Tobacco and Public Health - TCSC Indonesia

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TREATMENT OF TOBACCO DEPENDENCE
◆ Five first-line pharmacotherapies for tobacco dependence—sustained-release
bupropion hydrochloride, nicotine gum, nicotine inhaler, nicotine nasal spray,
and nicotine patch—are effective, and at least one of these medications should be
prescribed in the absence of contraindications.
◆ Tobacco dependence treatments are cost-effective relative to other medical and
disease prevention interventions; as such, all health insurance plans should include
as a reimbursed benefit the counselling and pharmacotherapeutic treatments
identified as effective in the updated guideline.
In 2002 the UK National Institute for Clinical Excellence issued the report: Guidance
on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation
(National Institute for Clinical Excellence 2002).
This report reviews in great detail the pharmaceutical treatment of tobacco dependence
as of today. Among many others the following are seen to be very important:
◆ Nicotine replacement therapy (NRT) and bupropion are recommended for smokers
who have expressed a desire to quit smoking.
◆ There is currently insufficient evidence to conclude that one form of NRT is more
effective than another.
◆ In trials, a combination of two different NRTs was in general more effective than
a single NRT.
◆ Both bupropion and NRT are considered to be among the most cost effective of all
health care interventions.
◆ The likelihood that a smoker will be successful in quitting depends on several factors:
the smoker’s motivation; the extent of the smoker’s tobacco dependence; the
intensity and quality of the support offered; and the use of pharmacological aids.
◆ NRT in general is associated with few adverse events. Users of bupropion, however,
will sometimes suffer adverse events, occasionally serious, and which are now well
known.
Advice to stop smoking—the possible role of the internet
In recent years the internet has come up as a convenient and comprehensive means of
information on how to stop smoking. A number of products to quit smoking is
offered. We have examined smoking cessation products distributed via the internet and
evaluated them from a scientific point of view (Eckl-Dorna and Groman 1999).
The study was conducted by using the search string ‘stop + smoking’ in two of
the most popular internet search engines, yahoo (www.yahoo.com) and lycos
(www.lycos.com). Sites offering only advice were excluded. Only sites that offered
products to stop smoking were chosen. These products were then evaluated, by screening
for published papers in peer-reviewed journals. In one case we tested a product
measuring resulting carbon monoxide levels.