Treatments – TheFrugalPharmacist

Ok, I’m going to ask you a question and I want you to give me your most HONEST answer. What three things are part of YOUR morning routine? Most people’s mornings are on auto-pilot, so I want you to really take a moment and reflect… Personally (when I’m not rushing out the door) my day begins with listening to a good song in bed, getting up and doing a quick 5-minute yoga stretch, and topping it all off with a strong cup of coffee. Now here’s where I need you to be honest, did YOUR answer include smoking a cigarette? Even if it wasn’t a cigarette per se, what about chewing tobacco or vaping? If the answer is yes, then today I want to talk to you! I think I might have some surprising reasons on why you should keep that nicotine in your life (yep, you read that right). Reason #1: You’re part of the “IT” crowd. Everything from athletes, to celebrities, to media have all influenced the culture of tobacco. While the highest percentage of smokers fall in the 18-24 year age category; smokers range in age from pre-teen to over 65 years old. With such a large age array being affected, it’s easy to understand how we’ve reached a number like 43 million smokers in the United States.4 Being part of the “IT” crowd also makes you one of the 443,000 Americans who, each year, die prematurely from the negative sequalae of smoking.4 Cigarettes, vaping, cigarillos, (really anything with nicotine) may look cool but being part of the “IT” crowd comes with a price. Reason #2: You enjoy taking risks Rock climbing, sky diving, police officers, firefighters, and smoking. They all have one thing in common, risk! As a smoker you willingly expose yourself daily to something that increases your risk of stroke, lung cancer, throat cancer, esophageal cancer, heart attack, osteoporosis, and more. Not to mention that those risks are even higher in the setting of diabetes, elevated cholesterol, and high blood pressure. You couldn’t grow up in the 90s and not recognize who Joe camel[ was. His message was so intriguing to me that he was the subject of my middle school science fair project, “Is the camel really cool?” To evaluate the environmental effect of cigarette exposure, my idea was to grow plants in two environments’; one with cigarette smoke and one without. Somehow, I got approval from the school and started my 8-week evaluation. Documenting growth rates, plant appearance, soil conditions, etc.! The results: although the camel looked cool, the effects seen in the plants exposed to cigarette smoke was not. They were shorter, smaller, and less green than their fuller vibrant smoke-free counterparts. Reason #3: You like to share Not only do you enjoy danger for yourself, but you also like making life riskier for those around you. I’m talking about the perils that come from second hand smoke. Simply being around smoke increases a non-smoking bystander’s risk of cancer, heart disease, and several of the same risk that come with smoking a cigarette directly.7 Lately public places have taken several positive strides towards reducing second hand smoke exposure. If you’re still reading you get the trend of this conversation. I started off promising to share reasons why you should keep smoking, but clearly the reason’s all suck. There’s no good reason to start or continue smoking. Your health is what’s important and not worth risking, therefore if you are a smoker, all signs point towards smoking cessation. How to start the smoking cessation journey? Taking steps towards quitting are steps in the right direction. Even if you don’t succeed on the first try figure out what stumped you and try again. Quitting is daily battle that you, and thirteen million other Americans struggle with daily.4 Going back to the start One of the first things you must do is pinpoint when and why you started smoking. Take a second to think about what the situation or reason was that led you to cigarettes. Write down or visualize that moment.7 This reality check not only allows you to move forward, but also prepares you to develop a strategy for how you will avoid those triggers in the future. Lifestyle changes7 I know it may have been tough to address your weakness/reason(s) why, but kudos to you for doing so. Now you’re really ready to S.T.A.R.T:6,8 S = Set a quit date. T = Tell family, friends, and the people around you that you plan to quit. A = Anticipate or plan ahead for the tough times you'll face while quitting. R = Remove cigarettes and other tobacco products from your home, car, and work. T = Talk to your doctor about getting help to quit. Eliminating tobacco dependence involves more changes than you might realize. Because of smoking’s highly addictive nature, you may not be