DIMENSIONS: Tobacco Pharmacotherapy

Hello, my name is Christine Garver-Apgar,
and I’m a research associate at the Behavioral Health & Wellness Program.
Today I’m going to be presenting information on tobacco cessation
pharmacotherapy. We’re gonna cover a lot of material today, including how nicotine
acts in the brain and the biology of why nicotine is so addictive. I’m going to
describe the symptoms and patterns of nicotine withdrawal and I’ll provide
information on all approved tobacco cessation medications both those
containing nicotine and those that do not–as well as combination therapies. And
I’ll discuss special considerations for specific populations of people. The
clinical guidelines for treating tobacco use and dependence states that although
both counseling and medication are effective when used by themselves for
treating tobacco dependence the culmination of counseling and medication
is more effective than either is buy themselves so clinicians should
encourage all individuals making a quit attempt to receive both counseling
services and medication. The reason that counseling and medication together are
most effective at treating tobacco dependence is because tobacco dependence has two parts. Pharmacotherapy addresses the first part
of tobacco dependence–the physical addiction to nicotine. Whereas counseling
addresses the second part of tobacco dependence, which is the habit or the
behavior surrounding tobacco use. We will be focusing, for this
presentation, on the left half of this figure. So thats the pharmacotherapy as a
way to address the physical addiction. I’ll start with giving some information on
the basic biology of nicotine addiction. We all know that nicotine is an
incredibly addictive drug. But what we may not know is that nicotine is so
addictive that individuals who have addictions to other substances, like
alcohol, heroin, or cocaine very often report that tobacco was the most
difficult addiction for them to overcome. More people who tried nicotine will
become a daily user of nicotine than those who try other drugs. And it’s also
true that a greater percentage of those who try nicotine just a single time will
become daily users than those who try other drugs like cocaine or heroin–even
just a single time. Nicotine addiction is really no
different from any other addiction other than being harder to to quit. People use
addictive substances because there are rewards from using them. And so in this
module we’re focusing on the biological rewards of nicotine addiction. This would
be things like feelings of arousal and pleasure. All drug addictions involve
physical dependence. And what we mean by that is experiencing both
tolerance to a drug as well as withdrawal. As tobacco users
become more tolerant, they must increase nicotine use–either to get the same
biological rewards or to simply avoid the negative symptoms of withdrawal,
which leads to craving and then to greater addiction. So why is it that
nicotine is such an addictive drug? Part of the reason is that tobacco companies
have spent many many decades now perfecting how to get nicotine to the
brain as fast as possible. Because the faster nicotine gets to the brain, the
faster an individual experiences behavioral reinforcement for smoking and
the more addictive it becomes. And what tobacco companies have come up with is
the cigarette. Tobacco leaves are burned at very high temperatures, and the
resulting smoke is inhaled. Each cigarette delivers about 1 – 2
milligrams of nicotine. And this is going to be important to know for dosing
nicotine replacement therapy. Which we’ll talk about in a few minutes. After a
person takes a puff of a cigarette, nicotine from that inhalation will reach
the brain within 10 seconds. If nicotine had been administered intravenously, it
would not reach the brain that fast. So this is a very efficient and quick way
of getting nicotine to the brain. Because it reaches the brain so fast, smokers can easily control how much
nicotine they get, which makes cigarette smoking more reinforcing than nicotine
obtained in any other way. And that’s why nicotine from other sources, like the
nicotine patch or gum or other sources of NRT, have much lower potential for
abuse. Just like cocaine heroin and amphetamines, nicotine stimulates the
release of the neurotransmitter dopamine in the midbrain. This pathway is
called a “reward pathway,” because dopamine induces feelings of euphoria and pleasure. This is the same pathway that causes people to drink when they’re thirsty, eat
when they’re hungry, and have sex and reproduce ourselves. For most of human
evolutionary history having a system that reinforced behaviors which tended
to keep us alive and reproducing was a good thing. But nicotine has hijacked this
system. The pleasure felt during these activities ensures that the behavior
which led to them will be repeated. So when smoking a cigarette, nicotine enters
the brain stimulates the release of dopamine which induces a near immediate
feeling of either pleasure or simply a relief of symptoms of nicotine
withdrawal, which will talk about more in just a minute. This rapid dose response and the fact
