Physicians from across the nation gathered to discuss smoking-related issues in the first-annual C. Everett Koop Tobacco Treatment Conference, held on Sept. 18 and sponsored by Dartmouth-Hitchcock Medical Center.
Former U.S. Surgeon General C. Everett Koop '37 gained national attention as surgeon general in part because of his work to increase awareness about the dangers of smoking tobacco.
The event's speakers highlighted emerging treatments for nicotine dependence and discussed the updated clinical guidelines for treating tobacco addiction. Attendees also completed an instructional clinic focusing on motivational interviewing techniques that may help patients stop smoking.
University of Wisconsin professor Michael Fiore presented the keynote lecture, "Treating Tobacco Dependence: New Clinical Practice Guidelines," which focused on new strategies and medications that can be used to help people quit smoking. Roughly 20 percent of Americans have a smoking habit, he said.
While the number of smokers has halved since the 1960s, "we still have a long way to go," Fiore said.
Most smokers who are trying to quit do so without assistance, Fiore said, which results in only a 5-percent quit rate. More than 70 percent of current smokers express a desire to stop smoking.
Medications designed to help smokers quit have been shown to be effective, Fiore said.
One such medication is varenicline, Megan Doty, a DHMC outpatient pharmacist, said at the event. Studies tracking smokers using the drug show a three-fold increase in long-term quit rates, she said.
Doty described a variety of additional treatments that have been shown to increase tquit rates, but emphasized that anti-smoking medication should only be administered after potential drug interactions have been considered. Chemical interactions among the drugs can change their efficacy, she said.
"We need to look at each element individually and match it up with patient needs," she said.
Studies have shown that medication and counseling combined produce higher quit rates than does either strategy alone, Fiore said.
These newly tested strategies need to be implemented on a larger scale, Fiore said. The Joint Commission, a health care accreditation organization, is working to revise guidelines for assessing and treating tobacco dependence in the hospital setting, in part by using an online survey to gather the opinions of doctors on proposed changes.
Standards must also be changed to promote tobacco-addiction treatment for psychiatric populations, according to Denise Jolicoeur, program director of the Center for Tobacco Treatment Research at the University of Massachusetts Medical School.
Psychiatric populations are two to three times more likely to smoke than is the general population, she said, adding that of the 435,000 people who die from smoking-related diseases each year, 200,000 have a mental illness or non-tobacco related substance abuse disorder.
For people with substance abuse issues, tobacco use is often seen as a lower priority than the immediate consequences of other substance use, Jolicoeur said.
"There are barriers, but they're beginning to fall away because the practitioners are saying, This isn't fair to our patients, we're letting them kill themselves,'" she said.
