How NOT to stop smoking

As readers of NHS BLOG DOCTOR will be only too well aware, I am a curmudgeonly, cantankerous old bugger at times. There is nothing more likely to reduce me to rage than a patient leaving a chitty from a “health care professional” instructing me to prescribe nicotine substitutes. Lots of reasons for my anger.  First and foremost, I am not going to be told what to do by an unqualified HCP. Secondly, most HCPs are not allowed to prescribe, and for good reason, and the ones who are so allowed are dangerous. The way things are going soon they will all be allowed to prescribe independently. So be it. I will not be responsible for their actions - and don’t say I didn’t warn you about the dangers.  Thirdly, I object to the taxpayer having to underwrite the substantial cost of nicotine substitutes. I think it is an outrage that they are available on prescription.

Fourthly, I used to smoke. It’s a long time ago now, but I still remember it, occasionally fondly. Life long non-smokers do not understand the pleasures of smoking. To them it is a filthy habit with no mitigating features. We ex-smokers know better. It is a filthy habit but, boy, the pleasure of that cigarette at the end of the meal... but enough of that! Suffice it to say that I know what smokers who genuinely want to give up are going through. I also know that no smoker will give up until they decide they want to.  All the nicotine substitutes are presented by Big Pharma as an instant, magic answer. Pop a piece of Nicorette in your mouth and you will never want a cigarette again. It is not like that. You have to genuinely want to stop.

I formulated my own psychological strategy to stop smoking, and I use it regularly to help patients. I will not go through it again now, but may I humbly suggest that any smoker who really wants to stop should try:

The Crippen Stop Smoking in 28 days Plan.

It works and it is free.

But back to the nurses, pharmacists and HCPs who give patients chitties telling me to prescribe various nicotine substitutes. I tear the chitties up and throw them away. If patients want a prescription from me, they have to see me. That makes them cross. Tough. if they won't see me, they can buy their own substitutes and save the taxpayer some money. When they do see me, if they are amenable, I take them through the Stop Smoking in 28 days Plan. If they do not want to do it that way, but have their own plan, that is fine. I will do my best to help them. But if they have no plan and think they can solve the problem by slapping on a nicotine patch, I do not prescribe. They can buy them themselves. Most of these people will end up with the patch or the gum and continue smoking as well.

I have never prescribed Zyban or Champix and I never will. Using this sort of medication is not the right way to stop smoking. Even if it worked, and it does not, I have always worried about dangerous side effects, particularly with Champix. I was therefore pleased to find that the Drugs and Therapeutics Bulletin (a non-promotional, no-advertising-accepted pharmacology journal) has grave reservations about Champix. The article is still in copyright so, sorry, you will have to pay to look. Fortunately, there is an excellent review of the problems with Champix at Pharmalot

It it not just the Drugs and Therapeutics Bulletin that has reservations.  It gets worse:

First, we’re told we can’t fly our planes if we’re also using Champix to quit smoking. Now, we can’t drive our rigs, either. The Federal Motor Carrier Safety Administration has issued a warning that advises medical examiners “to not qualify anyone currently using this medication for commercial motor vehicle licenses,” according to The Wall Street Journal. The move follows a study by the Institute of Safe Medication Practices that found a host of side effects linked to Pfizer’s quit-smoking pill

• serious accidents and falls
  
• potentially lethal cardiac rhythm disturbances
  
• severe skin reactions
  
• acute myocardial infarction
  
• seizures
  
• diabetes
  
• psychosis
  
• aggression
  
• suicide.
  

In all the study, linked Champix to nearly 1,000 serious adverse events. Just hours after the study was released two days ago, the Federal Aviation Administration banned the drug for pilots and air traffic controllers. So far, though, the FDA, which previously issued health advisories about psychiatric side effects, such as suicide, hasn’t taken any additional action. (full report here)

So ask yourself this. Do you want to take a drug that the Federal Aviation Administration has deemed to be too dangerous for pilots and air traffic controllers?