aware of all the times you’ve incorporated the habit into your day. Therefore, you have let your friends/loved ones know you’re quitting, get rid of the tobacco products in your home, and plan for times when the craving will strike. Incorporating more exercise, keeping sugar free candy on hand, and finding relaxation methods that work for you are all good options.7 As you begin to eliminate tobacco from your life, you will inevitably start to experience side effects precipitated by nicotine withdrawal. Some of these symptoms include feeling hungry, weight gain, being irritable, getting frustrated or angry, and maybe even a sore throat.7 The highest success in smoking cessation is seen when medications that help relieve the nicotine withdrawal symptoms are used in combination with counseling. Let’s talk meds! There are over-the-counter (OTC) products and prescription products to help you quit smoking. These products work in various ways to aid with smoking cessation. Let’s discuss them below. OTC Smoking cessation products It might seem a little backwards to give yourself nicotine when you’re trying to get nicotine out of your system. However, by using nicotine replacement products you give your body a lower amount of the drug than its adapted to when you smoke. This lower amount eases your body off nicotine and helps reduce extreme cravings...4 Cravings that could potentially sabotage your cessation progress. Dosing of these various options is based on when you normally have your first cigarette and what your pack per day amount is. If you decide to try any of these, you will need to complete about 8-12 weeks of treatment. Products available without a prescription include: Nicotine Gum:4,9 Comes in different flavors like cinnamon, fruit, and mintDelayed weight gain seen with this productThe how: Chew the gum slowly until you feel a tingling/peppery sensation. When that happens, you park the gum in between the cheek and gum (to let the nicotine release). Repeat the “chew” and “park” until there’s no tingle left.Cost/day: up to $3.70Nicotine transdermal patches:4,9 OTC = NicoDerm CQ® and some genericsDelayed weight gain seen with this productThe how: Apply the patch to a clean, hair free area. Can be worn for up to 16 hours each day. Do NOT apply patch to same site if it has been worn there in the past week.Cost/day: up to $3.48Nicotine lozenges:9Comes in different flavors like cherry and mintThe how: The lozenge takes about 10-30 minutes (depending on the size) to dissolve in your mouth. Do not chew or swallow.Cost/day: up to $3.78 Prescription smoking cessation products Nicotine transdermal patches: Rx = generic nicotine patchesDelayed weight gain seen with this productThe how: Apply the patch to clean, hair free area. Can be worn for up to 16 hours each day. When putting on a new patch, Do NOT apply it to a site if it has been worn there in the past week (7 days).Cost/day: up to $3.48Nicotine oral inhalers(puffers):9Nicotrol Inhaler®The how: The inhaler dispenses nicotine as a vapor. The vapor is inhaled into the back of the throat or puffed in short breaths. You do NOT inhale the vapor into the lungs as you would when smoking a cigarette. The action is more like a quick pull in and then blow out.Cost/day: ~$11.35Save up to $100 on your Nicotrol inhaler prescriptionNicotine nasal sprays:9Nicotrol NS® metered nasal sprayThe how: Dispense one spray into each nostril. Cost/day: ~$6.67Bupropion sustained release:9,10 Wellbutrin®, Zyban® sustained release tabletsDelayed weight gain seen with this productWorks best if started 1 or 2 weeks before you quit smokingThe how: This medication decreases nicotine cravings and withdrawal symptoms. You take it twice a day.Cost/day: up to $7.87check the price on Singlecare or Blink HealthVarenicline:9,10Champix®, Chantix® tabletsWorks best if started 1 week before you quit smokingThe how: This medication acts at the nicotine receptors in the brain. The result is decreased pleasure from smoking, less desire to smoke, and a decline in nicotine withdrawal symptoms. You take it twice a day.Cost/day: ~$11.86If your insurance doesn't cover it in full use the Chantix copay card There are several different options for nicotine replacement therapy and smoking cessation. They vary in cost, technique, and more. If a smoking cessation product is prescribed by your physician, your cost might be covered by your insurance. If you are paying cash, there are options available to get the medications you need. Talk with your local pharmacist. It may not seem like it, but you will save money when you quit smoking. Healthcare costs associated with tobacco use result in a yearly expense of ~96 billion dollars. Smoking cessation products are usually