ASH Daily News for 10 November 2009

Cigarette vending machine ban moves closer

CORRECTION: Contrary to what was reported in The Publican, the amendments were moved by Frederick Curzon, Earl Howe, Shadow Minister for Health and not Lord Geoffrey Howe of Aberavon, former chancellor of the Exchequer.

The removal of cigarette vending machines from pubs moved a step closer after the House of Lords rejected a bid to stop the plans. 

In a vote yesterday 170 peers voted against an amendment proposed by former Chancellor of the Exchequer Lord Howe against a complete ban, with 82 in favour of his plan to provide better regulation to prevent underage sales.

During the debate Howe argued that a complete ban will hit pubs and other small businesses hard. He added it could also result in 650 people who are directly employed in the vending machine industry losing their jobs.

Instead he called for better regulation and the use of improved technology to prevent underage sales.

“There is a proportionate and workable course of action open to Parliament in pursuing its wish to bear down on underage access to vending machines. That is to allow the government to lay regulations designed to ensure that such access does not occur, while at the same time allowing legitimate adult smokers to purchase cigarettes from vending machines as they wish.”

“We know that there is technology available and in use that would enable that to happen,” he said.

Others in favour of the amendment argued that a ban on machines will lead to greater sales of counterfeit cigarettes.

However other members of the House raised concerns about ease of access to cigarettes via machines by youngsters.

Baroness Thornton said: “We are sympathetic to small businesses that will be affected by the legislation to prohibit tobacco vending machines, but we are also concerned about how easily young people can get tobacco from vending machines.”

MPs in the House of Commons have already approved the plans.

Source: The Publican, 10 November 2009
Link: http://tinyurl.com/ybw9c3g

Reynolds in talks to buy maker of smoking-cessation products

Tobacco giant Reynolds American Inc. is in talks to buy a Swedish maker of products that help people stop smoking, a move that could signal a profound shift in direction in the global tobacco industry.

Reynolds, the second-largest U.S. cigarette maker by sales, is near a deal to buy closely held Niconovum AB, according to David Sweanor, a Canadian law professor and tobacco expert.

Niconovum, based in Helsingborg, makes nicotine-replacement therapies such as Zonnic pouch and Zonnic gum. The company, whose products aren't currently sold in the U.S., was formed in 2000 by Karl Olov Fagerstrom, a leading expert in nicotine dependence who has been involved in such products as Nicorette gum.

Mr. Fagerstrom, who has a small stake in Niconovum, didn't return phone calls seeking comment. A spokesman for Reynolds, based in Winston-Salem, N.C., declined to comment.

The potential deal would mark the latest and most dramatic move by Reynolds into nicotine products that represent alternatives to cigarettes. Sales of cigarettes in the U.S. have been declining for years, prompting Reynolds to move into products that studies have shown present much smaller health risks than cigarettes.

Reynolds, for example, sells a number of smokeless-tobacco products, including Camel Snus, a type of spit-free tobacco that satisfies nicotine cravings but exposes users to less risk than does smoking.

Britain's Royal College of Physicians, which sets health standards in the U.K., has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the product.

Reynolds and other tobacco companies, including U.S. industry leader Altria Group Inc., have owned pharmaceutical businesses, but none yet market or sell an approved smoking-cessation product.

Mr. Sweanor said the deal could be valued at €30 million ($44.5 million).

Source: Wall Street Journal, 09 November 2009
Link: http://tinyurl.com/ykk9pva

USA: Advocates call for treating tobacco dependence in psychiatric patients

Smoking cessation services should be integrated into substance use disorder treatment programs, according to David Kalman, MD, Department of Psychiatry, University of Massachusetts, and colleagues, in their recent review of tobacco dependency among patients who sought treatment for alcoholism.

“Clearly there exist many barriers to simultaneous treatment of tobacco dependence and other substance use disorders,” the investigators observe. “However, most alcoholics in treatment are concerned about their smoking and the preponderance of evidence indicates that trying to quit during substance use disorder treatment does not interfere with sobriety and, in fact, appears to be associated with better alcohol and other drug use outcomes.”

Kalman and colleagues are among a growing number of clinicians and researchers calling for the recognition of (and interventions for) tobacco dependence as a common comorbidity with other substance use and psychiatric disorders. Brian Hitsman, PhD, Northwestern University, Chicago, and colleagues published their review of evidence-based interventions for tobacco dependence in persons with mental health or addictive disorders a few months earlier, finding several psychological and pharmacological interventions supported by clinical data.2 They indicate that interventions to stop smoking should be offered along with treatments for psychiatric and substance use disorders to not only mitigate the health issues of tobacco but to improve mental health treatment outcomes.

“Treatment efficacy could be enhanced through promoting smoking reduction as an initial treatment goal,” Hitsman and colleagues propose, “extending duration of treatment, and delivering it within an integrated care model that also aims to reduce the availability of tobacco in mental health and addictive disorder treatment settings and in the community.”

