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Public Health England has been encouraging smokers to pick up an NHS Quit Kit from their local pharmacy. P3 takes a look at the smoking cessation options available and how advice and education is vital for motivating people to quit

The challenge

Public Health England has launched its latest smoking cessation campaign, promoting the role of pharmacies. Smokers are being asked to text in or go online to find their nearest pharmacy, where they can pick up an NHS Quit Kit. The Quit Kits are free for pharmacies and a great conversation starter with customers and may result in sales of an NRT product.

Pharmacies can play an important role in a smoker’s decision to give up the habit, says Royal Pharmaceutical Society (RPS) director for England Howard Duff. ‘Not only can pharmacies offer face-to-face support and guidance, they can also help to raise awareness of the dangers of smoking and the health benefits quitting can bring.’

Data suggest that access to NHS smoking cessation support is waning. In October 2013, Health and Social Care Information Centre (HSCIC) statistics revealed an 11 per cent drop within a year in the number of people attempting to quit smoking with the NHS Stop Smoking service. There was a seven per cent fall in the number of clients who successfully quit during this time frame. While pharmacies are well placed to offer smoking cessation advice, the HSCIC statistics showed that fewer people using the pharmacy-based NHS services were successful than those using primary care and other stop smoking service settings.

So what more needs to be done to encourage more people to quit smoking and, in particular, to access the pharmacy smoking cessation services on offer? Leyla Hannbeck, head of pharmacy services at the National Pharmacy Association, says that people are often unaware of the support and advice that’s available to them through community pharmacies, so promotion is key. ‘NPA members can access a range of materials to encourage customers to use pharmacy stop smoking services including press release templates, social media updates and Powerpoint presentations and talk notes to use at community groups,’ she says. ‘NPA members can also access an online information database, IRIS, where they can find resources on smoking cessation. This also includes the details of products that can be used to stop smoking and information, for example on questions the public are likely to ask.’

Pharmacy footfall

Hazel Cheeseman, special projects advisor at Action on Smoking and Health (ASH), says that providing ‘brief advice’ to smokers and directing them to services has been shown to be effective in motivating people to quit, particularly where people have a smoking-related illness.

‘Pharmacies can play an extremely important role in educating smokers about nicotine- containing products,’ she says. ‘Too many smokers mistakenly believe that nicotine causes cancer and many don’t use enough nicotine replacement therapy (NRT) when they are trying to cut down or quit. Pharmacists as trusted professionals in the community can play an important role in dispelling myths.’

Ash Soni, RPS English Pharmacy Board vice chair and community pharmacist, believes that there needs to be a change in how NRT products are advertised, to encourage more people into the pharmacy for advice. ‘Success rates are better if NRT is supported by a healthcare professional,’ he says. ‘So advertising needs to be more upfront about talking to the pharmacist rather than simply promoting the products. There needs to be a greater public awareness that pharmacy has a key role within the community. Pharmacies do use their windows displays, but these need to be clearer and less cluttered. For example, concentrate on one topic, such as smoking, for one month every quarter, rather than focusing on smoking, diet, weight, etc at the same time.’

Support choices

According to Shauna Lenagh, Wellness & NiQuitin marketing manager, pharmacists play a vital role in assisting consumers to find the most appropriate NRT format. ‘Pharmacists are instrumental in explaining combination therapy,’ she says. ‘Research shows that more smokers use over-the-counter NRT for a quit attempt rather than go to their GP or a specialist stop smoking service and therefore it is important that pharmacists offer a wide range of products and formats and should be prepared to have proactive conversations with customers, providing advice and support.’

According to GlaxoSmithKline, smoking cessation is worth £222 million within the OTC and Rx sector, and NiQuitin as a brand is worth £56 million, growing at 2.1 per cent year on year. ‘On a wider look at the category, e-cigarettes are impacting the growth potential of the OTC NRT category as a whole, with growth slowing down substantially,’ says Shauna Lenagh. ‘However, through NiQuitin and strong relationships with local healthcare professionals, GSK is well placed to support local smoking cessation programmes.’

GSK has recently launched the first and only oral nicotine strip in the category. The NiQuitin Strip’s unique format enables it to dissolve fast; it starts to relieve the urge to smoke in 50 seconds. ‘It’s important to communicate to consumers the difference in the NiQuitin products,’ says Ms Lenagh. ‘NiQuitin Clear Patch (nicotine) is a flexible option for consumers who are looking for 16-hour and 24- hour craving control. NiQuitin Minis (available in a discrete and convenient pack) is more suitable for people who want relief from the urge to smoke as the cravings happen.’

Nicorette has developed a pharmacy box to provide resources and tools to aid the counter assistant and pharmacist during customer consultations. The box contains a number of items, including posters, patient information and leaflets and a pharmacy training module. There's a poster for the pharmacist to use with the patient to choose the right product for them, and a till stand so that the pharmacist can advertise that smoking cessation help and advice are available.

Non-nicotine help

Earlier this year, NicoBloc99 launched in the pharmacy sector via Murrays Health and Beauty, introducing a completely new method of helping smokers to quit. NicoBloc99 is a viscous liquid made from food-grade ingredients (including corn syrup) that, when applied to the filter of a cigarette, is claimed to block up to 99 per cent of harmful tar and nicotine levels. This can be used to gradually reduce the body’s dependence while simultaneously protecting the user from common withdrawal symptoms.

Guy Revis, managing director of Health & Beauty Innovations, which distributes NicoBloc99 in the UK and Ireland, says: ‘NicoBloc99 offers the only non-nicotine “smoker assistance product” that is available over the counter and on NHS prescription. This method helps smokers to gradually wean themselves off their nicotine addiction by gradually reducing consumption until they are ready to stop smoking altogether – without the need for replacing nicotine in some other form.’

E-cigarette impact

ASH estimates that there are 1.3 million current users of e-cigarettes in the UK. This number is almost entirely made of current and ex-smokers, with perhaps as many as 400,000 people having replaced smoking with e-cigarette use. According to Public Health England, the increasing interest in e–cigarettes is believed to be impacting on NRT sales and pharmacy footfall for the category.

‘It remains to be seen what role e-cigarettes can play in supporting smokers to quit and on shaping the future tobacco market,’ says Ms Cheeseman of ASH. ‘There is some evidence that they are useful quit devices, even among those who are not planning to stop smoking. We also know that smokers find these products attractive, potentially more so than conventional NRT products.

‘However, there are no regulated products on the market yet and, until there are, healthcare professionals are not able to recommend their use over licensed nicotine-containing products – although they are able to inform smokers that e-cigarettes are likely to be much less harmful than continuing to smoke.’