Quitting Tobacco Use – Asrar Qureshi’s Blog Post #988

Quitting Tobacco Use – Asrar Qureshi’s Blog Post #988

Dear Colleagues! This is Asrar Qureshi’s Blog Post #988 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Alexandar Andreev

Credit: Antoni Shkraba

Credit: Eren Özdemir

Credit: Thibault Luycx

World Health Organization has issued “WHO clinical treatment guideline for tobacco cessation in adults” in July 2024. Link at the end.

I was a good (read heavy) smoker for many years before I quit about nineteen years ago. Of course, I still carry a soft corner for smokers, particularly, when I see them being restricted from all public places like restaurants, parks, hotels, airports, and so on. Life is not enjoyable for smokers anymore.

There was a time when tobacco chewing was part of culture and lifestyle, and smoking was iconic and related to real men. Almost all adults and elderly men and women in our society chewed tobacco in ‘paan’; Niswaar was another form preferred in some parts of the country. Then came more convenient and dangerous forms like ‘Gutka’ which was highly addictive and dangerous.

Presently, an estimated 1.25 billion people are using tobacco. Every year, around 8 million people die prematurely as a result of smoking. More than 7 millions of those deaths result from direct tobacco use, while about 1.3 million are non-smokers who are exposed to second-hand smoke. Tobacco use has been implicated in mouth, throat, and lung cancer.

Despite strong awareness campaigns during the last fifty or so years, tobacco addiction remains a substantial problem worldwide. Tobacco companies also keep fueling the fire through advertisements and other commercial campaigns. Nicotine is the substance in tobacco which causes addiction, and prevalence of individuals diagnosed as nicotine-dependent is higher than any other substance abuse disorder. 

Long time back, smoking was considered to be only a social activity, and it was seen in all TV plays and movies. Smoking was often used to convey certain emotions such as anxiety, depressed feelings, happy feelings etc. However, now it is clear that behavioral displays notwithstanding, smoking and tobacco use are due to addiction. That is why, of those smokers who try to quit, less than 5 percent are successful. 

Surgeon General of the USA 1988 report (still valid) described the pharmacologic basis of tobacco addiction and arrived at three major conclusions:

1. Cigarettes and other forms of tobacco are addicting.

2. Nicotine is the drug in tobacco that causes addiction.

3. The pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.

This is the background for WHO issuing 76-page clinical treatment guideline.

WHO Clinical Treatment Guideline for Tobacco Cessation in Adults

The guideline is primarily targeted at healthcare provider. This guideline provides recommendations on the use of behavioral support, delivered in both clinical and community settings, including: digital tobacco cessation interventions, pharmacological interventions, and system-level interventions and policies to enhance the adoption and implementation of tobacco cessation interventions.

WHO guideline makes 12 recommendations, which I am sharing here briefly.

Behavioral support delivered in both clinical and community settings

1. Brief advice – between 30 seconds and 3 minutes per encounter

2. More intense face-to-face counseling, group counseling, and telephone counseling

3. Text messaging. Smartphone application, Internet-based interventions, AI-based interventions

Pharmacological interventions delivered in both clinical and community settings

4. Varenicline, Nicotine Replacement Therapy (NRT), bupropion, and cytisine, as pharmacological treatment options for tobacco users who smoke and are interested in quitting.

5. Bupropion in combination with NRT or varenicline may be offered to tobacco users who do not respond adequately to first-line treatment.

Interventions for smokeless tobacco use cessation

6. Provide intensive behavioral support interventions (counseling) for tobacco users interested in quitting.

7. Varenicline or NRT as pharmacological options for smokeless tobacco users interested in quitting.

8. Combination of pharmacotherapy and behavioral interventions to support tobacco users interested in quitting. 

9. Traditional, complementary, and alternative therapies – evidence is insufficient to make a recommendation for or against such therapies. If a tobacco users wishes to use any of these, they should be given comprehensive support including counseling and/or pharmacotherapy.

System-level interventions and policies

10. All healthcare facilities should include tobacco use status and use of tobacco cessation interventions in their medical records.

11. Training of all healthcare providers on delivery of evidence-based cessation interventions, with ongoing prompting and feedback in their routine medical practice.

12. Evidence-based tobacco cessation interventions be provided at no or reduced cost to all tobacco users interested in quitting.

[Quote] The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) provides a comprehensive set of recommendations and obligations for countries to markedly decrease, and ultimately eradicate, the harms caused by tobacco, including the elimination of predatory marketing practices by the tobacco industry. Many of these recommendations focus on country-level and institutional policies and programs, such as the elimination of second-hand smoke (SHS) exposure; curtailment of tobacco advertising, promotion and sponsorship; increases in pricing, such as through taxation; anti-tobacco mass media campaigns; and product regulation. These policies and programmatic interventions have been shown to decrease initiation and the prevalence of tobacco use. However, the Parties to the WHO FCTC also have obligations to support tobacco users to quit under Article 14 of the WHO FCTC, which contains measures concerning tobacco dependence and cessation.

The WHO FCTC Article 14 guidelines emphasize that it is important to implement tobacco dependence treatment measures synergistically with other tobacco control measures. Implementing cessation and treatment measures in conjunction with population-level interventions covered by other articles of the WHO FCTC will have a synergistic effect, and thus maximize their impact.

Over 60% of the world’s 1.25 billion adult tobacco users want to quit. However, around 70% of them have no access to comprehensive tobacco cessation services due to the challenges that face health systems, such as limited human and financial resources – including limited capacity to deliver tobacco cessation services – as well as tobacco user- and policy-related obstacles to the promotion of tobacco cessation services in LMICs. Providing access to adequate cessation support and tobacco dependence treatment benefits all tobacco users and is particularly important for those who are dependent on tobacco. Tobacco or nicotine dependence is considered a chronic condition or disease, which often requires repeated intervention and multiple attempts to quit, so the need for ongoing support is critical. However, national clinical treatment guidelines for providing tobacco cessation support and tobacco dependence treatment do not exist in around 60% of World Health Organization (WHO) Member States. [Unquote]

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.

References:

https://www.who.int/publications/i/item/9789240096431 

https://www.ncbi.nlm.nih.gov/books/NBK53018/