A new approach to stopping smoking - Case study

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Case study - consultation in the pharmacy

Max is in his late 30s and is a regular customer in your pharmacy. One day he comes in and says that he has been trying to stop smoking and has tried different types of NRT with no success. He really wants to stop smoking and is determined to stop this time. A couple of his friends have managed to stop smoking using e-cigarettes but he isn’t sure about trying them as he thinks they are just as harmful as smoking.

Which of the following advice would you give to Max?

While e-cigarettes contain nicotine, they are likely to be less harmful than smoking

Correct! While e-cigarettes contain nicotine, they are likely to be less harmful than smoking

E-cigarettes contain nicotine and are likely to be as harmful as smoking cigarettes

Incorrect

Max says that he has tried nicotine patches and gum in the past; he wonders if he should perhaps try those again but asks if e-cigarettes would be more effective.

How would you reply to Max?

There is little data comparing the effectiveness of e-cigarettes to NRT

Incorrect

There is evidence that e-cigarettes containing nicotine increase quit rates compared with NRT.⁶ It is estimated that in 2017, more than 50,000 smokers stopped smoking with the aid of a vaping product²³

Correct! There is evidence that e-cigarettes containing nicotine increase quit rates compared with NRT.⁶ It is estimated that in 2017, more than 50,000 smokers stopped smoking with the aid of a vaping product²³

You show Max the range of e-cigarettes available in the pharmacy and he decides to try JUUL2.

After explaining to him how to use the device and how he can link it to the JUUL app, what additional advice would you give Max?

Any smoking is harmful, so people using e-cigarettes should stop smoking tobacco completely. JUUL2 is an alternative form of nicotine delivery and not a cessation device

Correct! Any smoking is harmful, so people using e-cigarettes should stop smoking tobacco completely. JUUL2 is an alternative form of nicotine delivery and not a cessation device

For adults interested in using nicotine-containing e-cigarettes, explain the importance of getting enough nicotine to overcome withdrawal symptoms¹³. JUUL2 is an alternative form of nicotine delivery and not a cessation device

Correct! Explain to adults who choose to use nicotine-containing e-cigarettes the importance of getting enough nicotine to overcome withdrawal symptoms¹³. JUUL2 is an alternative form of nicotine delivery and not a cessation device

Stop smoking support

You can signpost customers to the following websites for further advice:

NHS Stop Smoking Services
https://www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/

NHS Smokefree
https://quitnow.smokefree.nhs.uk

References

1. Office for Health Improvement and Disparities. “Nicotine vaping in England: an evidence update including health risks and perceptions”, 2022. 2022. [Online].
Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1107701/Nicotine-vaping-in-England-2022-report.pdf (Accessed 04 11 2022)

2. National Health Service. “What are the health risks of smoking?” 2018. [Online].
Available: https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-risks-of-smoking/ (Accessed 04 11 2022)

3. Featherstone, HJ. “Establishing a Smoke-free 2030 Fund” [Online]. Available at: https://ash.org.uk/uploads/Featherstone-H.-submission-to-APPG-Smoking-Health_-Establishing-a-Smoke-free-2030-Fund-FINAL.pdf (Accessed 07 11 2022)

4. smokefree.gov. “Challenges when quitting”. [Online].
Available: https://smokefree.gov/challenges-when-quitting (Accessed 04 11 2022)

5. Office for Health Improvement and Disparities. “Making smoking obsolete: summary”. 2022. [Online].
Available: https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary (Accessed 04 11 2022)

6. Cochrane Library. “Electronic cigarettes for smoking cessation (review)”. 2021. [Online].
Available: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub6/epdf/full (Accessed 17 11 2022)

7. Action on Smoking and Health (ASH). “Use of e-cigarettes (vapes) among adults in Great Britain”. 2022. [Online].
Available: https://ash.org.uk/uploads/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2022.pdf?v=1661865959 (Accessed 10 11 2022)

8. Office for Health Improvement and Disparities. “Nicotine vaping in England: an evidence update including health risks and perceptions, 2022”. 2022. [Online].
Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1107701/Nicotine-vaping-in-England-2022-report.pdf (Accessed 11 11 2022)

9. Russell, MH “Low-tar medium-nicotine cigarettes: a new approach to safer smoking.” BMJ. 1976. [Online].
Available: https://www.bmj.com/content/bmj/1/6023/1430.full.pdf (Accessed 10 11 2022)

10. Public Health England. "Health matters: stopping smoking - what works?" 2019. [Online]. Available at: https://www.gov.uk/government/publications/health-mattersstopping-smoking-what-works/health-matters-stopping-smoking-what-works (Accessed 10 11 2022)

11. Abrams, DB et al. “Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives”. 2018. [Online].
Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942997/pdf/nihms-1064283.pdf (Accessed 11 11 2022)

