Pharmacy U

Vaping’s in the news, but smoking’s still a big problem



By Jack Kohane


Chris Oliveiro wants to help people kick the tobacco habit. His efforts aren’t going up in smoke.


“Yes, we are making an impact,” says the pharmacist/owner of Springdale Pharmacy in Brampton, Ont. “I’ve received many words of thanks from spouses and children of smokers who are grateful that their parent has quit smoking. This is why smoking cessation services are essential in my pharmacy.”

His smoking cessation program involves keeping in touch with patients for at least one year. The service costs $125 and includes motivation and dialogue with each patient until he or she quits. The program comes with a readiness assessment, an assessment of smoking habits, and a collaborative assessment of which pharmacotherapy is best for that patient. “I first dialogue with my patient, and then inform their physician of my decision,” Oliveiro points out. “Inter-collaboration with health professionals keeps all important parties informed and involved.”

Tobacco cessation is also a key element of Jenna Anderson’s practice. A clinical pharmacist with Safeway Pharmacy in Saskatoon, she explains that all pharmacists employed by Safeway and Sobeys in Saskatchewan are PACT-certified. PACT (Partnership to Assist in the Cessation of Tobacco) is a provincial tobacco cessation program, providing pharmacists with additional training on tobacco cessation. “I’m extremely fortunate to have pharmacist colleagues who are just as passionate about tobacco cessation as I am,” affirms Anderson.

She and her pharmacy team present chronic disease management classes about the harms associated with tobacco and specific disease states, discussing how nicotine causes dependency, and smoking cessation strategies. “On an individual level, we include behavioural strategies as part of the patient’s comprehensive quit plan, providing follow-up for additional support.”

In helping smokers halt the habit, pharmacists are well placed to offer strategies and ongoing support, says Jane Ling R.Ph., BScPhm., adjunct clinical professor at the University of Waterloo School of Pharmacy.

She speaks at professional conferences and pharmacy schools across the country. “We explain what pharmacists should know about tobacco addictions and the different methods to quit,” she says. “The smoking cessation category is crucial to growing their pharmacy practice.”

Quit aids are helping

Mirroring that growth are the billowing sales of non-prescription Nicotine Replacement Therapies (NRT) in Canadian pharmacies. According to statistics published by Euromonitor International, a UK-based market research firm, dominant product formats in NRT smoking cessation aids in 2018 continued to be gum and patches, accounting for 54% and 42% shares of sales, respectively; NRT gum increased by 3% to reach C$85 million in 2015; and NRT patches increased by 2% to reach C$66 million. NRT inhalers and NRT lozenges each declined by 1%. NRT smoking cessation aids posted a growth of 2% in 2018, to reach C$156 million.

According to Amanda Hartzmark, a research analyst with Euromonitor, “The increased use of NRT aids, facilitated by a wide range of programs in Canada were amongst the drivers of growth.”

Pharmacists can rightly take credit for much of that decline. “Pharmacists are more convenient for patients to consult and are trusted by consumers,” says Robin Flamer, brand manager for Nicoderm and Nicorette, by Johnson & Johnson. She cites that counselling from a pharmacist can enhance quit rates by 40%. “Our consumer research shows that of those who still smoke, 80 % are unhappy about their smoking. About 43% of these are planning to quit or are actively quitting – this is double the percentage from 2008. And in 2016, 11% of quitters used e-cigs only, down 9% from 2014.”

Flamer notes that the vast majority of quitters try ‘cold turkey’/willpower alone but that only about 4-6% are successful this way. In 2016 in Canada, about 44% of quitters used nicotine replacement therapy. “This form of quitting is gaining in popularity although the end goal needs to be 100% abstinence,” she adds.

Innovation in the OTC NRT category comes primarily from new flavours and formats. An oral spray (QuickMist) is the most recent innovation in the NRT space. The pharmacotherapy resources to help in smoking cessation also include Zyban and Champix. Champix was approved by Health Canada in 2007. Since then, there have been no new smoking cessation treatments approved in Canada.

Guylaine Lessard, a Kirkland, Québec-based pharmacist and medical advisor with Pfizer Canada Medical (the maker of Champix), reinforces the importance of pharmacists counselling their patients on smoking cessation. On October 6, 2016, Health Canada authorized the inclusion in the Champix Product Monograph of a third method of setting a quit date, the gradual quit approach.

“The patient can now also elect to gradually reduce smoking during the first 12 weeks of treatment such as 50% reduction or more by four weeks of treatment, 75$ or more by eight weeks, to reach 100% by 12 weeks. Patients who follow this gradual quit approach to setting a quit date should be treated with Champix for 24 weeks.”

Whatever the approach and tools, pharmacist Chris Oliveiro believes it’s a total team effort to promote smoking cessation. “I inform my staff pharmacists to ask the smoking status of all patients where appropriate. I feel that it is my duty as a caring health professional to help these patients quit smoking.”