Panel: New Tools Help Smokers Quit

New Quit-Smoking Guideline Recommends Counseling and Medication

Medically Reviewed by Louise Chang, MD on May 08, 2008
From the WebMD Archives

May 8, 2008 -- An expert panel's new quit-smoking guideline says more smokers would quit if their doctors offered them both counseling and medication -- and if health plans covered the expense.

The official 256-page U.S. Public Health Service guideline comes from a panel of 37 experts who reviewed some 8,700 scientific articles -- about 2,700 of them published since the last guideline came out in 2000.

What's different? More hope, says panel chairman Michael C. Fiore, MD, MPH, founder and director of the University of Wisconsin Center for Tobacco Research and Intervention.

"The guideline represents a scientific statement of hope," Fiore tells WebMD. "We now have a substantial body of evidence that we can take a patient who smokes and dramatically increase that patient's likelihood of quitting."

Steven A. Schroeder, MD, head of the Smoking Cessation Leadership Center at the University of California, San Francisco, praises the new guideline. Schroeder was not a member of the Department of Health and Human Services panel.

"Our center is very happy with this. They broadened the sense of who can we help quit smoke," Schroeder tells WebMD.

Quit-Smoking Ball in Doctors' Court

The new guideline asks every doctor to intervene with every patient who smokes at every health care visit.

Doctors are encouraged to provide at least brief counseling, and to help patients who smoke find more intensive counseling from telephone quitlines (1-800-QUIT-NOW) and from trained providers.

"Thirty million smokers will visit a doctor this year. That is an incredible opportunity to remove a major health risk from the lives of our patients," Fiore says.

Won't this make smokers avoid health care? Fiore says there are studies showing the opposite. Smokers whose doctors talk to them about their smoking, he says, feel they are getting better health care than smokers whose doctors don't raise the issue.

"This tells me that most smokers -- in their hearts and in their guts and in their minds -- want to quit," Fiore says. "They feel trapped, trapped by a powerful addiction, trapped by a chronic disease they established as teens, trapped by a history of having tried to quit and having failed. The guideline offers ways out of this trap to these patients and to the doctors who treat them."

The guideline also encourages doctors to prescribe at least one of the seven medications proven to help people quit smoking. Five of those medications are nicotine-replacement products: nicotine gum, nicotine patches, nicotine inhalers, nicotine lozenges, and nicotine nasal spray.

Two are non-nicotine drugs. Zyban is an antidepressant shown to help people quit smoking. Chantix is a designer drug that plugs into nicotine receptors in the brain. This does two things: It reduces the pleasure a person gets from smoking, and it reduces craving for nicotine.

All drugs have side effects; Zyban and Chantix are no exceptions. There have been recent reports of rare side effects -- suicidal thoughts, agitation, and mood and behavior changes -- in Chantix users.

"It is going to be very difficult to determine if this is a real risk of Chantix. The problem is how to sort this out from the huge number of smokers who suffer mental problems," says Schroeder, who gets no funding from the drug's manufacturer. "There are 5 million prescriptions filled for Chantix, so if these side effects are real, they are rare. And 50% of smokers will die from smoking, so you have to balance the benefit with the risk."

Insurers Urged to Cover Quit-Smoking Counseling, Drugs

Another major emphasis of the new guideline is a direct recommendation that all insurance plans should cover the costs of quit-smoking counseling and medication.

The guideline notes that this recommendation is based on studies showing that "compared to not having tobacco use treatment as a covered benefit, individuals with the benefit were more likely to receive treatment, make a quit attempt, and abstain from smoking."

Fiore himself puts it more poetically.

"If the 45 million smokers in America today are not able to successfully quit, fully half -- more than 20 million Americans -- are going to be killed by a disease directly caused by their smoking, prematurely robbing them of some 10 years of life," he says. "How can we not address this with every patient at every visit?"

The full Health and Human Services guideline was released this week.

WebMD Health News



Fiore, M.C. "Treating Tobacco Use and Dependence: 2008 Update," May 2008; published online.

Michael C. Fiore, MD, MPH, professor of medicine and director, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison.

Steven A. Schroeder, MD, distinguished professor of health and health care and head, Smoking Cessation Leadership Center, University of California, San Francisco.

Fiore, M.C. and Jaen, C.R. Journal of the American Medical Association, May 7, 2008; vol 299: pp 2083-2085.

Schroeder, S.A. and Sox, H.C. Annals of Internal Medicine, Nov. 21, 2006, vol 145: pp 784-786.

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