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Treatment of Nicotine Dependence: Opportunities for Intervention Today

December 8, 2008: The Role of Nicotine Addiction in Tobacco Use

Corinne Husten, M.D., M.P.H., Interim President, Partnership for Prevention

Key messages:

  • Partnership for Prevention (PfP) is a nonprofit, non-partisan national health policy organization that works to improve the health of all Americans by increasing the priority on disease prevention and health promotion.
  • Tobacco use is a chronic relapsing condition that often requires repeated treatment before long-term remission is achieved.
  • Policymakers need to put treatment of tobacco use on a level playing field with other treatments and we need to increase the priority on developing more effective treatments.
  • While we wait for more research on addiction and the development of more effective interventions, it is crucial that we fully implement the effective interventions that already exist.
  • One of the reasons that tobacco users don't use the treatments that are currently available is because of misperceptions about the interventions. These range from concern about taking one addictive drug to combat another; bad press about side effects; confusion between new tobacco products and the medication that are often next to each other in the pharmacy; perceptions among physicians that treatments "don't work."
  • Finally, there is a lack of political will to implement effective community and policy interventions such as tobacco taxes, smokefree policies, sustained media campaigns to promote cessation, reducing out-of-pocket costs for treatment, telephone quitlines, provider reminder systems, and to fund comprehensive tobacco prevention and control programs.
  • Opportunities for increasing treatment of tobacco dependence include regulation of tobacco products by the FDA which would require content disclosure and restricting advertising to prevent tobacco use among youth. A second opportunity includes Congressional approval of the FCTC which has yet to be ratified by the U.S.
  • On December 11, 2008, Partnership for Prevention released policy recommendations for Congress that included: covering all A- and B-recommended services of the U.S. Preventive Services Task Force, provide 1st dollar coverage for high value preventive services (< $50,000 per life year saved) (which includes tobacco-use treatment), a dedicated funding stream for public health infrastructure, and implementing effective community preventive services (as defined by the Community Preventive Services Task Force).
  • On December 6, 2008 Partnership for Prevention released "A Call for ACTTION" (Access for Cessation Treatment for Tobacco in Our Nation) with the goal of expanding access to comprehensive tobacco cessation treatment to 50% of smokers by 2015, and 100% by 2020.
  • PfP supports barrier-full coverage of tobacco use treatment through the Federal Employee Health Benefits Program (FEHBP) which could serve as a model program for private health insurers.
  • PfP continues to advocate for full coverage of tobacco dependence treatment through Medicare and Medicaid, including coverage of Quitline counseling.
  • Increasing tobacco taxes may be more acceptable in the current economic climate (but they must be accompanied with a requirement that some of this revenue go toward tobacco prevention and control).
  • We cannot be complacent with a 20% prevalence rate and 400,000 deaths per year. Perhaps it is time for a bold initiative that calls for the eradication of tobacco-related disease with a focus and the resources similar to those that have led to the eradication of polio and smallpox.

Following Dr. Husten's remarks, there was discussion among ICSH members about the day's proceedings.

No public comments were offered and Committee members continued their discussion.

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