Tobacco Harm Reduction and Vaping Cessation – New Opportunities for Pharmacist Skills

 Since 2011, pharmacists in Ontario have had the authority to prescribe smoking cessation medications, varenicline and bupropion. Ontario pharmacists receive $125 annual remuneration through the Pharmacy Smoking Cessation Program for counselling Ontario Drug Benefits (ODB) and OHIP+ patients on their journey to become smoke-free.  

The Ontario Pharmacists Association (OPA) provides an online training program called Implementing Smoking Cessation in the Pharmacy which certifies pharmacists in smoking cessation to allow for billing ODB for smoking cessation services.  

The modules include: 

Module 1: Pathophysiology 

Module 2: How to Help Patients Quit Smoking 

Module 3: Prescribing Pharmacotherapy 

Module 4: Implementing Smoking Cessation in Your Practice 

Module 5: Harm Reduction 

Tobacco addiction is a chronic relapsing disease and is a risk factor for many chronic diseases including diabetes, hypertension, COPD, heart disease.[3] Smoking cessation is one of the most impactful and cost-effective preventative interventions in healthcare.[3] 

On average, it can take several quit attempts, but in each quit attempt patients learn strategies, become more knowledgeable and move towards success. Quitting smoking is challenging for any patient but with pharmacists by their side assisting them on their long and winding road, it can greatly improve their chances of success.  

Pharmacists are:
● the most accessible healthcare provider[4]
● one of the most trusted healthcare professionals
● an expert in medication management and treatment choices

PSFC have developed several tools, algorithms and videos to help pharmacists assist people on their journey to a smoke-free life. By using a combination of strategies including the 3A’s (Ask, Advise, Act) as well as motivational interviewing to gather patient history, pharmacists can work with patients to implement an effective, clinically suitable and sustainable smoking cessation plan.  

These PSFC resources can be found online:   

Canadian Pharmacist Smoking Cessation Pharmacotherapy Algorithm
 1) PSFC Algorithm Initial Tool
 2) PSFC Algorithm Follow Up Tool
 3) PSFC Patient Quit Tool 

Algorithme pharmacothérapie pour l’abandon tabagique
 1) PCSF Algorithme d’évaluation initiale
 2) PCSF Algorithme de suivi
 3) PCSF Plan d’abandon pour le patient 

In addition, Tobacco Harm Reduction and Vaping Cessation are two new emerging areas where patients are asking pharmacists for help. PSFC was a part of the development committee of:  

1) Lower Risk Nicotine Use Guidelines (LRNUG) – Health Canada/CAMH  

Nicotine is an extremely addictive substance that can be difficult to quit completely. For patients currently using or thinking of using nicotine products, LRNUG outlines modifiable behaviours and recommendations on the use of alternative nicotine products such as e-cigarettes. Pharmacists can share this Evidence Brief and Quick Tips page as a way to initiate conversation with patients who are looking to improve their health.  

2)  Vaping Cessation Resource Guide – CAMH  

These guidelines provide considerations for approaches to vaping cessation. In addition to asking all patients if they are smokers, all patients should be asked if they vape. Some patients use both cigarettes and e-cigarettes, and may be eligible for up to 8 weeks of free Nicotine Replacement Therapy (NRT) as well as access to an online program designed to help with vaping cessation through the STOP on the Net Program. Take into account patient preference, their personal goals, and smoking history when developing a treatment plan.  

With patients paying attention to their lung health now more than ever, pharmacists can help them navigate the changing landscape of smoking, tobacco harm reduction and vaping cessation. With all these new tools, pharmacists are poised to be leaders in assisting patients on their journey to a healthier smoke-free life. No one needs to be left behind. 

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