Pharmacists do a lot more than dispense medications and give flu shots. As we examined in our recent white paper, pharmacists offer a wide range of patient services regardless of whether they work in a hospital or a retail pharmacy. One of those services is helping people quit using tobacco – but every state has different rules for what pharmacists can do to accomplish that goal.
Why tobacco cessation matters
Approximately 32.4 million American adults still smoke cigarettes and more than 16 million Americans live with a disease caused by smoking. One in five Americans will die of a smoking-related disease, such as lung cancer or chronic obstructive pulmonary disease (COPD). Unsurprisingly, smoking tobacco is the number one risk factor for lung cancer and COPD: nearly 9 out of 10 cases of lung cancer and about 75% of COPD cases are caused by smoking. It’s not just the act of smoking that is dangerous, either. Any kind of tobacco use increases the risk of cancer, stroke, and coronary artery disease.
Switching to e-cigarettes or vaping isn’t a solution. While the long-term effects of these products are still uncertain, doctors know that inhaling nicotine, oils, and additives is inherently harmful. For example, vaping flavored liquids that contain diacetyl, a flavor enhancer, can cause bronchiolitis obliterans, also known as “popcorn lung.” Besides, nicotine is never safe to ingest in any form. Nicotine causes a narrowing and hardening of the arteries as well as increased blood pressure and heart rate, all of which contribute to heart attacks.
Clearly, it’s important for smokers to quit as soon as they can. But nicotine is highly addictive, which makes quitting on one’s own extremely difficult. That’s where pharmacists can come in.
How pharmacists help
Pharmacists are still considered the most accessible—and one of the most trustworthy–healthcare professionals. That accessibility makes pharmacists well-positioned to help the people more likely to smoke, who also tend to be people who lack access to quality healthcare.
Pharmacy organizations know that pharmacists can and should intervene to help patients stop using tobacco. The first step is helping the patient decide for themselves that they need–and want–to quit. Pharmacists are encouraged to use the “5 A's of Smoking Cessation” as a tobacco cessation gameplan:
- Ask: Ask whether the patient uses tobacco or nicotine products.
- Advise: Encourage the patient to quit without using judgmental language.
- Assess: At every visit, assess the patient’s readiness to quit.
If the patient is ready to commit to quitting, the pharmacist can move on to the final A’s:
- Assist: Help the patient develop a quit plan and set a quit date within 2 weeks. Offer resources they can use, such as 1-800-QUIT-NOW or smokefree.gov.
- Arrange: Provide follow-up after the first week, then after the first month.
Even a brief intervention from the pharmacist can help spur a patient to choose to quit and then quit successfully. The amount which the pharmacist can intervene, though, is determined by their state’s Board of Pharmacy and laws.
Thankfully, more and more states are steadily recognizing the impact pharmacists can have on patients’ long-term health. As of November 2019, twelve states had passed legislation allowing pharmacists to prescribe smoking cessation aids. In some cases, pharmacists are allowed to prescribe medications like Chantix and bupropion, which can help patients overcome nicotine addiction. In other states, pharmacists can prescribe nicotine replacement therapies (NRTs) like nicotine patches, gum, and inhalers.
In either case, the pharmacist provides much more than a pill or a patch. For example, under Indiana’s standing order, the pharmacist first assesses the patient’s willingness to quit, then performs a health screening. If the patient is not considered high-risk, the pharmacist can dispense whichever tobacco cessation products are appropriate and counsel the patient on the proper use of the product. Finally, once the patient’s questions have been answered, the pharmacist notifies the patient’s doctor and makes sure the patient understands they also need to follow up with their doctor.
While smoking cessation standing orders are relatively new, they will undoubtedly benefit both patients and pharmacists. Patients will face fewer financial and time barriers to tobacco cessation, and pharmacists will be able to bill insurance for tobacco cessation counseling. It’s a win-win!
Why it’s worth asking for help
Quitting tobacco not only improves long-term health but also has short-term benefits. Your breath will smell better. Food will taste better. Light activity like climbing stairs will be easier. You won’t need to stand outside in inclement weather to smoke, spit, or vape.
Other areas of your health will improve; for example, your dental health. Exposing your teeth to nicotine stains them and contributes to gum disease and tooth loss, all of which are expensive to fix. Speaking of expense: calculate how much money you spend on tobacco or nicotine products each month. That can be a great motivation to quit!
Think of the people around you, too. Secondhand smoke causes cancer and is particularly dangerous to children. Children whose parents smoke are at high risk for asthma, bronchitis, shortness of breath, and increased infections. Not only does this ruin a child’s quality of life, but increased doctor’s visits, childcare, and lost days of school and work negatively impact families.
It’s never been a better time to quit. With COVID-19 cases on the rise again, we all need to take care of our lungs. Even if your state hasn’t granted prescribing power to pharmacists, your local pharmacist can still help you quit tobacco. Ask for help creating a quit plan and give yourself a fresh start in 2021.