that people can regulate their own levels of nicotine on an hour-by-hour
basis reinforces and perpetuates the smoking
behavior. Dopamine is the primary neurotransmitter that nicotine acts on, but
nicotine stimulates the release of many neurotransmitters, all with different
effects, described here. It can lead to improvement in short-term memory and
attention, faster cognitive processing, relaxation
stress reduction, decreased pain, mood improvement, and appetite suppression. Although some of these effects may actually be just relief from nicotine
withdrawal. Nicotine doesn’t just have effects on the brain related to
dependence, of course. It also can lead to other physical facts things like
increased heart rate increased blood pressure and vasoconstriction increased
metabolic rate increase sleep disturbances insulin resistance just to
name a few almost every system in the body is affected by nicotine in one way
or another initially nicotine can sometimes cause
unpleasant symptoms like nausea dizziness coughing these adverse effects
quickly diminish with repeated tobacco use and for some people even these
initial effects of nicotine are positive so people would describe nicotine is
giving a pleasurable buzz even the first time they use it when people stop using
tobacco products and depending on their level of use they will very likely
experienced some or all of the symptoms mentioned here and usually they will
experience a strong desire or a craving for tobacco they can also experience
symptoms of depression because taking away nicotine has the effect of reducing
dopamine and serotonin activity in the brain in general withdrawal symptoms appear within the
first one to two days they peak within the first week and they gradually
disseminate or dissipate rather over the next two to four weeks so they’re most
intense within the first few days or the first week in May gradually get better
and if you compare this with heroin where withdrawal symptoms decrease
substantially after only a day nicotine withdrawal can hang around for
weeks and not only that but cravings and urges for cigarettes can take much much
longer even months or years to go away after quitting when somebody is
experiencing symptoms of withdrawal counseling is not particularly effective
which is why pharmacotherapy in combination with counseling can be so
helpful and now I just want to take you through
a day in the life of a smoker so this image depicts a smoker smoking one
cigarette every 40 minutes between eight in the morning and about 9 p.m. at night
until they retire for the evening the jagged line here represents venous
plasma concentrations of nicotine as the cigarette is smoked the shaded area of
this curve indicates plasma concentrations of nicotine where a
person feels just perfectly comfortable so they’re not experiencing pleasure or
arousal from smoking but they’re also not experiencing withdrawal symptoms the area above the curve when indicate a
venous plasma concentration whereby a person is experiencing positive rewards
from smoking so arousal or pleasure and the space underneath the curve would
depict the area where a person would be feeling lousy or would be feeling
negative withdrawal symptoms and what I want a notice about this figure is the
arousal or pleasure people experience after smoking the first cigarette of the
day nowhere else on this addiction curve do
you see a jagged line go so high above the comfort zone and into the pleasure
zone so this is why many smokers will say that their most important cigarette
is the first one of the day and how quickly somebody smokes that first
cigarette of the day is actually an indicator of tobacco dependence the
reason the first cigarette is the most pleasurable one is because tolerance
starts to develop shortly after that first cigarette and a smoker’s become
more tolerant nicotine throughout the day they get less pleasure out of each
cigarette and instead they simply get relief from nicotine withdrawal
overnight a smoker becomes really sensitized to nicotine and then the
cycle starts all over again next day with cigarette smokers can
easily regulate how much nicotine they’re absorbing and so there is wide
variability and how much nicotine one cigarette can deliver it depends on a
lot of things the puff volume the depth of inhalation the rate of puffing the
intensity of puffing there are also ventilation holes that smokers often
don’t know about and will either consciously or unconsciously block with
their lips or fingers while smoking and this also increases the amount of
nicotine that people can absorb so the idea that light cigarettes deliver net
less nicotine is really a myth because smokers will simply compensate their
puffing behavior so as to give themselves a steady dose of nicotine now
just a word on metabolism most nicotine about eighty-five to 90 percent is
metabolized in the liver by a major liver enzyme called cytochrome P 450 I’m
bringing up metabolism because the system that metabolizes many of the
toxins and carcinogens in cigarette smoke is the same system that processes
many psychotropic or psychiatric medications as well as caffeine and so
