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Quitting Smoking Saves Lives, But Medications to Help Are Under Prescribed

  • November 14, 2022
  • Serious mental illness, Treatment

On Nov. 17, 2022, the country will mark the Great American Smoke-Out, an event organized by the American Cancer Society to encourage people to quit smoking. Despite overall drops in tobacco usage over the past few decades, smoking still kills nearly an estimated 480,000 people a year.  

Addiction to tobacco is a substance use disorder, with many treatment options that work. While some quit cold turkey, help is available in the form of support groups, apps, and medications among other options.

Smoking is of particular interest to mental health clinicians because of the prevalence of smoking in people with mental illness (see below). The current accepted medical guidance is that people with mental illness who smoke should be prescribed medications to help them quit. But the reality is, according to a new commentary in Psychiatric Services by Eden Evins, M.D., M.P.H., and Corinne Cather, Ph.D., that doesn’t happen often. The commentary accompanies  reports on two studies that assess the problem and one solution.

American Cancer Society's Great American Smokeout 2022 Logo

The first, Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness, reports that 30% of people with mental illness smoke, compared to around 22% of people without, and that tobacco-linked diseases account for 50% of deaths among people with bipolar disorder, depression, or schizophrenia. But despite the disastrous health effect of smoking, in examining long-term data among more than 55,000 smokers, the researchers found that only 2% of smokers with or without mental illness were being prescribed nicotine replacement therapy.

When the researchers asked potential prescribers why they didn’t utilize the treatment, they said that many patients were not motivated to quit and many were using smoking as a coping mechanism. Medication side effects and interactions with other medications were also concerns. Ultimately, the study recommends incorporating smoking cessation efforts into the normal process of seeing and evaluating patients.

Once such effort is profiled in the second study in Psychiatric Services, A Pragmatic Cluster-Randomized Trial of Provider Education and Community Health Worker Support for Tobacco Cessation, which examined an intervention that helped people with serious mental illness quit.

In the study, a group of smokers receiving psychiatric rehabilitation for serious mental illness through two community agencies in Greater Boston were offered community health worker support for tobacco abstinence. The clinicians involved also received in-person education about medications for tobacco use disorder. Ultimately it worked: clinician education combined with community health worker support more than doubled the usage of varenicline, a smoking cessation drug, compared with usual care, and varenicline use nearly doubled abstinence rates.

The bottom line of the studies is that medications that help smokers quit could save lives, especially those with mental illness, if they are more globally adopted.

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