The Pharmacist’s Role in Ending the Tobacco

Pandemic

Alan Blum, MDAuburn University

Harrison School of Pharmacy

February 18, 2011

DEATHS FROM CIGARETTE SMOKING IN US SINCE 1964

12,000,000

Smoking Prevalence

CAUSES OF DEATH

1. Heart disease

2. Cancer

3. Stroke

4. COPD

5. Accidents

6. Diabetes

MARLBORO’S MYOCARDIAL MAYHEM

• ↑ oxygen demand• ↓ angina threshold• ↓ exercise performance• ↑ recurrent infarction

CAMEL’S CORONARY CONSEQUENCES

• Adverse lipid profile• Altered hematologic factors• Direct arterial wall effects• Elevated blood pressure

Cancer Death Rates for Men, US, 1930-2005

Cancer Dea th Ra tes fo r Women, US , 1930 -2005

COPD

• 5% of US population• 80% caused by smoking• 4th leading cause of death

DIABETES:

3x Cardiovascular Mortality

SMOKING + DIABETES:

11x Cardiovascular

Mortality

OTHER TOBACCOGENIC PROBLEMS

• Osteoporosis• Hip fractures• Early menopause• Macular degeneration• Peptic ulcer disease

SECONDHAND SMOKE

• Lung cancer: 3,000 deaths/year• Heart disease: 40,000 deaths/year• Asthma: 2 million visits/year

SMOKING IN PREGNANCY

• Low birthweight• Preterm labor• Spontaneous abortion• Abruptio placenta• Placenta praevia• Premature rupture of membranes

EFFECTS ON CHILDREN

• SIDS• Asthma• Bronchitis• Otitis media• Pneumonia

INFLUENCES

• Peers• Parents• Propaganda

SMOKING CESSATION

• 44.5 million smoke• 77% want to stop• 40% try each year• 5% succeed

MARKERS OF ADDICTION

• >20 Cigarettes /day• Smoke upon awakening• Psychiatric condition• Alcohol dependence

BEHAVIOR MODIFICATION

• Identify situations• Choose oral substitutes• Do five-minute plan:

Postpone

Inhale

Reconsider

SMOKING’S MYTHS

•Relieves stress•Keeps weight down•Low-tar, filters, are safer

THE PRODUCT

•Filter•Low tar•Lights•Menthol

MONEY LOST

Number of packs/day

x Cost/pack

x 365 days/year

X Number of years smoking

Total cash lost (plus interest)

INHALATION COUNT

Number of cigarettes/dayx 10 inhalations/cigarettex 365 days/yearx Number of years smoking

Total inhalations

BENEFITS OF STOPPING

• 1 day: ↓ MI risk• 1 year: ↓ Stroke risk 50%• 10 years: Stroke risk of non-smoker• 15 years: CHD risk of non-smoker

COSMETIC BENEFITS

• Fresher breath, clothing• Whiter teeth, nails• Endurance

NICOTINE REPLACEMENT THERAPY

• Gum (Nicorette)• Transdermal patch (Nicoderm)• Inhaler (Nicotrol)• Lozenge (Commit)• Electronic cigarette?

ADJUNCTIVE PHARMACOTHERAPY

• Bupropion• Clonidine• Nortriptyline• Verenicline• Rimonabant

SMOKING PREVENTION

• Increase cigarette taxes• Restrict teen access• Clean indoor air laws• Ban advertising• Educate on TV, radio, internet

SHIFTING THE FOCUS

• Substance → Product• Effects → Promotion• User → Pusher

AMERICAN TOBACCO COMPANIES

1. Philip Morris USA

2. Reynolds-American Inc.

3. Lorillard Inc.

4. United States Smokeless Tobacco

5. Liggett Vector Brands Inc.

6. Swedish Match

7. Imperial Tobacco

CANCER’S 7 WARNING SIGNS

1. Philip Morris USA

2. Reynolds American Inc

3. Lorillard Inc.

4. United States Smokeless Tobacco

5. Liggett Vector Brands Inc.

6. Swedish Match

7. Imperial Tobacco

Alan Blum, M.D.

Professor and Gerald Leon Wallace Endowed Chair in Family Medicine, College of Community Health Sciences, School of Medicine, The University of Alabama

Director, The University of Alabama Center for the Study of Tobacco and Society

ablum@cchs.ua.edu

STRATEGIC WEAPONS

•Map•Calendar•Camera

Alan Blum, M.D.

Professor and Endowed Chair in Family Medicine, The University of Alabama

Director, The University of Alabama Center for the Study of Tobacco and Society

ablum@cchs.ua.edu