this is going to become important when we talk about smoking cessation and
folks who are taking psychiatric medication towards the end of those
presentation so now I’m going to go through all of the tobacco cessation
medications that have been approved by national regulatory agencies and give
you some information on each one why should people use a medication for
quitting after quitting withdrawal symptoms can be so uncomfortable that
they often relapse cessation medications work by helping to alleviate nicotine
withdrawal so that people can focus on working to change their smoking behavior and be comfortable call they’re
doing it and most importantly cessation cessation medications improve a person’s
chances of quitting and we’ll go through some data slides in a few minutes illustrating that the slide lists these
seven medications that have been approved by the FDA for smoking
cessation five of these contain nicotine and they are called nicotine replacement
therapies or an RTE two of these do not contain nicotine three of the NRT
medications are available with out a perscription the nicotine patch the
nicotine gum and nicotine lozenge whereas the remaining medications all
require a prescription that would include the other two forms of NRT the
nasal spray and then nicotine inhaler as well as the medications that affect
tobacco cessation in by using other mechanisms which will talk about the
property on and ironically so NRT the safety of NRT has been very well
established it has very few side effects there are no known drug interactions
with psychiatric medications with the exception that using a combination of
energy and bupropion can increase the risk of hypertension however the FDA
still approves combination therapy with bupropion and NRT which I’ll go over in
more detail in just a minute and RT can also be used safely by individuals who
have stable cardiovascular disease it can be used safely by people with COPD
and it can be safely used and it’s even recommended when individuals are still
smoking or prior to a quit attempt so now we’ll go through each one first
up is the nicotine patch the patches available without a prescription and
three strengths either 21 milligrams 14 milligrams or seven milligrams of
nicotine is delivered to the body through the skin nicotine begins to be
absorbed 1 24 hours after the patches applied and the highest level of
nicotine in the body happens about anywhere from three to 12 hours after
the patches put on depending on the brand so this is not a fast-acting hit
of nicotine this is the most slow and steady version of NRT available the
patch should never be cut in half because nicotine is immediately released
through the cut portion and a person could receive too much nicotine all at
once rather than getting the sustained release that they’re intended to deliver
so don’t cut the patch and half the cat should be placed directly on the skin
somewhere on the upper body where there is not a lot of hair like the upper arm
or the upper back it should be replaced every 24 hours and it should be worn all
night long unless it causes sleeping problems which it can that’s one of the
side effects the patch should be moved around to a new location on the body
every day because the nicotine and the adhesive can cause some skin irritation
and politics 50% of patients do experience this reaction fewer than 5% discontinued the patch as
a result but that said the patch should probably be avoided in patients who have
dermatological conditions like psoriasis or eczema or who have a known allergy to
it he suppose although it’s the adhesive is the problem you can try switching to
a different brand and that will sometimes alleviate that problem the patch is recommended if individual
smoke at least half a pack per day if a person is smoking less than that then
you might try either a fourteen milligram pad or some other form of NRT
would be recommended in that case the starting dose of the patch is based on
how much tobacco a person is using so remember that if each cigarette delivers
between one and two milligrams of nicotine somebody who is smoking a pack
a day is getting between 20 and 40 milligrams of nicotine per day and so a
person person should be starting with a twenty one milligram patch if a person
smokes two packs per day they should start with 2:21 milligram patches expert
opinions of dosing and RT vary quite a bit but there is growing consensus that
energy is often under dost and that leads the user to believe it simply
doesn’t work for them which is unfortunate ok just some tips for
applying the patch you would reach peel off a half of the adhesive backing apply
the adhesive exposed side to the skin and then you would peel off the
remaining backing and press firmly with the palm of your hand for about 10
seconds to make sure the patches firmly adhered and remember to have patients
carefully dispose of the patch after they take it off every day it’s still
bill contains nicotine at the screen and so folding in on itself to prevent pets
or children from getting to it as the safe way to dispose of the patch ok
nicotine gum nicotine gum is sold by the brand name nicorette which is shown
