Self Care Pharmacy Blog

Posts Tagged ‘smoking cessation’


Chew or Dip, Time to Quit

Wednesday, November 5th, 2014

By Tyler Michael, PharmD Student

Smokeless tobacco use is on the decline in adults and children.1 This is not necessarily a time to celebrate for healthcare providers though. As the focus has been shifted away from the dangers of smokeless tobacco, some professionals have wrongfully started encouraging smokeless tobacco as a safer alternative to smoking.1,2 Someone seeking to quit smoking or using any tobacco products should seek nicotine replacement therapy, Chantix, or a combination with education if they wish to quit smoking.3

An article recently published by the American Heart Association discusses the heart health effects of discontinuing smokeless tobacco use. The goal of the cohort study, which followed the patients for 4 years, was to track how cessation of smokeless tobacco affects heart health after a myocardial infarction (heart attack). According to the article the mortality rate per 1000 people is 9.7 for those who stopped using smokeless tobacco and 18.7 for those who continued using it.4 These numbers show that people who continue using smokeless tobacco after a heart attack are almost twice as likely to die within the next 4 years. Not only did stopping smokeless tobacco use lower cardiovascular disease risk, but also cancer mortality risk as well. This shows that quitting is very important to the health of those already at risk, and in no way could its use be a safer alternative to cigarette smoking.

Some limitations of this study are that it only followed those who already had a heart attack, so it cannot be applied to the risks of those who have not previously had a heart attack.4 There were no exclusion criteria for this study so a patient could have had a terminal illness or another reason for death that would influence this data. There was a selection bias that did not allow patients over the age of 75 into the study, meaning it cannot be applied to anyone over that age.4

This article agrees with the current standard that smokeless tobacco poses a health risk. Siddiqui et al. shows in there research that those who use smokeless tobacco have higher blood pressure and cholesterol than those who do not use smokeless tobacco.5 Smokeless tobacco may have lower mortality risk than those who smoke over 15 cigarettes a day, but still a much greater mortality rate than those who do not use tobacco at all.6

Based on this article and the other articles on the topic, it is evident that smokeless tobacco is not healthy, and should not be viewed as a healthy alternative to smoking cigarettes. This article shows that smokeless tobacco use increases mortality risk and this research shows that it nearly doubles mortality risk in those who have already had a heart attack. I believe stopping use of all tobacco products is the safest route and nicotine replacement therapy can be used to help patients’ quit.3 Further research is needed to determine the best nicotine replacement therapy or smoking cessation medication in this population of patients with previous heart attack.

Stopping tobacco use is one of the best health decisions someone can make for themselves.  What method would you use to quit? If you have successfully quit, what worked for you?


References List


  1. Nelson D, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in Smokeless Tobacco Use  Among Adults and Adolescents in the United States. American Journal Of Public    Health [serial online]. May 2006;96(5):897-905. Available from: SPORTDiscus with  Full Text, Ipswich, MA.             Accessed October 1, 2014.
  2. Digard H, Proctor C, Kulasekaran A, Malmqvist U, Richter A. Determination of Nicotine Absorption  from Multiple Tobacco Products and Nicotine Gum. Nicotine & Tobacco Research [serial online]. January 2013;15(1):255-261. Available from: Consumer Health Complete – EBSCOhost,       Ipswich, MA. Accessed October 1, 2014.
  3. Heydari G, Masjedi M, Fadaizadeh L, et al. A Comparative Study on Tobacco Cessation Methods: A  Quantitative Systematic Review. International Journal Of Preventive Medicine [serial online]. June 2014;5(6):673-678. Available from: Academic Search Complete, Ipswich, MA. Accessed    November 2, 2014.
  4. Arefalk G, Hambreaus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of  Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation AHA. May 2014.  doi: 10.1161/CIRCULATIONAHA.113.007252
  5. Siddiqui S, Rana A, Singal S, Pandey D, Khan S. Assessment of Cardiovascular Risks of  Tobacco Chewers by Comparing it with Normal Human Beings. National Journal Of Physiology, Pharmacy & Pharmacology [serial online]. January 2014;4(1):76-79.   Available from: Academic Search Complete, Ipswich, MA. Accessed October 2, 2014.
  6. Bolinder G, Alfredsson L, Englund A, De Faire U. Smokeless Tobacco Use and Increased Cardiovascular Mortality among Swedish Construction Workers. American Journal Of Public Health [serial online]. March 1994;84(3):399-404. Available from: Business Source Complete, Ipswich, MA. Accessed October 2, 2014.

Are e-cigarettes a good option for smoking cessation?

