Pharmacology

Regional Grant funding does not cover TIS teams to offer nicotine replacement therapy (NRT) or other stop smoking medication (SSM) to people who smoke. This is because TIS teams are funded to carry out population health promotion activities, not individual smoking cessation support. However, it is important that TIS workers have up-to-date knowledge of the individual level cessation supports such as NRT and SSM, as these can inform population health promotion activities (e.g. community knowledge building).

A number of studies have examined the extent to which NRT is an effective smoking cessation treatment for Aboriginal and Torres Strait Islander populations. Overall NRT is effective, particularly if free/subsidised, and especially if accompanied by good follow-up support services. Evidence about the effectiveness of other SSM such as Varenicline (Champix) and bupropion (Zyban) in Aboriginal and Torres Strait Islander populations is limited. An article from the Talking about the Smokes (TATS) survey found that Aboriginal and Torres Strait Islander people are less likely to use NRT or SSM as part of a quit attempt (37%) than non-Indigenous people who smoke (58.5%). However, just under three quarters of those surveyed believed NRT and SSM did help people who smoke to quit. Cost is probably the main barrier to using pharmacological aids. Nicotine patches – available to Aboriginal and Torres Strait Islander patients at a subsidised cost on an authority script through the Pharmaceutical Benefits Scheme (PBS) – were the most common pharmacological aids used by Aboriginal and Torres Strait Islander people who smoke and recent ex-smokers (24%). Varenicline was the next most commonly used pharmaceutical at 11% and nicotine gum at 10%.

Observational research in remote Northern Territory communities, found that following recommended treatment for using NRT (compliance) can be limited by factors such as:

  • difficulties maintaining NRT supplies in remote areas
  • individuals running out of patches because they share with other family members
  • cost, particularly for forms not on the Pharmaceutical Benefits Scheme (PBS).

However, observation of the successful delivery of NRT in one community by a public health nurse showed how compliance improves when regular support and counselling is provided: NRT was supplied in one week blocks with face-to-face follow-up every week at the client’s home. There is also evidence from the

that combining NRT with intensive counselling and support is effective even in remote settings.

This suggests that focusing on increasing compliance is likely to improve quit attempts. This can be done through:

  • greater discussion around NRT options (e.g. gum, patches or combined therapy)
  • including patients in the decision process
  • providing appropriate regular support.

    NRT factsheet

Other activities to increase the use of NRT in helping Aboriginal and Torres Strait Islander people who smoke to quit are:

  • providing better information about NRT to the community
  • including access to NRT as part of a broader tobacco control program.

Another program which demonstrates the effectiveness of a comprehensive service for supporting quit attempts is the No More Boondah smoking cessation program based in ACT. The program combines weekly support groups, access to NRT (through a GP), phone follow-up, and home and workplace outreach.

You can find further information about nicotine replacement therapy in the video and factsheet produced by NBPU TIS which can be downloaded here.

Further reading