We CAN Project—Communities Accessing all-types of Nicotine Replacement Therapy

• 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.

Community Pharmacies

• 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 

ACT Government

• 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.