above it sold as a generic and it’s sold under a new brand name sonic nicorette
and the generic versions are sold in large boxes containing a hundred doses of gum as well as smaller boxes
containing just 20 doses sonic there was popping up and gas stations and it sold
in quantities of ten with a disclaimer that the stones may not represent a full
day’s supply it’s available in different flavors and its sugar free it’s absorbed
the nicotine from nicotine gum is absorbed through the lining of the mouth
and it is sold of course without a prescription the gum comes in two doses two
milligrams or four milligrams most folks are gonna start in the two
milligram dose but people may want to start with the four milligram dose if
one of the few things are true so if they smoke more than a pack a day if
they smoke their first cigarette as soon as they wake each morning if they have
severe withdrawal symptoms when they don’t smoke or if a lower dose has not
been successful in helping the person to quit they might want to start on a fun
with the four milligram dose the general manufacturer’s recommendation for
nicotine gum dou saying when it is used alone and not in combination with any
other treatments is to use no less than nine doses per day and no more than
twenty four doses per day the nicotine is one of these forms of
NRT that is frequently used incorrectly so clients need some instruction on
using the gum correctly otherwise they might think it is just not working for
them what clients should do is chew each
piece very slowly until the gun releases a peppery taste or a slight tingling
this is the nicotine being released out of the gun just as some people will say
it feels like a cool sensation at that point when the nicotine is released from
the gun they should park the gun between their cheek and their gum and just keep
it there and that will allow nicotine to be absorbed across their their buccal
mucosa then when that tingle goes away they resumed chewing it just long enough
for that tingle or that sensation to come back and then they park again and
they just repeat that chilling and parking process until the tingle has
faded from the come completely and that takes about 30 minutes because when
people just chew it what happens as most of the nicotine just get swallowed and
it doesn’t get absorbed at all and so it’s of course not effective in that
case the nicotine lozenge also comes into milligram and four milligrams
strengths it’s available without a prescription as well it comes in different flavors just like
the guy and it’s meant to be taken like other lozenges or cough drops sucking on
one until it completely dissolves and moving around from place to place in the
mouth because the laws and dissolves completely unlike the gum it provides
about 25% more nicotine than a comparable dose of nicotine gum so if
you had a to milligram those lozenge and had a chill to milligram piece of gum
you’re gonna get more nicotine out of the laws and the new it out of it
because some nicotine still stays in the Gulf a little bit for both the gum and
the laws and acidic beverages should be avoided for about 15 minutes before and
also during use because this interferes with nicotine option the acid interferes with nicotine
absorption across membranes the nicotine nasal spray delivers nicotine through
nasal membranes and this is available only with a prescription one dose of the
spray would be one spray and each nostril and a bottle contains about a
hundred doses which be a one-week supply for most people nicotine is absorbed more quickly with
the nasal spray them with any other form of NRT so this is actually the form of
NRT that’s most similar to a cigarette and the sense that plasma concentrations
increased the most rapidly with the nasal spray compared with any other form
of NRT side effects as with any means and
includes a nasal irritation or congestion or changes in similar tastes people don’t need to sniff the
medication while they’re administering it like you would with some other nasal
sprays as this can increase the nasal irritation that nicotine inhaler is also
sold only with the prescription it comes with a mouthpiece and a plastic
cartridge each kit comes with about forty two cartridges and each cartridge
delivers about four milligrams of nicotine and that’s absorbed through the
lining of the mouth the manufacturer recommends starting with at least six
cartridges per day during the first three to six weeks of treatment that
would be like one cartridge every one to two hours for it with a maximum of 16
cartridges daily the inhaler is designed to be similar to smoking and that
replicates the active holding including a cigarette up to your mouth and this
can be a good or bad aspect of the nicotine inhaler depending on your view
it may be enforced at hand to mouth behavior of smoking more so than any of
the other parties and some clients are not
interested in having that behavior reinforced and so this would not be a
good choice for them ok just a quick update there used to be
a warning on the label of NRT products that a person should not use the product
