1. Nicotine Replacement Prescribing Trends in a Large Psychiatric Hospital, Before and After Implementation of a Hospital-Wide Smoking Ban A. Douaihy, D. Scharf, T. Fabian, C. Fichter-DeSando & D.C. Daley Antoine Douaihy, MD Associate Professor of Psychiatry University of Pittsburgh SOM Medical Director, AMS Western Psychiatric Institute and Clinic Appalachian Tri-State Node of NIDA CTN Pre-SC Dissemination Workshop Sep 21 st, 2010

2. Disclosures None

3. Background Cigarette smoking highly prevalent among persons with psychiatric illness Cigarette smoking highly prevalent among persons with psychiatric illness >85% of seriously mentally ill persons currently smoke >85% of seriously mentally ill persons currently smoke Patients traditionally being allowed to smoke in psychiatric hospitals Patients traditionally being allowed to smoke in psychiatric hospitals New laws forcing hospitals to go smoke-free New laws forcing hospitals to go smoke-free Psychiatric inpatients may benefit from NRT to manage withdrawal interfering with recovery from mental illness Psychiatric inpatients may benefit from NRT to manage withdrawal interfering with recovery from mental illness Unknown if hospital-wide smoking bans prompt health care professionals to treat their patients nicotine withdrawal with NRT Unknown if hospital-wide smoking bans prompt health care professionals to treat their patients nicotine withdrawal with NRT

4. Objective To examine trends in prescribing NRT in a large psychiatric hospital (WPIC) before and after the hospital-wide smoking ban

5. Methodology NRT utilization data extracted from hospital pharmacy records for the 2 years before and after the ban ( additional data for one more year after) NRT utilization data extracted from hospital pharmacy records for the 2 years before and after the ban ( additional data for one more year after) Smoking ban went into effect on January 1 st, 2007 Smoking ban went into effect on January 1 st, 2007 Data represent n= 25,996 total inpatient hospital admissions Data represent n= 25,996 total inpatient hospital admissions

6. Primary Outcomes Change in average monthly rate of total NRT utilization from before until after the smoking ban Change in average monthly rate of total NRT utilization from before until after the smoking ban Change in average monthly rate of nicotine gum, lozenge and patch from before until after the smoking ban Change in average monthly rate of nicotine gum, lozenge and patch from before until after the smoking ban

7. Results

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16. Conclusions Findings suggest that clinicians/physicians are more likely to identify and treat symptoms of nicotine addiction when smoking is restricted Findings suggest that clinicians/physicians are more likely to identify and treat symptoms of nicotine addiction when smoking is restricted Increased rates of treatment likely persist for months and possible years after smoking is prohibited Increased rates of treatment likely persist for months and possible years after smoking is prohibited Trainees/clinicians/practitioners should be encouraged to assess and treat nicotine withdrawal symptoms to limit interference in the treatment of psychiatric and SUDs. Trainees/clinicians/practitioners should be encouraged to assess and treat nicotine withdrawal symptoms to limit interference in the treatment of psychiatric and SUDs.