Questions over Australia’s tobacco control

The World Health Organization’s (WHO) report on the global tobacco epidemic focuses on progress governments have made over the past two years to reduce smoking rates.
 
It identifies Australia as a ‘best practice’ country due to its implementation of public health interventions identified in the WHO Framework Convention on Tobacco Control (WHO FCTC) as the most effective measures for helping people to quit.
 
However, despite possessing the highest cigarette prices in the world and major advertising restrictions such as plain packaging, Australia’s daily smoking rates have hovered at around 14% for the past five years, well above targets set by the Council of Australian Governments (COAG) in 2008.
 
Tobacco treatment specialist and former GP, Conjoint Associate Professor Colin Mendelsohn, told newsGP while the current smoking rate is quite low, GPs could potentially contribute further to its decline by intervening more often and optimising interventions.
 
‘Smoking status should be regularly reviewed and all patients offered help to quit. There are many missed opportunities when smoking is not addressed,’ he said.
 
‘It is important to use the most optimal treatment to get the best results. The most effective treatment is a combination of counselling and support with pharmacotherapies. The most effective pharmacotherapies are combination nicotine replacement therapy (NRT) and varenicline.’
 
Associate Professor Mendelsohn suggests GPs and other healthcare professionals could benefit from more support to help patients quit smoking.
 
‘GPs and other health professionals get minimal training in tobacco treatment, especially as smoking is the leading cause of preventable death and disease in Australia,’ he said.
 
‘Australia needs to upskill ... we also need smoking clinics with trained staff in every hospital and community health service.’
 
On a wider scale, Associate Professor Mendelsohn suggests raising the legal minimum age for smoking to 21 could help push smoking rates lower, while mass media campaigns and the funding of combination NRT should also be considered.
 
‘There have been no national mass media anti-smoking campaigns since 2012. These campaigns motivate quit attempts and have been shown to be effective and cost effective,’ he said.
 
‘The government collects $17 billion per year from smokers, but spends only a tiny fraction of this on tobacco control and treatments … one of the most effective treatments for smoking is to pay smokers for quitting. This is also cost-effective and often works where other treatments fail. It should be implemented in Australia.
 
‘Combination NRT, such as patch and gum, lozenge, spray or inhalator, is the most effective form of NRT. However, the Pharmaceutical Benefits Scheme (PBS) only funds the patch.
 
‘Approval has been granted for funding of gum and lozenge; however, the combination is not funded, so patients must purchase one. This is a financial barrier for many smokers. NRT could be provided free to low-income smokers.’
 
Associate Professor Mendelsohn, who also chairs the Australian Tobacco Harm Reduction Association (ATHRA), said many patients are unable to quit in spite of best practice care and believes GPs should consider tobacco harm reduction in these patients.
 
‘Vaping is a far safer alternative to smoking which carries only a small fraction of the risk of smoking. Vaping delivers the nicotine smokers are addicted to and simulates the hand-to-mouth, sensory and social aspects of the smoking ritual,’ he said.
 
‘Vaping is the most popular quitting aid globally and a recent high quality randomised controlled trial found that it was twice as effective as combination NRT.’
 
However, Chair of the RACGP’s Smoking Cessation Guideline Group, Dr Nick Zwar, has previously told newsGP allowing widespread consumption of e-cigarettes could open a ‘Pandora’s Box’ of new harms.
 
‘The long-term health impacts are just not known … there are also risks around the uptake of e-cigarettes by non-smokers, which is a pretty major concern in the United States,’ he said.
 
‘The cautious approach in Australia has been strongly criticised by some people, but it might well be that in a couple of years’ time the cautious approach turns out to have been very wise.’
 
He also said the growing evidence of e-cigarettes’ effectiveness as a smoking cessation tool should be balanced against the need to limit any kind of nicotine consumption.
 
A recent US Centers for Disease Control and Prevention (CDC) Vital Signs report recorded a ‘surge’ in e-cigarette use among high school students over the preceding 12 months.
 
The RACGP’s updated Supporting smoking cessation: A guide for health professionals is due for release later this year.

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