Monday, December 2nd, 2013

by Tiffany Zehel, PharmD student

In 2011, an estimated 43.8 million U.S. adults were current cigarette smokers,[i] and currently, estimates of over one billion people worldwide are smokers.[ii] Cigarette smoking is a global epidemic that can give rise to several serious diseases with nearly 6 million deaths annually.[iii] The risk of serious diseases is significantly reduced after one quits smoking and maintains life-long abstinence. Unfortunately many nicotine replacement therapies (NRT’s), such as the patch or gum, have a low efficacy rate in real life practice.[iv] Many studies evaluating the use of nicotine replacement therapies find that while traditional NRT’s provided the chemical need for the individual, the behavioral and psychological needs of the individual were not being met.[v],[vi],[vii]

 The electronic cigarette (e-cigarette) was introduced to the U.S. market in 2007 to provide smokers with more freedom to smoke as well as a safer alternative compared to tobacco cigarettes.[viii] The standard e-cigarette is a battery powered electronic nicotine delivery device (ENDD) that resembles a cigarette, and delivers nicotine in a vaporized solution. The acceptance of the e-cigarette is attributed to the similarities of smoking, including the hand-to-mouth repetitive motion and the visual cue of the vapor, addressing the psychological and behavioral aspects of the addiction.[ix]

According to an article published in The Lancet, E-cigarettes were not shown to have a statistically significant difference in individuals that quit. However, they significantly reduced the amount of traditional cigarettes an individual used in a given day compared to the patch.[x] In this news article e-cigarettes are celebrated based on the fact that they show promise to eliminate tobacco smoking completely in the future, but not so much for the promise of helping people break their addiction. Smoking tobacco is very harmful and traditional cigarettes contain toxins that are carcinogenic. In that respect, e-cigarettes should be admired for their ability to replace cigarettes. The issue is that e-cigarettes are not regulated by the FDA like other NRT’s, and their safety has not been extensively researched, due to the recent emergence of the product.

The article also had several limitations. First, the study was underpowered, meaning any effect could have gone undetected, so the results may not be reliable. Another limitation is that there was a high drop out rate in the group given the nicotine patch; this is speculated to be due to the participants wanting to try e-cigarettes but instead where randomly assigned to receive the patch. A third limitation is that the e-cigarette, that this particular study group used, contained less than optimal amounts of nicotine and delivered nicotine inefficiently. As technology advances and e-cigarettes become more efficient in nicotine delivery, e-cigarettes may be proven more effective. The final limitation is that this study was over six months while the amount of time to quit cigarettes can be much longer depending on the individual.x The short amount of time also provided little ability to evaluate adverse effects that the e-cigarette may cause. Due to these obstacles, it is difficult to say whether e-cigarettes would or would not be better than the nicotine patch.

In an article published in the journal of Addiction Science and Clinical Practice (ASCP), a group of people that regularly used e-cigarettes were followed through a forum and interviewed regularly. One repetitive theme in the article was that the subjects, who identified themselves as “vapers,” drew a line between smoking cessation and nicotine cessation. They claimed that they wished to stop smoking because of the health ramifications, but because of the convenience and perceived safety of the e-cigarettes, they had no desire to quit their nicotine addiction.[xi] Up to this point, smoking cessation and nicotine cessation went hand-in-hand. NRT’s were prescribed to step the patient down from their nicotine addiction; currently e-cigarettes are not set up in this way. So now that we have this unique delivery system on our hands, we need to decide if nicotine cessation is as important as smoking cessation. We also need to do further studies on the long-term effects of e-cigarettes to evaluate their benefits over the alternative.

I do not think that replacing one addiction with a modified version of it is the best idea. While it does reduce the health risk, it does not solve the issue of nicotine addiction, the possible long-term effects, and the cost of feeding the addiction. However, I think that e-cigarettes can be beneficial for smoking cessation and nicotine cessation with proper monitoring from healthcare professionals and social support.

 Do you think that smoking cessation is more important than nicotine cessation? Do you think e-cigarettes should be utilized for nicotine-cessation?


[i] Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(44):889–94 [accessed 2013 Nov 29]

[ii] Available at: Accessed November 29, 2013.

[iii] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[iv] Casella G, Caponnetto P, Polosa R: Therapeutic advances in the treatment of nicotine addiction: Present and Future. Ther Adv Chronic Dis 2010, 1(3):95-106 (accessed Nov 29).

[v] Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, William J, Walker N. Electronic cigarettes for smoking cessation: a randomized controlled trial. The Lancet. 2013;382(9905)1629-1637 [accessed Nov 29).

[vi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).

[vii] Cahn Z and Siegal M. Electronic cigarettes as a harm reduction strategy for tobacco control: a step forward or a repeat of past mistakes? Journal of Public Health Policy 2011;32(1)16-31 (accessed 2013 Nov 29)

[viii] Pozin I. Electronic cigarettes : booming industry or health fiasco?;;; (accessed 2013 Nov 29)

[ix] Polosa R. Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduction Journal 2013;10(19)1-11 [accessed 2013 Nov 29].

[x] Kelland K. E-cigarettes as good as nicotine patches in helping smokers quit. (accessed 2013 Nov 29)

[xi] Barbeau A, Burda J, Siegel M.  Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. ASCP Journal 2013;8(5):1-7 (accessed 2013 Nov 29).