Treating Tobacco Use and Dependence
A Public Health Service Clinical Practice Guideline

Michael C. Fiore, M.D., M.P.H., Director, Associate Professor, Center for Tobacco Research and Intervention, University of Wisconsin Medical School

Press Briefing, HHS Auditorium, Washington, D.C. June 27, 2000

Good morning. I am pleased to share with you information that can greatly improve the health of millions of Americans—the recommendations of a new Public Health Service-sponsored Guideline, "Treating Tobacco Use and Dependence." I would like to give some context to this new Guideline. Approximately 20 million Americans will try to quit this year. That is one-third of all smokers in the United States. Regrettably, most of them will try to quit on their own or, in other words, "cold turkey." As a result, only one million of them will be able to quit and stay tobacco-free.

The treatment recommendations outlined in the PHS Guideline that we are releasing today will substantially increase the success rate. In fact, if every doctor, nurse, dentist, or other health care provider and health plan uses this tool in practice across America, we can double quit rates, from one to at least two million new quitters each year. The impact of an extra one million quitters will quickly translate into improvements in health, freeing them from an addiction that dictates how they live, and in many instances, how they die. These improvements will touch families across America.

There is no other public health or clinical intervention available that holds such promise. This Guideline promises to decrease the enormous burden of illness, death, and economic costs that result from tobacco addiction in our society.

It is difficult to identify a condition in the United States that presents such a horrific mix of lethality, prevalence, and neglect, despite effective and readily available interventions. Tobacco use is that condition.

The climate for treating tobacco dependence has tremendously improved over the last decade. This evidence-based Guideline takes the science, and in a practical way, translates it into cessation treatments that work. The expert panel that prepared this report concluded that-first, we need to call tobacco dependence what it is—a chronic disease, not unlike high blood pressure or diabetes. This recognition provides clinicians with a model for helping their patients quit.

So what is new since we released the original Smoking Cessation Clinical Practice Guideline in 1996? The new PHS Guideline provides information on innovative counseling strategies that work, including telephone counseling, and other techniques. It also contains evidence-based information about the effectiveness of new medicines that were not approved by the Food and Drug Administration when the original Guideline was issued and urges that every tobacco user who is motivated to quit be provided with one of these medicines in the absence of contraindications. Finally, the PHS Guideline now covers all forms of tobacco use, including smokeless tobacco—snuff and chew; and cigars and pipes.

Here are some of the key results:

• Effective cessation treatments are now available and every patient who uses tobacco should be offered these treatments. If a tobacco user is willing to try to quit, he or she should be provided treatments identified as effective in the PHS Guideline.

What are these treatments?

• To begin with, we identified five first-line medications that reliably increase long-term quit rates. Only two of them, the nicotine patch and nicotine gum were recommended in 1996. The new medications include the nicotine inhaler, the nicotine nasal spray, and the non-nicotine pill, bupropion.
• Next, advice and counseling work. The Guideline offers even stronger evidence of the association between the intensity of counseling and successfully quitting. In general, the more intense the counseling, the more effective the treatment. Telephone counseling, problem solving and skills training, and help in securing social support both inside and outside of the standard treatment settings are also very effective.
• Next, we challenge health plans to pay for tobacco cessation treatments in the same way they pay for the treatment of other chronic diseases such as high blood pressure or diabetes. The evidence lends even greater support to the fact that tobacco dependence treatments are both clinically effective and highly cost-effective relative to other medical and disease prevention interventions. This information strengthens the Guidelines' argument that insurers and purchasers should ensure that all tobacco users have both access to, and coverage of these services. What an unfortunate paradox, that virtually every insurance plan in America pays for the devastating and expensive health outcomes related to tobacco use such as heart attack, stroke, and cancer, but less than half of these plans pay the $200 to $400 that it costs to prevent those outcomes by helping their enrollees to quit.
• The Guideline also recommends that clinicians be reimbursed for providing tobacco dependence treatment just as they would be for other chronic conditions.

Finally, with the release of this new Public Health Service Guideline, we have a real opportunity to improve public health. Most importantly, as a result of this release, the great majority of tobacco users in America who want to break free of their tobacco dependence, will have a greater chance of success.

Any one of us who has ever smoked, or has witnessed a loved one addicted to this drug, recognizes that quitting tobacco use is among the most difficult challenges he or she will ever face. To quit requires both hard work and commitment. In this high-tech society, no magic bullet exists that will automatically transform a tobacco user into a non-tobacco user. But, the findings released today offer tobacco users their greatest hope of taking a determination to quit and translating it into a lifetime free of tobacco use—and in that way, rediscovering the wonderful gift of "life" for themselves and their loved ones.

Thank you.

Internet Citation:

Treating Tobacco Use and Dependence: A Public Health Service Clinical Practice Guideline. Press Briefing by Michael C. Fiore, , M.D., M.P.H., Director, Associate Professor, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, June 27, 2000. U.S. Public Health Service. http://www.surgeongeneral.gov/tobacco/mf062700.htm

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