From Dysfonction érectile - Tobacco Info No. 5 - April 2011
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BC government should subsidize smoking cessation therapies

Leading health advocates in British Columbia are urging the provincial government to improve the accessibility to quit smoking medications by subsidizing nicotine replacement drug therapies, saying that financial support for smoking cessation medications is recognition of the fact that nicotine addiction must be treated as a serious and chronic condition.

The Heart and Stroke Foundation of BC and the Yukon, and the BC Lung Association issued a press release on January 14 arguing that smokers in the province who are ready to quit, should be provided subsidized access to smoking cessation medications.

“Addiction to the nicotine in cigarettes is complex and what works for one smoker will not necessarily work for another,” said Scott McDonald, CEO of the BC Lung Association. “It is important that British Columbians know that there are effective strategies available to help them with nicotine withdrawal and dependence. Typically it takes a tobacco user six to seven attempts before they quit for good. Tobacco addiction is a chronic, relapsing medical condition, not just a personal choice.”

Both organizations came together to form the Clean Air Coalition of BC (CAC), an advocacy group committed to reducing the harm caused by tobacco use and exposure to second-hand smoke. They have come out in support of government cessation policies and initiatives that have proven to reduce smoking, including investing in the program QuitNow Services (www.quitnow.ca). However, they believe that the next step needs to be subsidized support and clinical tools.

The Saskatchewan government recently approved quit smoking medication subsidies and the Quebec government has been funding them for almost 11 years. BC health advocates are urging their government to do the same.

In a 2008 Lung Association report entitled Making Quit Happen, Canadian family physicians said affordable cessation programs and medications were the primary resources needed to achieve a reduction in smoking rates. The report outlined that stakeholder groups felt smoking cessation medications were too expensive and acted as a barrier to quitting for some individuals.

“Although smoking cigarettes is expensive, quit smoking medications are also expensive. Public and private insurance plans either do not cover them, or do not cover them sufficiently,” said Diego Marchese, Chief Operating Officer of the Heart and Stroke Foundation of BC and Yukon. “Many people who smoke have not had access to these [smoking cessation services] or products, and this is an important step forward to help those people quit smoking. The reluctance to spend money on medications leads many smokers to try to quit ‘cold turkey,’ the most popular method for quitting smoking.”

CAC smoking cessation report

The CAC sponsored a report tabled in September 2010 outlining specific recommendations to the provincial government for funding of nicotine replacement, prescription medication therapies and physical counselling.

The report, entitled Opportunities for Smoking Cessation Therapies in BC, prepared by healthcare consultant Garry Curtis of PhD Consulting, proposed program initiatives in four areas.

The first is physical counselling for smoking cessation. The report cites a US Department of Health and Human Services clinical study that, after analysis of 43 studies of clinical counselling, found that one session of clinical counselling reduced smoking by 12%, while eight or more sessions resulted in a 25% reduction, proving that clinicians can make a difference even with minimal intervention.

The second proposal is that drug therapy programs be funded through PharmaCare (a comprehensive drug program that helps British Columbians with the cost of eligible prescription drugs and designated medical supplies). A study by Jorenby, Rae et al, published in the Journal of the American Medical Association, reported a 23% decline in the number of smokers after one year with varenicline (Champix) therapy and 14.6% with bupropion (Zyban). Based on estimates and assumptions by both the CAC and Pfizer Canada — manufacturers of Champix — 70,000 smokers in BC could benefit from one of these prescriptions.

The third proposal is to fund Nicotine Replacement Therapies (NRT) for low income people. The effectiveness of the smoking cessation gum and patch has been scientifically proven. In addition, the report cites an Ontario study involving free nicotine replacement that produced two to four times the typical quit rates. Additionally, a similar study in New York of a free NRT therapy program achieved quit rates of 21 to 35%, compared to 12% for those with no NRT therapy. A program targeting low income British Columbians using a series of survey questions could be used to identify those in need of assistance.

The final proposal is to enhance the BC Lung Association’s QuitNow Services, which provide a range of smoking cessation services, resources, expert advice and quitting strategies free-of-charge to all British Columbians. The administration of the proposed subsidization of NRT therapies would be added to the association’s mandate. In addition, QuitNow would be able to refer their clients to family physicians in order to obtain counselling.

The CAC estimates that tobacco-related illnesses cost the BC government $2.7 billion annually in healthcare costs. Its report estimates that these four initiatives would cost the province a total of $37.8 million. The CAC proposes a one cent per cigarette tax to cover the associated costs, yielding approximately $38 million in revenue annually.

Recent research reports that 70% of the more than 550,000 smokers in BC have said they’d like to quit in the next 12 months. The CAC report states that in order to further reduce the number of people who smoke, attention to those who continue to smoke by providing subsidized cessation therapies is needed.

By Joe Strizzi