12. Royal College of Physicians. “Nicotine without smoke: Tobacco harm reduction”. 2016. [Online].
Available: https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction (Accessed 11 11 2022)

13. National Institute for Health and Care Excellence (NICE). “Tobacco: preventing uptake, promoting quitting and treating dependence”. Updated 2022. [Online].
Available: https://www.nice.org.uk/guidance/ng209/resources/tobacco-preventing-uptake-promoting-quitting-and-treating-dependence-pdf-66143723132869 (Accessed 10 11 2022)

14. “The Tobacco and Related Products Regulations 2016”. 2016. [Online].
Available: https://www.legislation.gov.uk/uksi/2016/507/data.pdf (Accessed 11 11 2022)

15. Royal College of Physicians. “Smoking and health 2021: A coming of age for tobacco control?”. 2021. [Online].
Available: https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-2021-coming-age-tobacco-control (Accessed 10 11 2022)

16. National Centre for Smoking Cessation and Training (NCSCT). “Incorporating e-cigarettes into your Stop Smoking Service: Making the case and addressing concerns”. 2021. [Online].
Available: https://www.ncsct.co.uk/usr/pub/NCSCT%20OHID%20e-cig%20v7.pdf (Accessed 11 11 2022)

17. UK Health Security Agency. “Clearing up some myths around e-cigarettes”. 2018. [Online].
Available: https://ukhsa.blog.gov.uk/2018/02/20/clearing-up-some-myths-around-e-cigarettes/ (Accessed 11 11 2022)

18. University College London news. “E-cigarettes not a substantial gateway to smoking for young people”. 2022. [Online].
Available: https://www.ucl.ac.uk/news/2022/mar/e-cigarettes-not-substantial-gateway-smoking-young-people (Accessed 10 11 2022)

19. National Centre for Smoking Cessation and Training (NCSCT). 2022 “Supporting clients who want to stop vaping”. [Online].
Available: https://www.ncsct.co.uk/usr/pub/Supporting%20stopping%20vaping.pdf (Accessed 11 11 2022)

20. Cancer Research UK. “Does vaping cause popcorn lung?”. 2021. [Online].
Available: https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/does-vaping-cause-popcorn-lung (Accessed 11 11 2022)

21. National Centre for Smoking Cessation and Training (NCSCT). “Very Brief Advice training module”. 2014. [Online].
Available: https://www.ncsct.co.uk/publication_very-brief-advice.php (Accessed 11 11 2022)

22. National Centre for Smoking Cessation and Training (NCSCT). “Training Standard Learning Outcomes for Training Stop Smoking Practitioners”. 2018. [Online].
Available: https://www.ncsct.co.uk/usr/pub/NCSCT_training_standard.pdf (Accessed 11 11 2022)

23. Gov.uk. “Vaping better than nicotine replacement therapy for stopping smoking, evidence suggests”. 2021. [Online].
Available: https://www.gov.uk/government/news/vaping-better-than-nicotine-replacement-therapy-for-stopping-smoking-evidence-suggests#:~:text=The%20best%20thing%20that%20a,safety%20fears%20about%20e%2Dcigarettes (Accessed 11 11 2022)

Warning: This product contains nicotine which is a highly addictive substance. JUUL is intended for use by adult smokers. Toxic if swallowed. Harmful in contact with skin or if inhaled. Harmful to aquatic life with long lasting effects. Keep out of reach of children. IF SWALLOWED: Immediately call a POISON CENTRE. Call a doctor if you feel unwell. If medical advice is needed, have product container or label at hand. IF ON SKIN: Wash with plenty of water. Dispose of contents and container to an approved waste disposal plant. Glacier Mint e-liquid contains peppermint oil. May produce an allergic reaction. Menthol e-liquid contains peppermint oil terpeneless. May produce an allergic reaction. Crisp Menthol e-liquid contains I-Carvone and peppermint oil terpeneless. May produce an allergic reaction.

The data and insights in this module are for information purposes only and pharmacists and their teams, as trained healthcare professionals, will exercise their own clinical judgment when it comes to delivering treatment, providing advice and making recommendations. Public health authorities' views are their own and do not necessarily reflect the views of Juul Labs. Juul 2 is neither risk-free nor a licensed cessation medication. For adult smokers concerned with their health, the best thing they can do is quit nicotine use altogether.

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After explaining to him how to use the device and how he can link it to the JUUL app, what additional advice would you give Max?

Stop smoking support

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Case study - consultation in the pharmacy

Which of the following advice would you give to Max?

How would you reply to Max?

After explaining to him how to use the device and how he can link it to the JUUL app, what additional advice would you give Max?

Stop smoking support

Log in