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Paying for nicotine replacement is poor use of public funds, says study

Governments like British Columbia's that pay for nicotine replacement therapies may be wasting their money, says a study released today.

"This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts," said a summary of the study by Harvard School of Public Health researchers Hillel Alpert and Gregory Connolly and University of Massachusetts researcher Lois Biene.

The study followed 787 adults in Massachusetts who had recently quit smoking. Each time the researchers checked in on the people in the study, nearly a third had relapsed. People who had used NRTs such as the patch or nicotine gum while quitting were just as likely to have relapsed as people who had not.

Among heavy smokers, people who had used NRTs but not received counseling were most likely to start smoking again.

British Columbia began paying for NRTs, as well as pharmaceuticals billed as quit smoking aids, in 2011 following a leadership campaign promise by Premier Christy Clark. The program was to cost between $15 and $25 million depending how many people used it, the May announcement said.

A December, 2011, press release noted that since the smoking cessation program was implemented in September, some 60,000 orders for the patch and gum have been filled.

"Funding ineffective services that aim to change individual behaviour may be resulting in the loss of scarce resources from public health programmes that have proven to be effective in changing social norms and reducing smoking," today's report said. Mass media counter-marketing campaigns, comprehensive smoke-free laws, higher prices for tobacco and restricted advertising are examples of more effective ways to prevent smoking, it said.

"We are aware of the study and will read it along with other research material to best inform how we support British Columbians who want to quit," B.C. health ministry spokesperson Ryan Jabs said in an email.

The ministry tries to offer various options to help people quit smoking, including counseling, NRTs and prescription drugs, he said. "In providing these options for smokers we consulted with stakeholders and quit experts in the health care system (within and outside of government), to ensure we had a broad number of perspectives to inform the program."

The ministry also based its decision on clinical studies that support using the therapies, he said. There are plans to review the program on an ongoing basis, he added. "We always want to make sure we are offering the most cost effective and evidence informed program."

Health researcher Alan Cassels said the study should cause the government to rethink its anti-smoking program. "It is another nail in the coffin of the whole policy," he said. Paying for anti smoking drugs, one of which was pulled from the market last year in France, was already questionable, he said.

Funding the NRTs was less controversial, but the government needs to take another look, he said. "Now we find out it doesn't work either."

It's significant that the study was funded by the American National Cancer Institute, not by the manufacturer of any anti-smoking products, he said. "You have to put a lot more credence in the independent research."

Andrew MacLeod is The Tyee’s Legislative Bureau Chief in Victoria. Reach him here.

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