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Smoking cessation drugs approved for provincial coverage  

Beginning Aug. 4, the Ontario government will fund the smoking cessation drugs Champix and Zyban, the Star has learned.

Adding the two drugs to the Ontario Drug Benefit Plan -- the list of medications covered by the province -- could cost between $10 million to $15 million a year, said Health Minister Deb Matthews.

"This will help people quit and prevent cancer," Matthews said. "I am enormously pleased with it."

The Ontario Medical Association, which has long urged the government to pay for smoking cessation therapies, applauded the Liberal move.

"These medications are proven to at least double the success rate for people who want to quit when other approaches don't work," said Dr. Stewart Kennedy, OMA president and a physician in Thunder Bay.

"We want to help our patients quit smoking," he said. "We believe that covering the costs of these medicines that can help them quit will pay big dividends for their health and ultimately save our health-care system much more money."

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EDITORIAL: Help smokers butt out  

Given that grim picture, anything we can reasonably do to reduce smoking rates further is worth trying. That's why Health Minister Deb Matthews' decision to make the smoking cessation drugs Champix and Zyban available on prescription . . .

Successful, cost-effective illness prevention measures are the key to getting our ever growing health care budget under control. Those measures can range from providing more and varied doctors' hours to keep people out of emergency rooms, to home care to keep the frail elderly out of nursing homes, to help to get people to lose weight or quit smoking, thereby preventing disease.

The new drug policy is an important acknowledgement that nicotine is a powerful addiction. Just raising the price of a pack or ostracizing smokers from public places won't get everyone to quit. Each year about a million people try -- and fail -- to kick their habit. They need more help, and Ontario is right to provide it.

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B.C. will pay to help smokers quit  

An estimated 600,000 British Columbians who smoke are being offered the chance to quit after Premier Christy Clark announced a $25-million program that would provide free nicotine-replacement therapies and smoking-cessation prescription drugs.

Clark told a news conference Monday that she grew up in a household where smoking was normal and smoked herself for 17 years until quitting. She said tobacco use causes the death of more than 6,000 people in B.C. each year and the health care costs associated with smoking are $2.5 billion annually.

"I'm grateful I made the decision to quit but it was a very, very tough decision, as anyone who has struggled to quit smoking will tell you," she said at a press conference in the Jean C. Barber BC Cancer Lodge on West 10th Ave.

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New UTHealth trial aimed at helping pregnant women stop smoking 

A clinical trial to test the safety and efficacy of a medication that could help pregnant women stop smoking has begun enrollment at The University of Texas Health Science Center at Houston (UTHealth).

The study targets pregnant women in their second and third trimesters when smoking can be quite harmful to the fetus, said Angela Stotts, Ph.D., associate professor in the Department of Family and Community Medicine at the UTHealth Medical School.

"Pregnant women receive counseling or self-help materials but they may need something more powerful to stop smoking. Nicotine is one of the hardest substances to quit due to its action in the brain," Stotts said.

The medication, bupropion, is known under the brand name Zyban for smoking cessation and as the antidepressant Wellbutrin in a stronger formula.

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• Ontario may pay for drugs that help kick nicotine habit  

Butting out may get a little easier in Ontario as the province eyes covering the costs of smoking cessation prescription drugs, the Star has learned.

Adding smoking cessation products to the list of drugs covered by the province could cost the public purse upwards of $20 million a year, according to the health ministry.

The provincial committee in charge of deciding which drugs to cover in Ontario has just finished reviewing the anti-smoking drug Champix, said Diane McArthur, the executive officer of the Ontario Public Drugs Division.

The expert advisory committee to evaluate drugs gave Champix a positive review and it is now studying the other smoking cessation drug Zyban, McArthur said in an interview.

“The review was positive within the context of what is the most appropriate way to provide access to the medication and in what context,” she said.

Both Champix and Zyban are prescription therapies and they are meant to be used as part of a comprehensive quit smoking plan that includes counselling and education.

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Ont. could soon pay for two smoking cessation drugs  

Butting out may get a little easier in Ontario as the province reportedly eyes covering the costs of smoking cessation prescription drugs.

Diane McArthur, who runs the Ontario Public Drugs Division, says a committee has just finished reviewing the anti-smoking drug Champix.

McArthur tells the Toronto Star the expert advisory committee to evaluate drugs gave Champix a positive review and it is now also studying Zyban.

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• So you've tried, and tried, and tried, AND TRIED to quit  

Somehow, this time - maybe it was the nicotine-replacement patch, maybe the counseling - Collins resisted the call of the cigarette. But there is no denying: The stranglehold nicotine places on smokers can sometimes prove insurmountable.

Ask Jerry Remy, the Red Sox TV analyst who acknowledged last month that, despite enduring lung cancer, he still falls prey to the occasional impulse to smoke.

Ask Barack Obama . . .

The failure to quit, research has shown, has nothing to do with weakness of will. Nicotine, the primary addictive agent in tobacco, steals into the brain, setting on fire circuitry that regulates our sense of pleasure. At the same time, cigarettes acquire a sort of social permanence in smokers' lives - a way to start the day, to end a meal, to celebrate good times, to muddle through bad times.

So specialists who treat smokers now emphasize a double-barreled approach that combines counseling and medication, including patches, gum, and other nicotine substitutes along with drugs designed to thwart nicotine's addictive effects. There's even a nicotine vaccine being tested that would prevent the substance from reaching the brain.

Still, it's estimated that while roughly 70 percent of smokers want to quit, fewer than 10 percent succeed each year. . . .

