How policymakers can help smokers quit now
On a trip to the supermarket these days you’ll be hard pressed to find canned food, toilet paper or hand sanitizer on the shelves. But if you swing by the pharmacy department, there’ll be plenty of nicotine patches and gum gathering dust.
Despite growing concern about a link between nicotine use and more severe coronavirus infections, cigarette and vaping sales are booming. Smokers find nicotine use relaxing (even though stress actually decreases after quitting), so it’s no surprise that many of America’s 38+ million smokers are panic buying now. However, this shouldn’t deter policymakers from helping them quit. If even a modest number do, their lives could be saved and countless ICU beds could be freed up for others.
Most smokers want to quit, and more than half have tried in the last year. However, less than a third have used counseling, nicotine replacement products or medications such as varenicline and bupropion to help them do so. That’s a shame, because these treatments dramatically increase odds of success.
Cost prevents many smokers from using effective treatments to quit. When they have better insurance coverage for these treatments they’re much more likely to take advantage of them and quit smoking.
As an addiction specialist, I’m constantly disappointed by how difficult insurers make it for smokers to quit. I’ve seen countless quit attempts stopped in their tracks due to poor insurance coverage. Though smoking causes serious health problems such as lung cancer, Americans switch insurers so frequently there’s no long term financial incentive for them to cover the costs of quitting.
Federal law requires many insurers to cover cessation treatments, but they often severely restrict access through co-payment requirements, limits on treatment duration, limits on the dollars of coverage provided and require patients to be in counseling before they can access medication options.
Step therapy requirements, which force patients to try treatments in a particular order — even if it’s against their provider’s recommendation — are another significant problem. So are ubiquitous and time consuming prior authorization requirements, which demand that doctors seek permission for coverage from insurers before prescribing. If we want to reduce smoking quickly, the last thing we need is for doctors to be spending an hour on the phone for each patient they’re trying to help stop.
Due to widespread job losses, more and more Americans will soon be relying on Medicaid for their health insurance coverage. This doesn’t bode well for smoking cessation efforts. Though current Medicaid enrollees smoke at a rate twice as high as privately insured patients, they receive particularly poor smoking cessation coverage. For example, 39 state programs still use medication prior authorizations to deter physicians from helping patients quit. Only 15 state programs cover all of the available smoking cessation treatment options, and among those “progressive programs” 13 still use at least one of the barriers discussed above to limit access.
Long before coronavirus, other countries recognized the significant long term savings to be reaped by providing cessation treatments for free. It’s a strategy the U.S. should seriously consider now. However, if our state and federal governments still can’t see the wisdom of this approach and insurers won’t improve access on their own, new legislation forcing insurers to remove treatment barriers could still help tremendously.
Increasing funding for state quitlines (1-800-QUIT-NOW) — whose coaches provide free cessation counseling online or by phone — is also essential. Despite their effectiveness, these valuable resources reach only 5 percent of smokers due to a lack of funding for promotion. Health care providers must also step up to make smokers aware of available treatment options. That’s harder than it sounds — more than 40 percent of smokers have never even been told to quit by a provider.
In our search for strategies to save lives during these trying times, we can leave no stone unturned. Soon after a smoker has stopped smoking, dramatic health improvements occur. As a result, making it easier to quit could realistically reduce coronavirus deaths over a period of months. Also, let’s not forget the benefits to children and others being exposed to secondhand smoke at home during this era of lockdowns and social distancing.
Though we’re in the midst of one of the darkest periods in modern history, by combining a broad array of strategies we can pull ourselves out of it. We’ve got the tools to help smokers quit smoking and save lives during this pandemic. Now we just have to make it easy for those who need them to get them.
Brian Barnett is an addiction psychiatrist and health services researcher in Cleveland, Ohio.