Ministry of Health Tobacco Health Target Update - Primary Care

Ministry of Health Tobacco Health Target Update - Primary Care "90 percent of enrolled patients who smoke and are seen in General Practice will be provided with advice and help to quit by July 2012"

Kia ora kotou Nicotine replacement therapies (NRT) and other medicines have been shown to double a person's likelihood of quitting, and when combined with advice and support to quit, people are four to five times more likely to successfully quit smoking. These products are often not well understood by patients and frequently not used correctly. This update provides more information about these products and provides a number of tools that can be used to assist patients.

NRT provision by GPs & other prescribers - what are the trends? Recent data from Pharmac regarding subsidised NRT products indicates that:  Overall NRT prescription has increased by about 400% in the last three years - NRT use in 2010 is about 5 times greater than it was in 2007.  Patches continue to be the most commonly prescribed product - prescribed twice as often as gum or lozenges, which are equally used.  The number of prescription-based referrals to NRT has continued to trend upwards over the last 12 months (with noticeable spikes each time tobacco tax was increased). Additionally, the number of scripts being issued for Champix (Varenicline) has more quadrupled since it was made available on special authority over the last seven months.

NRT Resources:  How to use nicotine therapies correctly - this video, featuring Hayden McRobbie, is avaialble on HIIRC and YouTube. It introduces each of the key NRT products and demonstrates correct use.  Factsheet: Nicotine Patches - gives brief information about nicotine patches and how to use them most effectively.  Nicotine Replacement Therapy (NRT): A summary of use and safety in practice - article by Dr Hayden McRobbie that summarises key practical and safety issues of NRT in clinical practice.  Brief review of evidence on access to, and use of, nicotine replacement therapy - research report by Litmus, exploring which smokers are using NRT, how they tend to access it, and why others don't.

Practitioner Supply Orders The range of items listed on the Practitioner Supply Order (PSO) was extended from 1 July 2011 to include all strengths and flavours of nicotine therapies. They are intended primarily for teaching and demonstration purposes, although is can be access for emergency use and groups where individual prescription is not practical. REMEMBER - Rural GPs are entitled to use PSOs to obtain NRT products to be directly supplied to patients. Rather than just write a script, they can give out the appropriate products.

Update: Champix (varenicline) - concerns regarding heart risk Recent media coverage highlighted concerns about increased heart-risk among users of Champix in response to the findings of a recent Canadian study.  Varenicline is only available through presecription for those who have been unsuccessful on other products.  The study quoted in the media quantifies the risk at just over 1% (1.06%) for smokers quitting using varenicline compared to just under 1% (0.86%) for smokers using the placebo.  There is a large lifetime heart risk from smoking and a much smaller risk from varenicline when used for a short period to help quit smoking.  It helps smokers quit by reducing cravings for nicotine and is around twice as effective as nicotine replacement therapies in helping quitters stay quit.  As with any medication, Champix has benefits and risks. Medsafe will continue to evaluate Champix but are encouraging patients to "continue to use Champix tablets as the benefits of the treatment outweigh the risks."

Carl Billington Senior Communication Advisor Tobacco Policy and Implementation Sector Capability and Implementation Directorate Ministry of Health 021 263 5508 http://www.moh.govt.nz mailto:[email protected]