while they’re still smoking or using other nicotine containing products
however these warnings have been removed because there are no significant safety
concerns associated with using NRT products with other nicotine containing
products including cigarettes simultaneously nor are there any safety
risks associated with the use of energy products for longer than the labeled
number of weeks of use on the packaging and this is routinely done using these
products for longer than what the label specifies and as well current marketed NRT products do not
appear to have any significant potential for abuse or dependence and so the
labels have been changed to to relax the these original concerns bupropion sustained release is actually
a medication commonly used to treat depression when it is used to treat
depression it’s called wellbutrin when it’s used to treat tobacco cessation
it’s called zyban its sole with a prescription either as I ban or as a
generic the medication does not contain nicotine and its efficacy in treating
tobacco dependence appears to operate independently of a person’s depression
history so in other words it’s been shown effective for tobacco cessation
among individuals who have and who do not have a history of depression
bupropion may also reduce weight gain associated with tobacco cessation which
can be helpful for some people the initial dose is a hundred and fifty
grand milligrams per day for three days followed by a hundred and fifty
milligrams twice daily for another six to twelve weeks although this medication
can be safely used for longer than that longer-term use in fact may help reduce
or delay relapse to smoking and this medication can be stopped abruptly it
does not require tapering insomnia is the most common side effect of bupropion
but there are a few others listed here dry mouth at education there are some
contraindications for bupropion or situations in which a treatment using
bupropion would not be advisable bupropion can lead to a higher incidence
of seizures so for folks who are already at a higher risk of seizures bupropion
would not be advised this would include people who suffer from eating disorders
or other seizure related disorders and for those with bipolar disorder PPro
brianna is also not advised because it can precipitate me and both be pretty on and varenicline
whatcha wanna talk about in just a minute have a black box warning so I’ll
talk about that when I get to burn a clean varenicline is sold as chantix
with the prescription like bupropion varenicline does not contain nicotine it
works in a couple of different ways it mimics nicotine in the brain so it helps
to prevent withdrawal symptoms but it doesn’t have as strong as an effect and
so it blocks the places in the brain where nicotine would normally work but
it doesn’t produce quite a strong of a signal and follow-up people will say is
that when they’re taking varenicline if they smoke a cigarette they really don’t
get any effect from the cigarette they don’t feel the same rewards the initial
dosing is half of a milligram per day for three days and then twice daily for
four days and then for the next 11 weeks the doses one milligram twice daily the
most common side effect of her in a clean is not sure which often disappears
over continued use of folks can take this medication with meals which can
help also many people experience vivid dreams while taking over in a clean
they’re not nightmares but they may still be disturbing to some people
although other people report quite like in the bad dreams like be Perpignan
varenicline has a black box warning a black box warning is used when a
prescription drug that is known to be effective for some patients may cause
serious side effects and others so what both side man and chantix some people
have reported changes in behavior agitation depressed mood and thoughts of
suicide when attempting to quit smoking because these symptoms resemble those
that are associated with nicotine withdrawal it’s possible that some of
these symptoms are a response to nicotine withdrawal and not to the
cessation medication itself but because of these findings the FDA required a black box warning to
be put on both of these medications and because of the concern with agitation
and thoughts of suicide and depression independent studies have now examined
the safety of varenicline specifically in people with serious mental illness
and so far these studies have found no significant safety concerns of
varenicline within this population but nevertheless anybody you know
experiencing as with any medication something that they just feel it’s not
right should stop the medication and see their provider right away in March 2015
so fairly recently the FDA approved a few additional label warnings
specifically concerning alcohol until patients know how chantix affects their
ability to tolerate alcohol they should decrease the amount of alcohol they
drink and so this sounds like you know a lot how precautions and warnings on on
this medication but I think it’s always a good idea to consider what an FDA
warning would look like if you saw one on the box of cigarettes and so like all