Her first major attempt to quit was in 2000, when she went to group counseling at Mass. General. "I'd go there and I'd talk. And I'd leave immediately and have a cigarette.'' She tried again and again to stop smoking for good. Finally, last year, she decided, "This is ridiculous.'' She again sought counseling and wore the most potent nicotine patch available.

Her last drag on a cigarette, she said, was last October.

"No one can tell you to quit smoking. No one can make you feel like a social miscreant to make you quit smoking,'' said Collins, who lives in Belmont. "You have to summon it up from inside. You really, really do.''

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Drug helps pregnant drug users to stop smoking 

Treatment with an antidepressant drug significantly improves the mood in pregnant substance-dependent women who also smoke cigarettes, according to preliminary results reported at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SNRT-Europe.

The data also suggest that the antidepressant - bupropion -- helps these women curb their smoking.

"We are encouraged by the findings given that both depression and smoking are highly prevalent in pregnant, substance-dependent patients and are associated with adverse maternal and neonatal outcomes," said Dr. Margaret S. Chisolm, assistant professor of psychiatry at Johns Hopkins University in Baltimore, Maryland.

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Relapse prevention interventions for smoking cessation 

Some people start smoking again shortly after quitting and are said to have 'relapsed'. Interventions used to help people avoid relapse usually focus on teaching the skills to cope with temptations to smoke. This approach and others have not been shown to be helpful, either for people who quit on their own, or with the help of a cessation treatment, or who quit because they were pregnant or in hospital. Many trials conducted so far have not been of a strong enough design to detect possible small effects. Among drug treatments, extended use of varenicline may help some smokers. Studies of extended use of nicotine replacement treatment are urgently needed. . . .

Authors' conclusions

At the moment there is insufficient evidence to support the use of any specific behavioural intervention for helping smokers who have successfully quit for a short time to avoid relapse. The verdict is strongest for interventions focusing on identifying and resolving tempting situations, as most studies were concerned with these. There is little research available regarding other behavioural approaches. Extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect. Studies of extended treatment with nicotine replacement are needed.

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NEWS BLACK BEAT BAD HABIT WITH ANTI-DEPRESSANT 

Funnyman JACK BLACK has conquered his smoking habit with antidepressant medicine Wellbutrin. The movie star admits he's still an occasional smoker, but he's no longer hooked on nicotine. He tells Blender magazine, "I took the Wellbutrin for two years... They say you've got to be careful quitting Wellbutrin because some people have withdrawal symptoms." And Black admits he did suffer side effects as he weaned himself off the medication. . . .

Black isn't completely smoke free, admitting to the "occasional celebratory jay (joint)," and he marked the birth of his son Thomas with a cigar.

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• Anti-smoking drug could tempt athletes to cheat ($$) 

This is an Olympic year, and athletes the world over are gearing up for the Beijing games in August. There they will face afternoon temperatures that average 30 °C and can hit 42 °C, along with high humidity that will make cooling down harder. In such conditions athletes in endurance sports reach exhaustion long before their muscles would normally tire, as their brains tell them to ease up before they reach brain-damaging temperatures over 40 °C.

Romain Meeusen of the Free University of Brussels (VUB) in Belgium discovered in 2005 that the drug bupropion can cheat this switch.

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A Double-blind, Placebo-Controlled, Randomized Trial of Bupropion for Smoking Cessation in Primary Care 

Conclusions Bupropion more than doubled the odds of continuous abstinence from smoking. The adherence of general practitioners and participants to the protocol was excellent, making our findings robust and easy to generalize to the context of primary care.

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Bupropion helps primary care patients stop smoking 

Research question Can bupropion help primary care patients quit smoking?

Answer Yes. It doubles the odds of continuous abstinence for one year compared with placebo. . . .

What does it mean? This trial tested the effects of bupropion in an unselected population of smokers who were treated entirely by general practitioners. The findings suggest that this established treatment works well in primary care, doubling the odds of continued abstinence for almost a year. Lots of people failed to complete their treatment, but that's typical of smoking cessation trials, say the authors. The chances of giving up were still high compared with other trials in more specialised settings. This trial was managed, monitored, analysed, and interpreted independently of bupropion's manufacturers (GlaxoSmithKline), which paid for a pilot study, the drugs, the placebo, and the carbon monoxide monitors.

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Bupropion helps primary care patients stop smoking 

Research question Can bupropion help primary care patients quit smoking?

Answer Yes. It doubles the odds of continuous abstinence for one year compared with placebo. . . .

What does it mean? This trial tested the effects of bupropion in an unselected population of smokers who were treated entirely by general practitioners. The findings suggest that this established treatment works well in primary care, doubling the odds of continued abstinence for almost a year. Lots of people failed to complete their treatment, but that's typical of smoking cessation trials, say the authors. The chances of giving up were still high compared with other trials in more specialised settings. This trial was managed, monitored, analysed, and interpreted independently of bupropion's manufacturers (GlaxoSmithKline), which paid for a pilot study, the drugs, the placebo, and the carbon monoxide monitors.

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CYP2B6 Genotype Alters Abstinence Rates in a Bupropion Smoking Cessation Trial 

Background

CYP2B6 is the primary enzyme involved in bupropion metabolism. Genetic polymorphisms in CYP2B6, such as CYP2B6*6, can alter bupropion metabolism and may affect bupropion treatment outcome.

Conclusions

These data suggest that smokers with the CYP2B6*6 genotype have a higher liability to relapse on placebo and that they may be good candidates for bupropion treatment for smoking cessation.

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