The We CAN Program (Communities Accessing all-types of Nicotine Replacement Therapy) aims to reduce smoking among people utilising specialist alcohol and other drug (AOD) non- government services by providing subsidised access to all types of nicotine replacement therapy (NRT) e.g. patches, gum, lozenges, spray, inhalator. AOD workers provide a voucher to service users that is redeemable at a partnering community pharmacy for a full course (8 – 12 weeks) of all types of NRT. Service users concurrently receive smoking cessation support through the AOD workers and/or the pharmacies.
The Program enables best practice nicotine dependence treatment to be delivered to this population with extremely high smoking rates, and for this treatment to be implemented as part of routine AOD treatment and support within specialist AOD services. The Program:
- targets a priority population with very high smoking rates—i.e. people who access specialist AOD services;
- takes a settings-based approach, (i.e. delivering the Program in non-government specialist AOD services);
- enables delivery of best practice nicotine dependence treatment—full courses of combination NRT, complemented by specialist smoking cessation support
- is implemented as part of routine AOD treatment and support—thereby increasing smoking cessation, and improving AOD treatment outcomes
- leverages and enhances specialist AOD services’ treatment and support expertise— including organisational tobacco management policies, and a trained workforce
- leverages on existing smoking cessation training and resources through ACT community pharmacies
- leverages ACT Health and the Commonwealth’s existing specialist AOD treatment and support investment
The We CAN Program continues to be delivered in eight specialist AOD NGO services, including all residential services. Operating data from the Program shows a potentially high rate of quit attempts—the majority of participating service users provided with a NRT voucher follow through on redeeming these at the community pharmacies. Many of these service users are accessing sufficient NRT to make a quality quit attempt, particularly as indicated by the amount of NRT purchased and whether they purchased a combination of patches and intermittent forms of NRT. All participating service users also received smoking cessation support from a specialist AOD treatment and support worker and/or a pharmacist or pharmacy worker.
The We CAN Program has demonstrated that people accessing specialist AOD services want to engage in smoking cessation. Best practice care, which includes full courses of subsidised NRT, should be provided as core business. ATODA continues to advocate for further funding to be provided for the community to access subsidised NRT to meet demand.
- National data identifies high smoking rates among people accessing drug treatment services (ANPHA 2013), and anecdotally workers in the alcohol and other drug (AOD) sector in the Australian Capital Territory (ACT) report smoking rates among service users of between 80–100%.
- People experiencing disadvantage often want to quit (or reduce) smoking, and can do so with the right support.
- Nicotine replacement therapy (NRT) is recognised as an effective tool to aid smoking cessation and reduction (Cahill et al 2013), and there is evidence of better outcomes for people experiencing disadvantage when NRT is provided free of charge (Hartmann-Boyce et al 2013). Using any form of NRT makes it more likely that a person’s attempt to quit smoking will be successful (Stead et al 2012).
- Best practice in NRT use includes:
- providing 8–12 weeks worth of NRT as a course (Stead et al 2012)
- using combination therapy that combines patches with an intermittent form of NRT (e.g. gum, strips, inhalator, lozenges, spray) (Stead et al 2012)
- offering comprehensive multi-session counseling and support (Zwar et al 2011)
- All forms of NRT are available over-the-counter at community pharmacies.
- Access to affordable NRT is limited to patches through the Pharmaceutical Benefits Scheme (PBS), and only with a prescription (see PBS website)
- For many smokers who access AOD services:
- intermittent (and therefore un-subsidised) forms of NRT are unaffordable
- low levels of contact with general health services means low access to scripts for NRT patches
- AOD workers have identified lack of access to affordable nicotine replacement therapy (NRT) as a significant barrier to smoking cessation for service users.
- Limited access to subsidised NRT is available to service users of the government AOD service, but was not, until now, available through AOD NGOs.
- Workers at AOD NGOs screen service users for nicotine dependence and assess their suitability to use NRT to quit or reduce smoking.
- If eligible (aged over 12, nicotine dependent), service users are offered the option of participating in the Program, and are provided with a voucher with a unique identifier.
- The service user attends the local community pharmacy and presents the voucher to the pharmacist or his/her staff.
- The pharmacy establishes an account for the service user that enables him/her to access 8–12 weeks worth of any types of NRT (patches, gum, inhalator, lozenge, spray, strips) over multiple visits.
- The service user receives smoking cessation advice from both the AOD worker, and from the pharmacy, including on the most appropriate NRT for their needs.
The Program is evidence based and has broad and strong support from:
The AOD sector
- The Program was initiated by the ACT ATOD Worker’s Group and has been endorsed by Executive Directors of AOD services.
- There is widespread support from front-line workers to implement and evaluate the Program.
- Pharmacies in the ACT are keen to strengthen collaborative relationships with the AOD sector.
- Community pharmacies are engaged with smoking cessation activities, including through the ACT Pharmacy Guild Smoking Cessation Project
- The ACT Government is committed to evidence based drug policy, and to funding, supporting and expanding the Program
- The We CAN Program builds on the Under 10% Project that has developed capacity within health and community services to prioritise and better manage tobacco, including:
- Implementing organisational tobacco management policies and procedures
- Supporting the workforce to quit or reduce smoking, including by providing subsidised NRT
- Smoking cessation training for workers
The We CAN Program is being independently evaluated by LeeJenn through the collection of operational data and surveys with participating service users, and workers in AOD NGOs and pharmacies. During the first 12-months of its implementation, workers at specialist ATOD NGOs will invite service users to participate in surveys to assess the success of the Program. Workers and pharmacy staff will also be asked to be part of the evaluation by participating in an online survey and giving feedback at meetings facilitated by ATODA.
Australian National Preventive Health Agency (ANPHA). (2013). Smoking and Disadvantage. Evidence Brief. Prepared by the Cancer Council Victoria for the Australian National Preventive Health Agency. Canberra:ANPHA.
Cahill, K., Stevens, R. Perera and T. Lancaster. (2013). Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews, 2013; DOI: 10.1002/14651858.CD009329.pub2.
Hartmann-Boyce, J., L. F. Stead, K. Cahill and T. Lancaster. Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews. Addiction, 2013; 108(10): 1711-1721.
Stead, L.F., Perera, R., Bullen, C., Mant, D., Hartmann-Boyce, J., Cahill, K. and Lancaster, T. (2012) ‘Nicotine replacement therapy for smoking cessation’. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD000146.pub4.
Zwar, N., Richmond, R., Borland, R., Peters, M., Litt, J., Bell, J., Caldwell, B. and Ferretter, I. (2011). Supporting smoking cessation: a guide for health professionals. Melbourne:The Royal Australian College of General Practitioners.