prescription medications it’s important to be monitored by a physician and these
are no different but they’re they’re safe medications and they’re very
effective and that’s what I want to briefly go through some data slides now
showing the efficacy of these various medications at helping people quit and
remain abstinent for various lengths of time so this first table shows various
forms of energy compared to a placebo and it’s looking at abstinence six
months out so for the patch an odds ratio here of
1.9 means that compared to people who received a placebo or a sugar pill
during the study people who received the patch or 1.9 times as likely or about
twice as likely to remain abstinent for six months after quitting and these
other NRT products showed similar results that previous slide was based on
a meta analysis of lots of study’s findings all averaged together but this
slide is based on a single trial of the nicotine lozenge and here it looks like
individuals who received the two milligram dose were also about twice as
likely to be abstinent at six months compared to those who received a placebo
and folks who received the four milligram dose were almost three times
more likely to be abstinent at six months compared to those who received a
placebo here beyond also this is a meta analysis of 24 studies also finding that
the medication makes it about twice as likely that somebody will be abstinent
at six months if they use the medication in the attempt and then this is a busy
slide but it’s based on two studies comparing the efficacy of varenicline
which is the yellow bar with bupropion which is the pink bar and then comparing
those to a placebo which is the blue bar and looking at whether people remained
abstinent for at least four weeks after quitting folks who received over in a
clean were twice as likely as those who received appropriate on to remain
abstinent for for continuous weeks and they were almost four times more likely
to remain abstinent compared to those who received a placebo and then these
same two studies followed these people for an entire year and what we see here
is that varenicline maintains its advantage even when you’re after
quitting and this graph compares even longer term
efficacy among the various tobacco cessation medications these quick rates
were maintained over three years and in all cases the takeaway from this graph
is that the three-year quit rate is higher for those using a medication than
for those who just received a placebo so in every case the medication is more
effective than not using it at helping people to remain quit for at least three
for three years now there are a few newer strategies for using FDA-approved
cessation medications some going to go over those researchers have found that
cessation rates are higher when individuals used combination therapy
rather than using one medication at a time so in 2008 the clinical practice
guideline recommendations were updated to include combination therapy and the
recommendations for combination use are shown here it is considered safe to use
the patch along with any other form of NRT so a common way to do this would be
to have folks use a patch for the steady dose of NRT but when cravings hit and
people need some reinforcements are some additional support something that’s a
little more fast acting they can use either the gum or lozenges for for those
for those times when a craving strikes it is also considered safe to use
bupropion with either the patch the gum or the lozenge and although using
chantix in combination with NRT has not been approved by the FDA as a
combination therapy prescribers will do this in practice but it would still be
considered off-label at this time and here’s just another day to slide
showing how combination therapy works in this study the nicotine patch was used
long-term so at least 14 weeks and combined with either the gum or nasal
spray or with the nicotine inhaler on an as needed basis six-month absence rates were compared to
a placebo and recalled that the patch on its own doubled the likelihood that a person
would remain absent for six months but in this study we see that using the
patch + the gum or the spray as needed more than tripled this likelihood so we
see some increase in gains from using multiple therapies in combination with
each other another strategy to increase the efficacy of NRT is to start using it
be for the quit date it’s very difficult to overdose on nicotine people taking
too much nicotine start feeling really lousy nauseous long before they would
experience any significant long-term consequences of too much nicotine and
supervisors have started using nicotine replacement therapies before an
individual makes a quit attempt and results from studies have shown that
there are no increase side effects from this practice in one study indicated
that using the patch prior to a quit date doubled the success rate of that
quit attempt compared with using the patch beginning on the Quickie so that’s
something to consider for clients and mill in the last few minutes I just want
to provide some information on special considerations when recommending
pharmacotherapy to specific population groups ok so I’ll start with women among women
