Advice, Healthpathways, for details.
Giving advice on the risks and benefits of nicotine and tobacco alternatives such vaping and heated tobacco products. See Appendix C.
Te Hā — Waitaha Stop Smoking Canterbury
Referring a person, wanting to quit smoking, to an organisation for behavioural support, will substantially increase their chance of quitting. See here.
Each DHB in New Zealand is funded to supply smoking cessation services. The following website maps where each service is based. https://www.smokefree.org.nz/help-advice/stop-smoking-services
Te Hā – Waitaha Stop Smoking Canterbury, is the CDHB’s stop smoking support organisation.
The referral forms for Te Hā – Waitaha, Stop Smoking Canterbury, can be found on the Toniq templates, under CDHB Stop Smoking. Alternatively the Te Hā – Waitaha Stop Smoking Canterbury, website can be used to refer.
Te Hā – Waitaha Stop Smoking Canterbury, is a collaboration of organisations (see below). Referrals for support go to Stop Smoking Practitioners within these organisation, who complete the NZQA smoking cessation practitioner training.
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Some of the additional benefits of referral into Te Ha – Waitaha Stop Smoking Canterbury, include free Nicotine Replacement Therapy, vouchers for free doctor’s appointments to consider varenicline prescribing, and pregnancy incentive vouchers.
Appendix B: Prescribing Funded Nicotine Replacement Therapy (NRT)
· From 2017, New Zealand Pharmacists have been able to authorise the subsidy of funded NRT. Details of this service can be found here
· All staff members may give advice around smoking cessation (see training options below). However it is only the pharmacist that can authorise the subsidy of the NRT.
· When prescribing NRT pharmacists will need to document the patient information and products prescribed, on a signed and dated prescription copy or similar document, and file the prescription in their batch as with a normal prescription.
· When processing the prescription the pharmacist should list their Pharmacy Council number in the prescriber field preceded by 00-(NZPC number)
· Two repeats may be added to each NRT prescription
· Follow the instructions on the Ministry of Health’s, ” Guide to Prescribing Nicotine Replacement Therapy (NRT)”
· Full boxes (OP’s) of Nicotine gum may be supplied each month if the instructions correlate to the quantity, eg Maximum of 12 pieces of gum or as directed
· Prescribe enough NRT to relieve withdrawal symptoms. For highly dependent smokers (smoking the equivalent of 20 or more cigarettes a day and needing to smoke within the first hour of waking), a high strength (21mg) patch may be used plus frequent regular use (one every waking hour) of the gum or lozenge for at least the first two weeks after quitting smoking. See healthpathways (Nicotine Replacement Therapy) for further prescribing advice.
· While it is up to the individual pharmacist’s discretion how many NRT prescriptions are written, it is recommended that if the consumer is using NRT long term the pharmacist should periodically ask if they want help to withdraw from the NRT. If this is the case the consumer should be referred to Te - Ha Waitaha, Stop Smoking Canterbury or alternatively pharmacists can follow the guidance in the following document; Long Term Supply of Nicotine Replacement Therapy. (1)
Training
· Whilst pharmacists are able to supply funded NRT without additional training, it would be beneficial for all staff involved in giving advice about smoking cessation to complete smoking cessation training.
There are a number of options:
1. For a short course aimed at health professionals, create an account with learn online and complete the course; “Helping people Stop Smoking”
2. For general staff training, the CDHB smokefree team is well placed to provide on-site smokefree training for pharmacists and their staff. Email smokefree@cdhb.health.nz for more information.
3. For those wanting an in depth training on providing multi-session stop smoking support go to the National Training Service. Their resource page also gives useful information about smoking cessation.
Impact of stopping smoking on some medications
Stopping smoking affects the metabolism of some medication taken concurrently. This is related to the polycyclic hydrocarbons in cigarette smoke, not to the nicotine. Therefore dosage adjustment may be necessary, even where the person is using NRT or vaping to quit smoking. The four main medications that are affected that pharmacists should be aware of are Clozapine, Olanzapine, Theophylline and Warfarin. Please see here for details.
Appendix C: Nicotine and Tobacco Alternatives
Vaping
The use of vaping products is growing rapidly in NZ. Currently they are unregulated consumer products. However the Ministry of Health (MoH) is moving towards regulation.
Vaping is not harmless and the risks of long term vaping are unknown. However vaping is thought to be considerably less harmful than smoking.
The MoH considers vaping products have the potential to make a contribution to the Smokefree 2025 goal, and could disrupt the significant inequities that are present. See here
Accordingly they have developed a consumer-facing Vaping Facts website which can be used by those people wanting to quit smoking using vaping as a tool. The Pegasus Health, Vaping to Quit FAQs – Information for Patients, (2) can also be used.
The MoH has also released a notice to “reiterate its advice about vaping”, cautioning that vaping products are intended for smokers only and should not be used by children, young people and non-smokers.
Heated Tobacco Products (HTPs)
There is no evidence to support HTPs as a smoking cessation tool and there are substantial safety concerns. See thePegasus Health Position Statement on Heated Tobacco Products (3)
For further information on Smoking Cessation promotion in Canterbury Pharmacies please contact:
Robyn Harris
Liaison Pharmacist
Canterbury Community Pharmacy Group
C: 021 815 119, E: robyn.harris@ccpg.org.nz