Quit Tobacco Series Fact Sheet #13: Clinical Practice Guideline
The U.S. Public Health Service published the 2008 update to the Clinical Practice Guideline: Treating Tobacco Use and Dependence. Recommendations were based on evidence published in more than 8,700 peer-reviewed journal articles. Here’s what’s new or different from the previous edition published in 2000.
Quit Line counseling is effective with diverse populations and has broad reach. Wisconsin Tobacco Quit Line callers on average are four times more likely to quit tobacco use than those who attempt to quit without treatment.
The combination of counseling and medication is significantly more effective than either alone. When at all practical, both should be provided. However, medication should not be used when contraindicated—and is not recommended for pregnant women, light smokers, adolescent smokers or smokeless tobacco users. Otherwise, the pairing of coaching and medication should be routinely offered to patients trying to quit.
This Guideline Update includes information on nicotine lozenges and varenicline. Seven medications are now approved by the FDA as safe and effective for tobacco-dependence treatment.
Certain medicinal combinations have been shown to be effective:
Tobacco dependence is a chronic condition that often requires repeated intervention to achieve long-term abstinence. Many patients relapse several times before quitting for good. Clinicians should intervene using the recommended treatments in the Guideline Update, regardless of the smoker’s past success.
Recommendation for counseling is strengthened for:
For smokers with a history of depression, buproprion SR is significantly more effective than placebo.
Quit-tobacco counseling and medication are effective with diverse populations, including: Racial and ethnic minorities; those of limited education or finances; patients with medical or psychiatric co-morbidities; LGBT patients.
Healthcare policies and systems changes can significantly reduce barriers to treatment:
There are new strategies to increase interest in quitting among patients not willing to quit at the current time. Specific actions by providers can lead to increased motivation and quit attempts among these smokers.