Pharmacists Help Smokers Quit

Published on 19 October 2015

Nearly 64 percent of smokers in Missouri tried to quit in the past year. Only a fraction of those smokers were successful. Sue Bollmeier, Pharm.D., BCPS, AE-C, professor of pharmacy practice, helps patients end their tobacco use. 

When do most people try to quit smoking and using tobacco?

A lot of people like to quit during the holidays because they want to prove to their families they can; many people make it their New Year’s resolution. Another popular time is the third Thursday in November — the American Cancer Society’s Great American Smokeout. The event challenges people to stop using tobacco for a day, giving them the motivation they need to quit for good. 

What is the biggest motivating factor for someone wanting to quit?

Number one for my patients is probably their health. They have seen their physician for a health-related condition and they might not be breathing as well as in the past, or noticed a worsening of shortness of breath, maybe some chest pain, or they can’t walk as far as they used to. After health, the other motivating factor is their kids or grandkids. From what I see, men most commonly want to quit for their health. Women want to quit for their families.

Do people really understand the health risks associated with smoking and tobacco use?

I think the older patients, like those who have been smoking for a while, do realize the health ramifications but not usually until they’ve had a health scare. I think the younger smokers, like teens and young women, probably don’t realize what they’re doing to their bodies and their lungs. They think they’re invincible. A lot of women smoke to maintain weight or to lose weight. I don’t think they fully understand the risks.

Why is the stuff so addictive?

Inhaled nicotine from cigarettes can actually reach the brain within seconds, causing pleasurable feelings. We quickly learn to associate smoking with those feelings of pleasure. Most people tell me that they feel more alert and energized yet also less anxious and calm after a cigarette. The brain will crave more nicotine to continue to produce these effects in smokers because of its actions on the dopamine reward pathway. That’s what leads to repeated use.

Where do you start with a patient who wants to quit?

I ask questions from the Fagerstrom questionnaire; it’s a validated tool I use to figure out a patient’s dependency on nicotine. Based on how people respond, I tally a score. Then, based on this number, I can tell how physically dependent on nicotine they are. The more dependent someone is physically, the higher the likelihood of physical withdrawal symptoms. For those patients, I generally recommend nicotine replacement products.  Things like patches and gum to help lessen symptoms of withdrawal.

Then what?

It depends on what the patient wants to do. If they use a particular agent, I look at how long they’re supposed to use that agent. For example, most patients will use the nicotine patch for about eight weeks. Each patient is different and requires different lengths of counseling and treatment. If they use an oral medication like Zyban (bupropion) or Chantix (varenicline), it’s usually a three-to-six -month process.

What about patients who aren’t physically dependent on nicotine?

If they’re not physically addicted, it could be that they have a psychological addiction — a habit embedded into their daily routine. I usually ask those patients to keep a log or journal of each time they smoke throughout the day. They write down the time they smoked, how many cigarettes they smoked, and why they needed that cigarette(s). It makes them think about when they’re smoking and why. For those with strong psychological addition, I like to use Bupropion, an anti-depressant drug that has been shown to help patients quit smoking. It works on norepinephrine and dopamine in the brain. Also a newer agent, Chantix, or varenicline, a nicotine receptor antagonist can help. This drug works by blocking the effects of nicotine in the brain making it less pleasurable and rewarding to smoke.  

What about people who don’t think they can quit?

You have to be really encouraging. I usually tell them up front that most people don’t quit the first time they try. I’ve been at the county (department of public health) for more than ten years, and I’ve helped the same people several times. The average quitter will attempt to stop approximately five times before they finally succeed.  I find that its important to be up front with patients about this to decrease frustration.

What’s your reward for a job well done?

For me, it’s fulfilling to realize my time and effort has helped them succeed in quitting. They feel better, breathe better, and can do more. I’ve helped empower them to take control of their own health. It’s a good feeling. 

(Adapted from Script, Winter 2009)

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