in general and dirty is not as effective as it is in men so when I said that
medication + counseling was more effective the medication alone this is
particularly true for women and bupropion maybe one exception because it
is helpful at alleviating that short-term weight gain associated with
tobacco cessation and so this may be of particular concern for women and it may
be particularly helpful for them for pregnant and nursing women the recommendation is that former co
therapies not be used as a first-line treatment for tobacco dependence because
they simply haven’t been sufficiently tested in these populations however they
may be prescribed women may be prescribed pharmacotherapy during
pregnancy under the supervision of a physician some positions will do it
someone not particularly though if women are very result to quit smoking during
pregnancy or if they’ve tried other strategies in these other strategies
have not proven effective although NRT does expose a fetus to nicotine and
tobacco fetus’s blood levels of nicotine or about 15 percent higher than the moms
blood levels whether energy or are nicotine from a cigarette and RT is
preferable to cigarettes because of course it doesn’t contain all of the
other harmful chemicals in tobacco so long as the dose of nicotine remains at
or below what a woman would be taking him just from smoking already have women
getting more nicotine and they would just from smoking energy for tobacco
users under 18 is considered off-label but it can be prescribed it should be
considered only when there is clear evidence of nicotine dependence and also
a meaningful desire by the client to quit so this is not for a kid who gets caught
smoking but who is not exhibit adding nicotine dependence or who doesn’t
themselves I’m really want to quit smoking generally expert recommendations for
giving pharmacotherapy youth is fairly next the 2008 clinical guidelines does
not ring recommend an RTE or bupropion for use for example whereas other
agencies will recommend much more aggressive treatment with an arty and
other pharmacotherapy especially for those over sixteen the evidence right
now is fairly mixed and expert recommendations are are a bit
conflicting people with mental illnesses or addictions to other substances are
often more nicotine dependent than tobacco users who are not struggling
with these other conditions these levels of addiction burn intensive
pharmacotherapy and counseling there are no known medical reasons not to use the
FDA approved medications for tobacco cessation with this population
particularly if inpatient treatment settings are hospitals are tobacco-free
it’s especially important to offer cessation medications so that patients
are comfortable during their temporary abstinence from nicotine studies have
found that among psychiatric inpatients those who are not provided and RT were
two times more likely to discharge from the hospital against medical advice than
those who were provided some sort of a dirty during their treatment people on
psychiatric medications require special considerations when they quit smoking
and I alluded to this a little bit earlier when we were talking about
metabolism this is because the system that metabolizes many of the toxins and
carcinogens in cigarette smoke also processes many psychotropic medications
along with caffeine it’s important because tobacco cessation
can affect the blood levels of many different types of medications so as
tobacco users metabolized and excreted nicotine and other chemicals in
cigarettes they’re also more quickly metabolizing prescribed medications and
what happens is when an individual quit smoking blood levels of many of these
medications can significantly and sometimes dangerously increase because
metabolism slows down after somebody quit smoking and so sometimes side effects of higher dosages of
prescribed medications are actually confused with nicotine withdrawal or
psychiatric symptoms so it’s very important that prescribe that
prescribing providers are aware that their patients are quitting smoking and
they need to be monitoring psychiatric medical medication levels in that case
I’m tobacco use cessation has the same effect with caffeine so individuals who
use large amounts of caffeine may not be able to tolerate these levels any longer
when they stop smoking again because that metabolism slows down and the
levels of cap being an increase in the system and I would just like to close
with this statement that everyone who uses tobacco should be offered an
opportunity to make the decision to stop and i want to just briefly put up some
resources that the behavioral health and wellness program has on our website and
we have lots of resources available and so I encourage you to visit our website
and take a look at what we have to offer also if you have questions that this
presentation brought up or if you have other questions related to tobacco
cessation we are always happy to answer your questions and can be emailed at this address and I
thank you for listening to this presentation today

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