An NIMH report published in December 2008, “Tobacco Use and Cessation in Psychiatric Disorders,” for which Hitsman was a coauthor, documented an exceptionally high rate of smoking among psychiatric patients. The report considers possible biological, psychological, and social factors for this, including the lack of smoking cessation treatments available in mental health settings. The NIMH report notes that “self-medication” and “individual rights” have historically been concerns used to rationalize continued tobacco use in mental health treatment programs. The report rejects these as reasons for not offering effective treatment to psychiatric patients who have tobacco dependence and criticizes the extent to which tobacco use may have been accepted to “self-medicate.”

“Although research has shown that tobacco use can reduce or ameliorate certain psychiatric symptoms,” the NIMH report indicates, “overreliance on the self-medication hypothesis to explain the high rates of tobacco use in psychiatric populations may result in inadequate attention to other potential explanations for this addictive behavior among those with mental disorders.”

In their review of treatment studies for tobacco dependence co-occurring with psychiatric disorders, Hitsman and colleagues describe two trials in patients with schizophrenia and schizoaffective disorders as “especially noteworthy.” Both studies combined bupropion, nicotine replacement (eg, patch, gum), and cognitive-behavioral therapy. In each, the active treatment was associated with significantly higher rates of abstinence than placebo at follow-up, in 6 months with one study and in 3 months with the other.

In considering patients with mood disorders, Hitsman and colleagues found substantially more studies of tobacco dependence in patients with depression than with bipolar disorder. They welcome a recent increase in studies of the latter, however, because it is reported that 60% of patients with bipolar disorder smoke.

Bupropion is commonly used in treatment combinations for patients who have depression, with encouraging results, and Hitsman and colleagues characterize the early indications of effectiveness of such regimens for patients with bipolar disorder as “promising.” They recommend extending the course of psychological and pharmacological treatment in patients with mood disorders, “because it allows repeated quit attempts that are often necessary before sustained abstinence can be achieved.”

A variety of treatment regimens for tobacco dependence have been used in patients with addictive disorders, a population with a particularly high prevalence of smoking. Hitsman and colleagues consider the major unresolved treatment issue for this population to be whether smoking cessation treatment should be provided concurrently with treatment for the substance use disorder or delayed until after its successful remission. Hitsman and colleagues are in agreement with Kalman’s group in preferring concurrent treatment.

“Evidence indicates,” they conclude, “that concurrent treatment of tobacco dependence in the context of substance use disorder treatment can be efficacious and does not have a significant adverse influence on substance use disorder treatment outcomes.”

A new study assesses the effects of naltrexone and topiramate on tobacco use among alcohol-dependent outpatients.4 Naltrexone has been approved for the treatment of alcoholism and topiramate is being studied for that possible application. Danilo Baltieri, MD, Department of Psychiatry, University of São Paulo, Brazil, and colleagues sought to determine whether these agents could also reduce the number of cigarettes smoked over a 12-week period. In addition, the researchers compared alcohol treatment outcomes between the smokers and nonsmokers in the study cohort.

After a 1-week detoxification period, 155 patients were randomized to receive naltrexone 50 mg daily, topiramate up to 300 mg daily, or placebo. The researchers found no significant differences between the naltrexone and placebo group or between naltrexone and topiramate. Topiramate in comparison to placebo, however, was associated with a significantly greater reduction in the number of cigarettes. Adverse effects from both medications were rated as mild or moderate, and all resolved without specific medical intervention. The researchers also determined that continued smoking increased the odds of relapse into drinking by 65%, independent of the medications prescribed.

For this difficult comorbidity of tobacco dependence and alcoholism, Baltieri and colleagues suggest that topiramate could be a useful option for the treatment of alcoholics who smoke, “even if they do not wish to stop both substances at the same time.”

“At least,” they add, “health professionals should explore the option of dual cessation with their patients and, if possible, provide adequate and effective treatment for both conditions.”

Source: Psychiatric Times, 07 November 2009
Link: http://tinyurl.com/ycx67z8

Japan: Men's smoking rate at record-low 36.8%

The smoking rate among men in Japan has fallen to a record-low 36.8% since the survey of its kind was launched in 1986, while the rate among women stood at 9.1%, dropping below 10% for the first time since 2001, the Health, Labor and Welfare Ministry said. The rate among the men and women in total was 21.8% in the survey conducted a year ago, down 5.9 percentage points in five years.

The percentage of smokers who want to quit smoking was 28.5% for men and 37.4% for women. The ministry attributed the smoking rate decrease to rising health consciousness and introduction of ‘‘taspo’’ smart cards in July last year, which are only issued to people aged 20 or older and enable holders to buy cigarettes at vending machines.

Source: Japan Today, 10 November 2009
Link: http://tinyurl.com/ykrgve7