New NICE guidelines aim to improve stop smoking interventions and services in primary care and community settings – but a leading charity has warned that “a declining number of specialist services” are available to implement the guidance.
The guidelines emphasise the importance of targeting smokers with mental health problems, those who misuse substances and those with health conditions caused or exacerbated by smoking. Services also need to reach populations with a high prevalence of smoking, people in disadvantaged or custodial settings, and pregnant women.
Emphasis is also placed on the importance of delivering evidence-based interventions: individual and group behavioural support; bupropion; short- and longacting nicotine replacement therapy (NRT); varenicline; and very brief advice.
Healthcare professionals should explain to people who want to quit that “a combination of varenicline and behavioural support or a combination of short-acting and long-acting NRT are likely to be most effective” but an approach should be agreed that “best suits” a smoker’s preferences.
Varenicline should be prescribed normally as part of a programme of behavioural support. Varenicline, bupropion or NRT should be prescribed or provided before the person stops smoking. A quit date should be agreed within the first two weeks of treatment with bupropion, and the first one to two weeks of taking varenicline. The smoker should be reassessed “shortly before the prescription ends”. Those using NRT should also agree a quit date.
“At every opportunity”, pharmacists should “ask people if they smoke and advise them to stop smoking in a way that is sensitive to their preferences and needs”, the guidelines say. Healthcare professionals should discuss any stop smoking aids the person has used, including those bought without prescription.
Pharmacists should offer advice about NRT and e-cigarettes on general sale and should explain that e-cigarettes are not licensed medicines, but are controlled by the Tobacco and Related Products Regulations 2016. Pharmacists should add that “many people” find that e-cigarettes help them quit. However, pharmacists should encourage people using e-cigarettes to stop smoking tobacco completely and explain that while “the evidence suggests that e-cigarettes are substantially less harmful” than smoking they “are not risk free”.
If people are not ready to quit, the guidelines stress the importance of ensuring that smokers appreciate that stopping smoking reduces the risks of developing or exacerbating smoking-related illnesses. Pharmacists should suggest that smokers consider adopting a harm reduction approach and encourage them to seek help to quit smoking completely.
Action on Smoking and Health (ASH) welcomes the new guidelines, but “is deeply concerned that there are a declining number of specialist services around the country to implement this guidance”.
The charity says that the lack of services is “of particular concern for vulnerable groups such as pregnant smokers and those with a mental health condition”. It is important to have good guidance but without services to make the guidance a reality, then it becomes an academic exercise, says director of policy Hazel Cheeseman.