Medication, counseling, insurance coverage help smokers quit

Putting more emphasis on combining counseling and medication is "greatly increasing" smokers' ability to quit, according to an update of a federal tobacco-cessation study released this week.

But some advocates of potential reduced-risk products said that using smokeless tobacco and snuff, as well as quitting "cold turkey," remain more effective for the 45 million Americans who smoke.

The report represents the first update to the Treating Tobacco Use and Dependence guidelines from the U.S. Public Health Service since 2000. The initial report was published in 1996.

The report released Wednesday touted the seven medications approved by the Food and Drug Administration as smoking-cessation treatments. The medications are bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch and varenicline.

The guidelines cited the effectiveness of telephone "quit lines" and recommended that private and public health-benefit plans cover smoking-cessation programs.

"While most smokers want to quit, and millions try each year, most do not avail themselves of the evidence-based treatments that improve success rates," said William Corr, the executive director of the Campaign for Tobacco-Free Kids.

"As the guidelines emphasize, providing insurance coverage for these evidence-based treatments increases both the rates that smokers use these treatments and the rates that smokers quit."

The guidelines also encouraged the use of motivational techniques on tobacco users unwilling to quit, such as talking to parents about lessening their children's exposure to secondhand smoke. The strong emphasis on combining counseling and medication was a key element in the updated study for Dr. John Spangler, a professor in the Department of Family and Community Medicine at Wake Forest University School of Medicine.

"Every single smoker should be told by their physician or a health-care provider about the rewards of quitting and the ways to overcome the roadblocks to quitting," Spangler said.

"They should be given this counseling within the context that nicotine is a hard addiction to quit," he said.

"There are too many doctors that either don't ask their patients whether they smoke, or don't act to providing counseling. The more methods used to intervene with a person who uses tobacco, the more likely they are to quit."

Bill Godshall, the executive director of Smokefree Pennsylvania, said he agreed that doctors and public-health professionals "have an ethical duty" to tell smokers they can reduce their health risks by switching to noncombustible tobacco/nicotine products.

"But the Public Health Service tobacco-treatment guidelines fail to mention that more than a million American male smokers have quit smoking by switching to less hazardous smokeless tobacco products -- more than have quit smoking by using nicotine-reduction treatments and other pharma products," Godshall said.

"The guidelines also fail to acknowledge that far more American smokers have quit smoking via 'cold turkey' than have quit via the nicotine medication and other pharma products."

Targacept Inc., based in Winston-Salem, is developing drugs based on nicotine research that will treat diseases of the central nervous system. On Monday, Targacept received a $500,000 payment from GlaxoSmithKline for progress made in its smoking-cessation program as part of its partnership with the pharmaceutical giant.

"In the grand scheme of things, providing a smoking-cessation aid that really goes after the addiction-to-nicotine process has proven to be more successful than nicotine-replacement products," said Don deBethizy, the president and chief executive of Targacept.

"I also agree there are a lot of benefits to combining pharma therapy and behavioral therapy in trying to treat underlying disease processes."

Reach Richard Craver at rcraver(at)wsjournal.com.

(Distributed by Scripps Howard News Service, www.scrippsnews.com.)