Smoking Cessation: The Urgent Need for Increased Utilization of Varenicline

Gaballa, Dianna; Drowos, Joanna; Hennekens, Charles H.

doi:10.1016/j.amjmed.2016.11.015

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…Despite the availability and proven benefits of these medications in treatment of SUDs, their utilization remains suboptimal (Gaballa, Drowos, & Hennekens, 2017;Kelly, Reilly, Quiñones, Desai, & Rosenheck, 2018;Tsui, Burt, Thiede, & Glick, 2018). A contributing barrier to greater utilization of medication-assisted treatment (MAT) in mental health clinical settings is clinicians' and programs' reluctance to include MAT in their routine practice.…”

Section: Introductionmentioning

confidence: 99%

Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians’ Confidence and Readiness to Address Substance Use Disorders

Iheanacho

Bommersbach

Fuehrlein

et al. 2020

Community Ment Health J

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Despite the availability and effectiveness of medication-assisted treatment (MAT) for substance use disorders (SUDs), utilization of these medications remains suboptimal, especially in public sector settings. A key limitation is clinicians' reluctance to include MAT in their routine practice due, in part, to low confidence about managing SUDs and limited awareness of the disease model of addiction. This study evaluates the impact of a one-day MAT training for community mental health clinicians using a 30-item pre-and post-training questionnaire. Of the 109 clinicians who attended the training, 107 completed the pre-and post-training questionnaires. Factor analysis of the questionnaire identified two domains: readiness to address SUDs among patients (factor 1) and understanding SUDs as diseases (factor 2). Post training, there was a significant change in both factor 1 (p= .00001) and factor 2 (p= .00003), indicating that a brief MAT training can increase clinicians' confidence and readiness to address SUDs and improve their understanding of the disease model of addiction.

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Section: Introductionmentioning

confidence: 99%

Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians’ Confidence and Readiness to Address Substance Use Disorders

Iheanacho

Bommersbach

Fuehrlein

et al. 2020

Community Ment Health J

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“…Despite strong evidence for efficacy of first-line pharmacotherapies for smoking cessation in those with psychotic and mood disorders, [1][2][3][4][5][6][7][8][9][10] smoking prevalence remains higher and is declining more slowly in those with mental health conditions than in the general population [11][12][13][14] , with one in 3 cigarettes in the US and UK sold to someone with a mental illness. 13,15 Despite the fact that the mortality gap, largely due to smoking-related illness, for those with a serious mental illness compared to those in the general population is large and growing, [16][17][18] pharmacotherapeutic cessation aids are underutilized in those with mental illness, arguably due at least in part to neuropsychiatric (NPS) safety concerns 13,[19][20][21][22][23][24][25][26][27] . The health benefit of smoking cessation is clear, 28,29 thus assessment of relative NPS safety and efficacy of smoking cessation pharmacotherapies in large samples of smokers with psychiatric illness is needed by clinicians, policy-makers, and patients in order to clarify their benefit-to-risk ratio.…”

Section: Introductionmentioning

confidence: 99%

Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With Psychotic, Anxiety, and Mood Disorders in the EAGLES Trial

Evins¹,

Benowitz

West

et al. 2019

J Clin Psychopharmacol

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Background-Neuropsychiatric safety and relative efficacy of varenicline, bupropion, and transdermal nicotine patch (NRT) in those with psychiatric disorders is of interest. Methods-We performed secondary analyses of safety and efficacy outcomes by psychiatric diagnosis in EAGLES, a 12-week, randomized, double-blind, triple-dummy, placebo-and active-(NRT)-controlled trial of varenicline and bupropion with 12-week follow-up, in a subset population, n=4092, with a primary psychotic (n=390), anxiety (n=792) or mood (n=2910) disorder. Primary endpoint parameters were incidence of pre-specified moderate and severe neuropsychiatric adverse events (NPSAEs) and week 9-12 continuous abstinence rates (9-12CAR). Results-The observed NPSAE incidence across treatments was 5.1-6.3% in those with a psychotic disorder, 4.6-8.0% in those with an anxiety disorder, and 4.6-6.8% in those with a mood disorder. Neither varenicline nor bupropion were associated with significantly increased NPSAEs relative to NRT or placebo in the psychiatric cohort or any psychiatric diagnostic sub-cohort.

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“…The success rate of smoking cessation can be increased by incorporating behavioral and pharmacologic interventions, such as varenicline, which can lead to permanent cessation in about 1 of 5 to 1 of 3 of participants. 22,23…”

Section: Therapeutic Lifestyle Changesmentioning

confidence: 99%

Prospects for the Primary Prevention of Myocardial Infarction and Stroke

Caldwell

Martínez

Foster

et al. 2018

J Cardiovasc Pharmacol Ther

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Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem in the United States and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity, both of which are alarmingly common in the United States, prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke as well as other clinical manifestations of CVD. Although adoption of TLCs would avoid the need for adjunctive drug therapies in many primary prevention subjects, this strategy is difficult to achieve or maintain for most and may be insufficient for many, especially those at high risk with metabolic syndrome. The criteria for metabolic syndrome, affecting over 40% of the adult population older than 40 in the United States, include overweight or obesity, dyslipidemia, hypertension, and insulin resistance, a precursor of diabetes. The adjunctive therapies of proven benefit in the primary prevention of MI and stroke include statins, blood pressure medications, aspirin, and drugs to treat insulin resistance and hyperglycemia. Fortunately, even for patients who prefer prescription of pills to proscription of harmful lifestyles, these drug therapies still have net benefits. The adoption and maintenance of TLCs and adjunctive drug therapies into clinical practice will reduce both the incidence of and mortality from a first MI and stroke as well as other major clinical manifestations of CVD.

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Smoking Cessation: The Urgent Need for Increased Utilization of Varenicline

Cited by 7 publications

References 12 publications

Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians’ Confidence and Readiness to Address Substance Use Disorders

Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians’ Confidence and Readiness to Address Substance Use Disorders

Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With Psychotic, Anxiety, and Mood Disorders in the EAGLES Trial

Prospects for the Primary Prevention of Myocardial Infarction and Stroke

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