NewMethod to Quit Smoking

Speaker: Mr. William Chui

Education Director, Drug Education Resources Centre,

The Society of Hospital Pharmacists of Hong Kong

23th Oct 2006

LEGCO approved to ban smoking in restaurants

Smokers are more determined to quit

LEGCO approved the Smoking (Public Health) (Amendment) Bill 2005, which is recommended to be effective from Jan, 2007.Non-smoking areas will be expanded in Hong Kong: smoking will be strictly prohibited in enclosed public places like restaurants, indoor workplaces and karaokes.Also, government will enforce more restrictions on the packaging, labeling and promotions of cigarettes.Survey reveals that the restriction of smoking

in restaurant urges more than half of the smokers to quit.

How to quit smoking effectively?

Smokers in Hong KongAccounts for 1 in 5 adultsApprox. 800,000 smokes in HKMale : Female = 86% : 14%

Female smokers aged 30-49 increased 15% in the past 3 years

7,000 people die prematurely from smoking-related diseases each yearAbout 60% smokers have never thought of quitting or unwilling to quit shortly, and they are not going to join any smoking cessation program

Smoking as an addiction

Physically:Nicotine dependenceAbrupt stop or reduction of nicotine in-take may lead to withdrawal cravings, nervousness, anxiety, over-eating and weight gain etc.

Psychological and social factors:

In addition to physical addiction, stress and social activities also contribute to a smoker’s dependence on cigarette

Common ways to quit smoking

Non-medical treatments:1. Stop smoking immediately by willpower2. Switch to light cigarette with less nicotine3. Snacking instead of smoking4. Alternative methods like hypnotherapy,

acupuncture etcMedical treatments :1. Use Nicotine Replacement Therapy (NRT) abruptly

(e.g. patch, gum or inhalator) to manage withdrawal cravings

2. Seek advice from medical professionals and use medicine (non NRT treatment like Bupropion ) to reduce the desire of smoking

The efficacy

Quit smoking without using any kind of treatment

90% will relapseThe lack of willpower and perseverance might finally lead to relapse Overseas clinical study reveals that:

90% will relapse within 12 months if not using any kind of treatment to quit smoking, most of them will smoke again within one week. 1

1. Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

The myth of “light” or “ultra light”

(Cigarettes with less tar and nicotine)

Toxins are even more harmfulMay lead to compensatory smokingThere are 4,000 toxins from light cigarettes that are more harmful than nicotine. Among them, 40 toxins is proven carcinogenic

Shiffman et al. J Consult Clin Psychol, 1996; Henningfield et al. Tob Control, 1998

Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

Snacks as a replacement of cigarettes:

Lead to weight gain, not long lasting

No scientific proof for alternative smoking cessation

methods

Hypnotic therapy & acupuncture etc

Determination + cut down cigarette consumption + NRT

Increase the chance of successful quittingMost of the smokers not yet know

about NRT

Seek medical professionals’ advice and use appropriate medications:Highly effective yet seldom used

Shiffman et al. J Consult Clin Psychol, 1996; Henningfield et al. Tob Control, 1998

Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

“NRT – Cut down then Stop”More effective than no treatment

Study indicates that “Cut down and Stop” can increase the success rate of smokers who are not ready or unable to quit smoking, and prepare for a complete cessation. The more you cut down, the higher chance of successful cessation.

Likelihood of successful cessation increases dramatically if daily consumption of cigarette can be reduced by more than 50%.Heavy smokers need to reduce nicotine levels in order to achieve successful cessation.

For those who want to quit smoking but not ready or unable to stop abruptly, an effective, safe and convenient approach to

cut down smoking might lead to a higher chance for successful quitting.

Latest cessation strategy “NRT – Cut down then Stop”

approachTargets smokers who want to stop but not yet ready or unable to stop abruptly.A first step to help increase confidence, motivation and compliance to stop completely.Cutting down gradually may reduce withdrawal symptoms when cessation is attempted.Achieve the ultimate goal of complete smoking cessation after reduction.

