Smoking rates in patients with psychiatric comorbidities are up to five times higher than in the general population, leading to serious health consequences for these patients.
by Ron Pohar
In fact, it has been estimated that approximately 50% of all cigarettes are consumed by individuals with mental health disorders. Patients with psychiatric comorbidities can be an ideal target for tobacco cessation or reduction interventions given the high prevalence of smoking and the potential for significant benefit.
Healthcare providers may be reluctant to address tobacco use disorder in individuals with psychiatric comorbidities due to the unique considerations and complexities of developing smoking cessation plans for these patients. Moreover, misconceptions on the part of healthcare providers about patient motivation and willingness to quit have historically been a barrier to treating tobacco addiction in this population.
Failing to address tobacco use, however, results in a missed opportunity to assist patients in taking the most important step towards improving their health. The Ontario Ministry of Health and Long-Term Care’s pharmacy-based smoking cessation program provides a good framework that can be adapted to meet the needs of individuals with psychiatric comorbidities during their smoking cessation journey.
What are the key considerations for providing smoking cessation interventions to patients with psychiatric comorbidities so that pharmacists are more confident in their abilities to address tobacco use disorder in this population?
The 5A’s approach to intervening (Ask, Advise, Assess, Assist and Arrange) can be applied to safely manage and support quit attempts in patients with psychiatric comorbidities. Pharmacists can learn tips for management, appropriate monitoring and follow-up, and tools for monitoring, along with gaining information on nicotine replacement therapy dosing.
Ron Pohar graduated with distinction from the Faculty of Pharmacy at the University of Alberta in 1995 and began his career as a clinical pharmacist specializing in mental health, geriatrics and smoking cessation, particularly in those with mental illnesses.