Implementing the July 2015 NICE Quality Standard to reduce harm from smoking

Transcription

1 Implementing the July 2015 NICE Quality Standard to reduce harm from smoking Deborah Arnott Chief Executive Action on Smoking and Health Smoking Cessation in Mental Health conference 20 th October 2015

2 Harm reduction measures Often viewed as controversial Sexual activity Guidance on safer sex Distribution of condoms Use of recreational drugs Needle exchange schemes Safe injection sites Consumption of alcohol Recommended limits unit counting Facilitating consumption nominated drivers 2

3 Why tobacco harm reduction? Not all smokers are ready or willing to quit: Around a third of smokers will try to quit each year Two thirds will not Support beyond the traditional quit model has been shown to help people reduce risk to themselves, others and increases their chances of quitting completely

4 Deprived communities have most to gain The recommendations are particularly relevant to people who are highly dependent on nicotine and groups where smoking prevalence is higher than average. Examples include: people with mental illness, people from lower socioeconomic groups Tobacco: harm reduction approaches to smoking, NICE, 2013

5 Smoking has declined least among most disadvantaged CIGARET T E SM OKING BY DEPRIVAT ION IN GREAT BRIT AIN: GHS & % prevalence M os t a fflue nt Poore s t DEPRIVAT ION SCORE

6 Increased odds of smoking by nearly any indicator of disadvantage

7 d e p r e v. t c Poorer smokers are more likely to be highly dependent 350 Plasma cotinine by depriv ation in cigarette smokers: HSE Plasma cotinine (ng/ml) Mean ± 95% CI DEPRIVATION SCORE

8 Gap in smoking rates will remain unless we do something different Cigarette smoking % Routine & manual Non-routine Year

9 PH45 tobacco harm reduction June 2013 NICE published PH45 guidance on Tobacco Harm Reduction Does include: Recommendations for helping smokers not yet ready or willing to quit Guidance for the whole system not just stop smoking services Doesn t include: Recommendation on e-cigarettes Prescriptive guidance for practice

10 Other relevant NICE guidance Smoking cessation in secondary care: acute, maternity and mental health services (PH 48) Smoking cessation services (PH10) Identifying and supporting people most at risk of dying prematurely (PH15) Workplace interventions to promote smoking cessation (PH5)

11 Quality standard Statement 1. People who are unwilling or not ready to stop smoking are offered a harm-reduction approach to smoking. Statement 2. People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

12 Quality standard Statement 3. People who are unwilling or not ready to stop smoking are advised about using nicotine-containing products and supported to obtain licensed nicotine-containing products. Statement 4. 'Stop smoking' services offer harm-reduction approaches alongside existing approaches to stopping smoking in one step.

13 Harm reduction approaches Types of intervention: Cut down to quit (with or without NRT) Temporary abstinence (with or without NRT) Complete substitution with alternative source of nicotine Nature of interventions: Advice in a mainstream service Support in a mainstream service Self-help materials Support through a stop smoking service

14 Percentage of smokers reporting a quit attempt in the previous 12 months Increase likelihood of quit attempt as a function of harm reduction activities Other smokers SR without NRT TA with NRT SR with NRT SR & TA with NRT Source: Beard, E., & West. R. (2012). Addiction

15 25% Address poor knowledge among public (and professionals) According to what you know or believe, what portion of the health risks of smoking comes from nicotine in cigarettes? 20% 15% 10% 5% 0% None or very small Some but well under half the risk Around half the risk Much more than half the risk Nearly all the risk Don t know

16 Ensure perceptions of risk don t undermine choice 80% Perception of relative safety e-cigarettes 70% 67% 60% 50% 53% 40% 30% 33% 20% 17% 10% 0% Current electronic cigarette user and ex-smoker Current electronic cigarette user and current smoker Ex-electronic cigarette user and current smoker % who agree electronic cigarettes are a lot less harmful than regular cigarettes Never electronic cigarette user and current smoker

17 Move smokers towards less risky behaviours Around half the population has ever smoked 57% 4% 6% 34% Ex-smoker Less risk More risk Current smokers Ex-smoker uses e- cigarettes Current smoker uses e- cigarettes

18 Examples of some projects

19 Small cut down to quit pilot Mental health unit in Devon

20 Cut down to quit programme NICE Guidance PH45 Harm reduction approaches to smoking PHE Smoking cessation in secure mental health settings 2015 Working with those not ready to quit Offered cut down to quit as an alternative

21 Results Residents engaged well with Cut Down To Quit model 7 out of 12 smoking residents and 1 staff member took part 4 quit

22 Observations Reduction of medication a key motivation Residents were more aware of their physical health, had increased knowledge and selfempowerment Those that did not quit made behaviour changes Partnership working was highly successful Staff became motivated to make further change

23 ecig-friendly service Leicester City On No Smoking Day 2014 service launched its self as first e-cig friendly service in the country Actively recruited smokers wanting to use e- cigarettes into the service Also changed how they talked about e-cigarettes to those enquiring rather than: we can t recommend them said: we can t supply them Provided advice on purchasing effective products and using them correctly

24 Results Product Number set a quit date Number successfully quit % Quit Rate NRT % Product Number set a quit date Number successfully quit % Quit Rate E-cigarette only % Concurrently with medication % Consecutively with medication % Grand Total %

25 Observations Recognition in a stop smoking service of e-cigarettes as a means of stopping smoking appears to be a valid means of attracting people to services This may help to increase numbers of people benefitting from behavioural support from experienced stop smoking advisors

26 Conclusions Harm reduction approaches offer an alternative way to help smokers particularly those highly addicted and not yet ready to quit NICE guidance is a useful framework Organisations should consider the role of electronic cigarettes in supporting smokers to reduce harm to themselves and others

27 Harm reduction resources Materials to help shape policy jointly produced by PHE, NCSCT, NICE and ASH duct.html Guide on e-cigarettes from NCSCT igarette_briefing.php and briefings from ASH Harm reduction yammer group