Ten years after the Rx-to-OTC switch of nicotine replacement therapy: What have we learned about the benefits and risks of non-prescription availability?

Shiffman, Saul; Sweeney, Christine T.

doi:10.1016/j.healthpol.2007.08.006

Cited by 54 publications

(49 citation statements)

References 51 publications

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“…Most data come from clinical trials, which have samples that tend to differ in important ways from general population samples 79 and in which NRT is provided free together with behavioural support, which may affect normal usage patterns. By contrast, most NRT in the UK is used without advice and bought over the counter, 80 and in many other countries (unlike in the UK) it is rarely provided for free on prescription. 81 Consequently, there is a need for further research in the area of harm reduction (as recently indicated by NICE) 82 as investigating this issue will allow more precise quantification of the likely benefits or harms of substituting cigarettes with NRT among current and ex-smokers.…”

Section: Rationale and Study Aimsmentioning

confidence: 99%

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

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BackgroundNHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned.ObjectivesThe main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives.DesignThe ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use.SettingThe setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services.ParticipantsThere were 202,804 cases included in secondary analysis and 3075 in the prospective study.InterventionsA combination of behavioural support and stop smoking medication delivered by SSS practitioners.Main outcome measuresAbstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test.ResultsJust over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected.ConclusionsStop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012–13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites.FundingThe National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.

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Section: Rationale and Study Aimsmentioning

confidence: 99%

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Dobbie

Hiscock

Leonardi‐Bee

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…Making NRT available over the counter in supermarkets and convenience stores increases accessibility and uptake (Shiffman & Sweeney, 2008) although the evidence for its effectiveness when used in this way is somewhat mixed (Hughes, Peters, & Naud, 2011;Leischow, Ranger-Moore, Muramoto, & Matthews, 2004). The provision of NRT, assuming affordability, could be extended to other nonhealth settings, (e.g., workplaces), but effectiveness and cost effectiveness of such initiatives need to be determined.…”

Section: Need To Enhance Population-based Tdt Interventionsmentioning

confidence: 99%

Research Priorities for Article 14--Demand Reduction Measures Concerning Tobacco Dependence and Cessation

McRobbie

Raw

Chan

2012

Nicotine & Tobacco Research

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“…If a person has too much NRT, they may feel like a teenager having their first cigarette -light headed or nauseated. Nicotine toxicity is rare [29]. At the time of writing, short-acting NRT is not subsidised by the Pharmaceutical Benefits Service.…”

Section: Pharmacological Treatment Of Nicotine Dependencementioning

confidence: 99%

Smoking or Alcohol Dependence Among Indigenous Australians: Treatment May Be Needed, Not Just Education

Conigrave

Lee

2012

Heart, Lung and Circulation

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Ten years after the Rx-to-OTC switch of nicotine replacement therapy: What have we learned about the benefits and risks of non-prescription availability?

Cited by 54 publications

References 51 publications

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study

Research Priorities for Article 14--Demand Reduction Measures Concerning Tobacco Dependence and Cessation

Smoking or Alcohol Dependence Among Indigenous Australians: Treatment May Be Needed, Not Just Education

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