1. Attempting to increase the use of smoking cessation medications Brendon Baker Ministry of Health

2. Most people try to quit without support Cold Turkey!

3. Quitting without support The majority of people who quit this way will relapse in the first week Only 2.5% abstinent at 1-year

4. Why do smokers quit without support? People who smoke Don’t believe they need treatment Don’t know about treatments Can’t access treatments (cost and availability) Don’t believe treatments work

5. Why do smokers quit without support? Healthcare professionals May lack knowledge / feel unsure about tobacco dependence and smoking cessation May hold similar beliefs to those of smokers Don’t believe they can help Lack resources (time, money) to help as they might like

6. Subsidised Pharmacotherapy Odds ratio (95% CI)NNT NRT1.77 (1.66 -1.88)17 Bupropion1.94 (1.72 – 2.19)13 Nortriptyline2.34 (1.61 – 3.41)13 Varenicline 3.22 (2.43 – 4.27) 7 Cochrane Library of Systematic Reviews Nicotine replacement therapy Bupropion (Zyban) Nortriptyline Varenicline (Champix) (since 1 November 2010 on ‘special authority’)

8. New Sole Supply NRT agreement in 2011 Pharmaceutical and formulation Strength Pack size Proposed price and subsidy Nicotine lozenge 1 mg 216 $19.94 Nicotine lozenge 2 mg 216 $24.27 Nicotine patch 7 mg 28 $18.13 Nicotine patch 14 mg 28 $18.81 Nicotine patch 21 mg 28 $19.14 Unlike the currently listed smaller pack sizes, no rebate would apply to the larger pack sizes of nicotine lozenges and nicotine patches.

9. NRT monthly expenditure 1st NY ad campaign & annual CPI adjustment Quit Cards online Prescribers give out Quit Cards On prescription Excise tax

10. Prescribing of NRT Prescriptions issued for 21 mg patches: September 09 – 814 (5012 Quit Cards) May 10 – 1802 (8031) July 10 – 1847 (5379)

11. Prescribing of Zyban Sep 09 – 2168 scripts July 10 – 3935 scripts

12. Where to from here? Māori Affairs Select Committee recommendations Tobacco companies should pay for meds NRT required to be sold everywhere tobacco is Allow Pharmacists to be Quit Card providers

13. Conclusions There has been significant progress made More can be done - still 650000 smokers Potential growth areas: Prescribers Champix/Zyban/Nortripyline Māori Affairs Select Committee Recs