Canadian Smoking Cessation Clinical Practice Guideline

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CANADIAN SMOKING CESSATION GUIDELINETOOLS/RESOURCESTITLECanadian Mental HealthAssociationCanadian Psychiatry AssociationNicotine Dependence Clinic(Centre for Addiction and MentalHealth)TEACH ProgramHere to HelpDESCRIPTIONProvides resources for various mental health conditionsThis national professional association provides clinical practiceguidelines on various mental health conditions and other resources.This clinic offers service to smokers and tobacco users who want to quitor reduce their tobacco use. It also provides specialized treatmentservices for smokers with other substance use issues, chronic mentalillness and serious health concerns.No referral is requiredTobacco Interventions for patients with mental health and/or addictivedisordersOffers a specialized course about the detection and treatment ofconcurrent tobacco dependence and mental health and/or addictivedisorders.A partnership of seven leading mental health and addictions non-profitagencies working to help people prevent and manage mental health andsubstance use problems. Work is funded by the BC Mental Health andAddiction Services.RESEARCH GAPSNRT to assist with reducing to quit, highdose off label use and combination NRT inthis population.Safety and efficacy of varenicline in thispatient population.Efficacy of free pharmacotherapy forsmoking cessation in psychiatric patientsincluding those currently taking psychiatricmedication.Monitoring for consequences of long-termuse of smoking cessation medication.Whether approaches or interventions shouldbe tailored to different levels of mental healthand addiction services (e.g. crisis, firstpsychosis, etc.).Establish the efficacy and safety ofconcurrent or sequential quitting of tobaccouse in addiction treatment settings.MENTAL HEALTH AND/OR OTHER ADDICTION(S) 31
CANADIAN SMOKING CESSATION GUIDELINEOVERVIEW OF EVIDENCEThe following recommendations, and supportingevidence, have been extracted from existing clinicalpractice guidelines to inform the development of the CAN-ADAPTT Summary Statements.• SPECIFICPOPULATIONS:Pregnant &Breastfeeding WomenCAN-ADAPTT’s Clinical Practice GuidelineDevelopment Group;Section Lead: Alice Ordean, MD, CCFP, MHScCAN-ADAPTT worked with the Guidelines AdvisoryCommittee (GAC) to conduct a literature search(years: 2002-2009) to identify existing clinical practiceguidelines (CPGs). Five existing clinical practiceguidelines were identified as meeting the high qualitycriteria set out in the AGREE Instrument. Therecommendations contained in these high qualityCPGs have been used as the evidence base for theCAN-ADAPTT guideline development process.The strength of evidence classification for each ofthese existing CPGs can be found in Appendix F.Note that the grade of recommendation/strength ofevidence summary table for CAN-ADAPTT’ssummary statements can be found in Appendix B.U.S. Department of Health and Human ServicesPublic Health Service (2008) 13Because of the serious risks of smoking to thepregnant smoker and the fetus, wheneverpossible pregnant smokers should be offeredperson-to-person psychosocial interventionsthat exceed minimal advice to quit. (Strengthof Evidence = A)Although abstinence early in pregnancy willproduce the greatest benefits to the fetus andexpectant mother, quitting at any point inpregnancy can yield benefits. Therefore,clinicians should offer effective tobaccodependence interventions to pregnantsmokers at the first prenatal visit as well asthroughout the course of pregnancy.(Strength of Evidence = B)New Zealand Ministry of Health (2007) 14Offer all pregnant and breastfeeding womenwho smoke multi-session behaviouralsmoking cessation interventions from aspecialist/dedicated cessation service.(Grade=A)All health care workers should briefly advisepregnant and breastfeeding women whosmoke to stop smoking. (Grade = A)NRT can be used in pregnancy and duringbreastfeeding following a risk-benefitassessment. If NRT is used, oral NRTproducts (for example, gum, inhalers,microtabs and lozenges) are preferable tonicotine patches. (Grade=C)PREGNANT & BREASTFEEDING WOMEN 32
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Canadian Smoking Cessation Clinical Practice Guideline

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