“NRT – Cut down then Stop”Help 40% of smokers who are not ready or unable to stop smoking to quit successfully

0%

10%

20%

30%

40%

50%

Without NRT With NRT-Cut down then stop

Carpenter M, Hughes J, Solomon L, Callas P. Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. J Consult Clin Psychol 2004; 72: 371-381

6 months test results for 616 smokers who are not interested (or unable) to quit smoking

quit

succ

essf

ully

in 6

mon

ths

(% )

16%

43%43%

“NRT – Cut down then Stop” Double the chance of complete

cessation

成功戒煙機會增加 1.875 倍

Placebo group NRT group

Increase the chance of success by 1.875 times

Month 4 Month 12

Part

icip

ants

%

0.5%

6.3%

8%

23%

Source: Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up. 2003 Society for the Study of Addiction to Alcohol and Other Drugs.

How to choose the method for smoking cessation?

Can you stop smoking right away?

Yes No

Can you stop smoking from next month (with help)?

Can you reduce your daily consumption of cigarette from now on, then stop completely in the near

future?

Yes Yes No No

Use NRT to quit smoking within a short

time

Use NRT to reduce cigarette

consumption, then stop smoking

completely

Seek pharmacists or

medical professionals’

advice

“NRT – Cut down then Stop” 4 Steps Approach

Nicotine

Nicotine

Nicotine

Nicotine

Nicotine

Nicotine

“NRT – Cut down then Stop” 4 Steps Approach

Nicotine

Nicotine

Nicotine

Nicotine

Nicotine

Nicotine

Nicotine

Using nicotine replacement products

Nicotine

SummaryLegislative Council has just passed the “Smoking (Public Health) (Amendment) Bill 2005” which further expands indoor statutory non-smoking area such as restaurants or bars etc. There is an urgency for smokers to quit smoking. Study reveals that success rate will increase significantly if daily consumption of cigarette can be reduced.The latest strategy : “NRT – Cut down then Stop” is appealing to smokers who are not yet ready to quite

Double the chance of complete cessation as compared with the placebo group.

Smokers who are not ready or unable to quit smoking should seek advice from pharmacists, medical professionals or smoking cessation groups, to tailor-made a quit smoking plan and to use NRT products to achieve complete cessation. Determination is the key to successful quitting.

Falba et al. Addiction,2004; Fagersrom et al.Tobacco Control, 1997; Bolliger et al. Br Med J, 2000

Thank You

Background information

Health Hazards of Smoking

80% of lung cancer deaths.*20% of deaths from coronary heart disease.*Increase the risk of heart attack.For those women using oral contraceptives, it will further increases the risk of heart attack, stroke or other cardiovascular diseases.Increase the chance of spontaneous abortion, premature birth, lower birth weight babies.Increase sperm abnormalities and impotence in men.

WHO website, WHO policy recommendations on smoking cessation and treatment of tobacco dependence, 2003

Hazards of Secondhand SmokeMainstream smoke: directly inhaled by smokers, comprise

15% of all secondhand smoke. Sidestream smoke: smoke emitted from the burning of cigarette in the air which comprise 85% of all second-hand smoke. As it has not been filtered, it contains more toxic chemicals, more than 3 times of tar and 6 times of nicotine than mainstream smoke.Secondhand smoke: mixture of smoke emitted during cigarette burning and exhaled smoke of smokers during smoking. Secondhand smoke contains more than 4,000 particles and gases, Many potentially toxic gases are present in higher concentrations in sidestream smoke than in mainstream smoke. Inhaling secondhand smoke may cause:

Sore throat, eye irritation, cough, headache, etc.Serious diseases, e.g. cancer, heart attack, asthma, etc.

參考資料 : 香港吸煙與健康委員會網頁

Adapted from Henningfield, N Engl J Med, 1995; 333:1196-1203

“NRT – Cut down then Stop” is less addictive than

cigarette

Cigarette = highly addictive

NRT = low potential of abuse

1

10

100

-10 0 10 20 30 40 50 60Time (minutes)

Blo

od

nic

oti

ne

co

nc

en

tra

tio

ns

(n

g/m

l)

Cigarette

4 mg Gum

15 mg Patch

Cigarette (Arterial)

Arterial

Venous