From 2005 to 2019, nearly 98% of smokers—including those with and without serious mental illness (SMI)—were not prescribed treatments for tobacco use disorder, according to a study published yesterday in Psychiatric Services.
“Pharmacotherapy is safe and effective for smokers with mental illness, and evidence shows that these medications improve outcomes without worsening psychiatric symptoms,” wrote Sarah White, M.S.P.H., of Johns Hopkins Bloomberg School of Public Health, Karly Murphy, M.D., M.H.S., of Johns Hopkins School of Medicine, and colleagues. “However, estimates indicate that only 25% of specialty mental health treatment facilities offer [nicotine replacement therapy] and 21% offer non-nicotine cessation medications.”
White, Murphy, and colleagues analyzed Medical Expenditure Panel Survey (MEPS) data from 2005 to 2019 to examine how often individuals with and without any mental illness received smoking cessation medications, including varenicline, bupropion, and nicotine replacement therapy (NRT). The data included medical conditions, smoking status, prescribed medicines, inpatient and outpatient services, and office-based visits for individuals aged 18 and older. Participants were divided into groups based on their smoking status and presence of mental illness, including SMI (defined as a diagnosis of schizophrenia, bipolar disorder, or major depressive disorder).
The MEPS data included 55,662 smokers: 18,353 individuals had mental illness (7,421 of whom had SMI), and 37,309 did not have mental illness. From 2005 to 2019, the proportion of smokers with or without any mental illness who were prescribed any of the three cessation medications never exceeded 17%. There was a slight increase in smoking cessation prescriptions among smokers with SMI during the study period, rising from 0.3% in 2006 to 2.4% in 2019 for varenicline; 0.4% in 2005 to 1.6% in 2016 for NRT; and 8% in 2005 to 16.7% in 2019 for bupropion.
The authors also conducted interviews with 20 general internists and 20 psychiatrists in October and November 2017. Interviewees were asked about cessation treatment practices and barriers and facilitators to help people with mental illness stop smoking. Eighty-five percent reported routinely screening their patients’ smoking status, and 95% also reported offering smoking cessation medication, though only 58% offered counseling for smoking cessation. Three barriers to smoking cessation treatment were consistently cited: patients’ perception that tobacco is a helpful coping mechanism, patients’ unwillingness to engage in cessation practices, and an inability to use certain medications due to previous negative side effects or interactions with psychotropic medications.
“Low rates of delivery of guideline-concordant treatment for tobacco use disorder to people with serious mental illness are of particular concern given the high prevalence of tobacco smoking, adverse social determinants of health, and the 25- to 30-year mortality gap (vs. people without mental illness) among individuals in this population,” Eden Evins, M.D., M.P.H., and Corinne Cather, Ph.D., of Harvard Medical School wrote in an accompanying commentary. “System- and provider-level strategies to incorporate evidence-based smoking cessation treatment into standard workflows are needed to increase delivery of smoking cessation medication to people with and people without mental illness who are addicted to smoked nicotine.”
For related information, see the Psychiatric News article “Psychiatrists Can Do More to Help Patients Quit Smoking.”
(Image: iStock/Altayb)
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