Governments should pay for treatments that help people quit smoking, according to an editorial in the current Canadian Medical Association Journal. And a Vancouver doctor who is certified in addiction medicine says he fully supports the recommendation. Milan Khara, clinical director of Vancouver Coastal Health’s tobacco-dependence clinic, says the fact that some cessation therapies aren’t covered by the B.C. government is not only economically illogical but also reflects a lack of understanding of the nature of addiction itself.
“Not covering cessation medications”¦makes no sense,” Khara tells the Georgia Straight by cellphone having just returned from Bath, England, where he attended the Society for Research on Nicotine and Tobacco Europe’s annual meeting. “It would save money in the long term. But we [doctors who support public funding of cessation therapies] suspect that the reason the provincial governments don’t cover these treatments is because they view smoking as a habit, a lifestyle choice. We really strongly argue that any credible medical-classification system considers tobacco dependence an addictive disorder.
“We’ve done very well when it comes to tobacco control with such measures as high taxes, bans on advertising, bans in public places,” adds Khara, who is also a clinical associate professor in UBC’s department of medicine. “Cessation, though, is where we’ve missed the mark. That’s the measure we need to support. The government really has not pushed through on tobacco control in this area.”
The CMAJ editorial dismisses the “naí¯ve” view of quitting smoking as merely a matter of individual choice.
“For many, if not most, smoking is a powerful addiction, similar to alcoholism and other forms of substance abuse,” states the editorial, which was written by a team of doctors. (A disclaimer states that the content doesn’t necessarily reflect the opinions of the Canadian Medical Association.) “Provincial health ministries already reimburse the cost of pharmacotherapy for other drug addictions, such as methadone for heroin addiction or naltrexone for alcohol dependence. Perhaps funding for smoking cessation lacks political and public support because of the social stigma associated with smoking, ironically a deliberate achievement of tobacco prevention campaigns.”
B.C. Minister of Healthy Living and Sport Ida Chong notes that the province provides annual funding for smoking-cessation services to the B.C. Lung Association’s QuitNow program. The free service offers telephone and Internet support to people hoping to stop smoking.
“B.C. has already begun a review of smoking-cessation products, including nonprescription nicotine-replacement therapies and other prescription drugs,” Chong tells the Straight. The review is expected to be completed next year.
“Nicotine-replacement products are over-the-counter products which do not need a prescription,” Chong says. “As such, these products are widely available for self-selection by smokers, and they may, in fact, cost less or similar compared to the cost of cigarettes or other smoking products.”
NDP health critic Adrian Dix says that paying for a broad range of cessation strategies “simply makes a lot of sense”.
“We have been calling for this for a while,” Dix says in a phone interview. “Clearly, the health-care payoffs make it, even in the short term, one of the best health-promotion initiatives and one of the most cost-efficient.
“Techniques that work can be prohibitively expensive,” he adds. “I remember hearing from a woman who was spending a huge share of her salary trying to quit.”
Green party leader Jane Sterk also supports provincial-government funding of all cessation methods, provided they’re evidence-based and scientifically proven to work.
“We support anything that moves toward prevention and health promotion,” Sterk says in a phone interview. “Taxes from the sale of cigarettes could go directly to these initiatives”¦instead of into general revenue.”
The cost of smoking-cessation products acts as an “insurmountable barrier” for some smokers, or, at the very least, a powerful disincentive, the CMAJ editorial authors claim. They also note that other countries have given the issue progressive public support.
In 2007, for instance, the Canadian Agency for Drugs and Technologies in Health recommended that the smoking-cessation drug varenicline be added to provincial drug plans. However, Quebec is still the only province that provides public funding for all smoking-cessation medications, according to the CMAJ editorial, while Yukon and Prince Edward Island reimburse residents for some products.
Australia and the United Kingdom, meanwhile, offer citizens reimbursement for all smoking-cessation products, including prescription medications and over-the-counter nicotine-replacement therapies.
A 2009 review by the Cochrane Collaboration—an independent, international, nonprofit health-research organization—found that full reimbursement of the cost of smoking-cessation medications significantly improved one-year abstinence rates among smokers.
According to Health Canada, about 18 percent of the population smokes, and smoking is the leading cause of preventable disease and death. In British Columbia alone, there are more than 5,700 smoking-related deaths each year. people have the best chance of quitting if they use a combination of counselling and medications, Khara says.
Although smoking rates in Vancouver are lower than in other parts of the country, Khara notes that this trend is not true for people with mental illnesses, who are two to four times more likely to smoke cigarettes than members of the general population.
Khara is critical of the sale of cigarettes in pharmacies: B.C. and Manitoba are the only provinces that allow this.
“We have pushed the College of Pharmacists [of B.C.] and the government to change this, but there is no will to do so,” Khara says. “Pharmacies are all understood to promote good health, yet they’re still selling cigarettes. It’s very troublesome.”