Treating Tobacco Use and Dependence
A Public Health Service Clinical Practice Guideline
Michael C. Fiore, M.D., M.P.H., Director,
Associate Professor, Center for Tobacco Research and Intervention, University of
Wisconsin Medical School
Press Briefing,
HHS Auditorium, Washington, D.C. June 27, 2000
Good morning. I am pleased to share with you information that can greatly
improve the health of millions of Americans—the recommendations of a new Public
Health Service-sponsored Guideline, "Treating Tobacco Use and Dependence." I
would like to give some context to this new Guideline. Approximately 20 million
Americans will try to quit this year. That is one-third of all smokers in the
United States. Regrettably, most of them will try to quit on their own or, in
other words, "cold turkey." As a result, only one million of them will be able
to quit and stay tobacco-free.
The treatment recommendations outlined in the PHS Guideline that we are
releasing today will substantially increase the success rate. In fact, if every
doctor, nurse, dentist, or other health care provider and health plan uses this
tool in practice across America, we can double quit rates, from one to at least
two million new quitters each year. The impact of an extra one million quitters
will quickly translate into improvements in health, freeing them from an
addiction that dictates how they live, and in many instances, how they die.
These improvements will touch families across America.
There is no other public health or clinical intervention available that holds
such promise. This Guideline promises to decrease the enormous burden of
illness, death, and economic costs that result from tobacco addiction in our
society.
It is difficult to identify a condition in the United States that presents
such a horrific mix of lethality, prevalence, and neglect, despite effective and
readily available interventions. Tobacco use is that condition.
The climate for treating tobacco dependence has tremendously improved over
the last decade. This evidence-based Guideline takes the science, and in a
practical way, translates it into cessation treatments that work. The expert
panel that prepared this report concluded that-first, we need to call tobacco
dependence what it is—a chronic disease, not unlike high blood pressure or
diabetes. This recognition provides clinicians with a model for helping their
patients quit.
So what is new since we released the original Smoking Cessation Clinical
Practice Guideline in 1996? The new PHS Guideline provides information on
innovative counseling strategies that work, including telephone counseling, and
other techniques. It also contains evidence-based information about the
effectiveness of new medicines that were not approved by the Food and Drug
Administration when the original Guideline was issued and urges that every
tobacco user who is motivated to quit be provided with one of these medicines in
the absence of contraindications. Finally, the PHS Guideline now covers all
forms of tobacco use, including smokeless tobacco—snuff and chew; and cigars and
pipes.
Here are some of the key results:
- Effective cessation treatments are now
available and every patient who uses tobacco should be offered these
treatments.
What are these treatments?
- To begin with, we identified five first-line medications that reliably
increase long-term quit rates. Only two of them, the nicotine patch and
nicotine gum were recommended in 1996. The new medications include the
nicotine inhaler, the
nicotine nasal spray, and the non-nicotine pill,
bupropion.
- Next, advice and counseling work. The Guideline offers even stronger
evidence of the association between the intensity of counseling and
successfully quitting. In general, the more intense the counseling, the more
effective the treatment. Telephone counseling, problem solving and skills
training, and help in securing social support both inside and outside of the
standard treatment settings are also very effective.
- Next, we challenge health plans to pay for tobacco cessation treatments in
the same way they pay for the treatment of other chronic diseases such as high
blood pressure or diabetes. The evidence lends even greater support to the
fact that tobacco dependence treatments are both clinically effective and
highly cost-effective relative to other medical and disease prevention
interventions. This information strengthens the Guidelines' argument that
insurers and purchasers should ensure that all tobacco users have both access
to, and coverage of these services. What an unfortunate paradox, that
virtually every insurance plan in America pays for the devastating and
expensive health outcomes related to tobacco use such as heart attack, stroke,
and cancer, but less than half of these plans pay the $200 to $400 that it
costs to prevent those outcomes by helping their enrollees to quit.
- The Guideline also recommends that clinicians be reimbursed for providing
tobacco dependence treatment just as they would be for other chronic
conditions.
Finally, with the release of this new Public Health Service Guideline, we
have a real opportunity to improve public health. Most importantly, as a result
of this release, the great majority of tobacco users in America who want to
break free of their tobacco dependence, will have a greater chance of success.
Any one of us who has ever smoked, or has witnessed a loved one addicted to
this drug, recognizes that quitting tobacco use is among the most difficult
challenges he or she will ever face. To quit requires both hard work and
commitment. In this high-tech society, no magic bullet exists that will
automatically transform a tobacco user into a non-tobacco user. But, the
findings released today offer tobacco users their greatest hope of taking a
determination to quit and translating it into a lifetime free of tobacco use—and
in that way, rediscovering the wonderful gift of "life" for themselves and their
loved ones.
Thank you.