only needed for 8-12 weeks and cost as much or less than buying one to two cigarette packs per day.4 Other routes to the finish line The most successful methods to accomplish smoking cessation are those that have been tested. There are some untested methods that purport having significant outcomes in reducing nicotine dependence. Some of these methods include mindfulness meditation, herbal supplements, acupuncture, hypnotherapy, aversive conditioning, and transcranial magnetic stimulation (TMS). Let me briefly discuss some of these topics with you. Herbal supplements:1 Cytisine is a natural product that has been touted as an effective agent for smoking cessation. It has been used in Central and Eastern European countries but is not an FDA approved product. Mindfulness meditation:1,11 This cognitive behavior therapy involves focused breathing and thought redirection to reduce the stress-reactivity stimulus in the brain. It has shown some promise with smoking cessation. Aversive conditioning:2 Successful aversive conditioning pairs some type of unwanted behavior with smoking. Examples include offensive odors, rapid smoking, electric shock, etc. Transcranial magnetic stimulation:2,12 This one sounds pretty shocking, and it definitely is (no pun intended)! It involves electromagnetic stimulation of the brain region involved in addictive behaviors. It is current being studied and is showing significant promise as a smoking cessation aide. There is help out there! Smoking cessation is a daunting enough task to take on solo. So, don’t! There are several programs available to help you successfully quit. The center for disease control (CDC) has several great resources and a mobile app as part of its anti-tobacco campaign. This app includes smoking cessation guides and will also send you daily text message reminders along your journey.3 Another great tool to look in to is www.smokefree.gov. They have online resources and even a 1-800-QUIT-NOW hotline for people trying to quit.8 You are the only you, so why put your life at undue risk?! Quitting will always seem hard, but you are strong enough to do this! The instant you put the cigarettes/tobacco down, the benefits start. Your blood flow improves, your lungs become more active, and your heart rate/blood pressure are lowered.7,8 When you stop completely you reduce your risk of premature death, various cancers, and stop the aging of your skin.7 The journey starts with the first step. Commit to the S.T.A.R.T. and we’ll see you at the finish line. Complementary Health Approaches for Smoking Cessation. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/smoking. Published November 14, 2017. Accessed September 21, 2018. 7.18 Alternative therapies and emerging treatments. Prevalence of smoking-teenagers - Tobacco In Australia. http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-18-unproven-methods. Accessed September 21, 2018. Tips From Former Smokers ®. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/?utm_source=google&utm_medium=cpc&utm_campaign=EST 4059 - Tips 2016 Campaign Search - English - Cessation Terms&utm_content=Support - Broad&utm_term=stop smoking support&gclid=Cj0KCQjwof3cBRD9ARIsAP8x70Odwb0eZ4IfnaP-bCbjWgAfoLxiFmTV4v2jCQwNVuGVhLgqd8-UoXYaArSBEALw_wcB&gclsrc=aw.ds. Published May 23, 2018. Accessed September 21, 2018. Smoking and Smoking Cessation. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed September 21, 2018. Nicotine. Lexi-Tox. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed September 21, 2018. Quitting Smoking for Teens and Young Adults. Patient Education- Disease and Procedure. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed September 21, 2018. Quitting Smoking GIF. Patient Education- Disease and Procedure. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed September 21, 2018. Quitting Smoking. Patient Education- Disease and Procedure. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed September 21, 2018. Pharmacologic Product Guide: FDA-Approved Medications for Smoking Cessation. https://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/pharmacologic-guide.pdf. Accessed September 21, 2018 Prescription Drugs to Help You Quite Tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/prescription-drugs-to-help-you-quit-smoking.html. Accessed September 21, 2018. Wong C, Fogoros RN, ND. Mindfulness Meditation - How Do I Do It? Verywell Mind. https://www.verywellmind.com/mindfulness-meditation-88369. Accessed September 21, 2018. Rubin E. Can Brain Magnetic Stimulation Help People Quit Smoking? Psychology Today. https://www.psychologytoday.com/us/blog/demystifying-psychiatry/201412/can-brain-magnetic-stimulation-help-people-quit-smoking. Accessed September 21, 2018.