Professor Sanjay Agrawal NHSEI National Speciality Advisor for tobacco dependency NICE NG209 1121 Tell people who smoke that a range of interventions is available to help them stop smoking Explain how to access them and refer people to stopsmoking support if appropriate ID: 1043550
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1. E-cigarettes – NICE guideline (NG209) and the NHS LTPProfessor Sanjay Agrawal – NHSEI National Speciality Advisor for tobacco dependency
2. NICE (NG209)1.12.1 Tell people who smoke that a range of interventions is available to help them stop smoking. Explain how to access them and refer people to stop-smoking support if appropriate. [2021]1.12.2 Ensure the following are accessible to adults who smoke:behavioral interventions:behavioral support (individual and group)very brief advicemedicinally licensed products:bupropion nicotine replacement therapy – short and long actingvareniclinenicotine-containing e-cigarettes
3. NICE (NG209)1.12.7 Advise people that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:varenicline a combination of short-acting and long-acting NRTnicotine-containing e‑cigarettes
4. NICE (NG209)Advice on nicotine-containing e-cigarettes1.12.13 Give clear, consistent and up-to-date information about nicotine-containing e‑cigarettes to adults who are interested in using them to stop smoking [2021]1.12.14 Advise adults how to use nicotine-containing e‑cigarettes. This includes explaining that:e‑cigarettes are not licensed medicines but are regulated by the Tobacco and Related Products Regulations (2016)there is not enough evidence to know whether there are long-term harms from e‑cigarette useuse of e‑cigarettes is likely to be substantially less harmful than smokingany smoking is harmful, so people using e‑cigarettes should stop smoking tobacco completely. [2021]1.12.15 Discuss:how long the person intends to use nicotine-containing e‑cigarettes focusing them for long enough to prevent a return to smoking and how to stop using them when they are ready to do so. [2021]1.12.16 Ask adults using nicotine-containing e‑cigarettes about any side effects or safety concerns that they may experience. Report these to the MHRA Yellow Card scheme, and let people know they can report side effects directly. [2021]1.12.17 Explain to adults who choose to use nicotine-containing e‑cigarettes the importance of getting enough nicotine to overcome withdrawal symptoms, and explain how to get enough nicotine. [2021]
5. Regulation of e-cigarettesNicotine containing e-cig’sNon-nicotine containing e-cig’sGeneral product safety regulation (2005)Tobacco and related products regulation (2016) No MHRA medically licenced e-cigarette product yet – cannot be ‘prescribed’ currently
6. NHS LTP Tobacco dependence treatment programme (by 2023-24) Report outcomesIdentify (MH trust, community, GP) Opt –out treatment (MH trust, LG SSS, pharmacy) Report outcomes Identify (Primary & secondary care, community, ambulance) – lower SES groups Offer treatment (Hospital trust, SSS, pharmacy, digital) Report outcomesAcute hospital inpatientsHospital based servicesMental health hospital inpatientsPregnant women (and partners) who smokeScreen ALL patients for smokingOpt-out referral to in-house Tobacco Dependence AdvisersTreat tobacco dependence: in-house services, referral to LA smoking cessation services, community pharmacy involvementPeople with Severe Mental Illness (community)NHS staff who smokeExpanding beyond hospital
7. AdmittedScreened for smoking & dual NRT prescribedSmoking recorded electronically With automated opt-outreferral to in-house * TDABedside TDA consultation* TDA = tobacco dependency advisorApp’t with ** LG SSS set-up prior to discharge NRT on discharge meds* *Local government stop smoking service or community pharmacistDischarge home On-going pharmacotherapy& 12 weeks of behavioural support from ** LG SSS 4-week quit recorded & reported12345678Treatment pathway
8. NHS LTP Delivery Model – Mental Healthhttps://future.nhs.uk/NHSpp/view?objectId=121515749
9. Local procurement & supply ( e-voucher, vape shops, local government stop smoking services)Local practice and pathways - NHS/ local government services/ community pharmaciesHospital ‘smokefree grounds’ policiesRisk from chargersCommon themes