Professional practice guidelines for pharmacists: Nicotine dependence support

Executive summary

Tobacco smoking remains the leading cause of preventable death and disability in Australia, contributing significantly to diseases such as cancer (especially lung cancer), chronic obstructive pulmonary disease (COPD) and cardiovascular disease.^1,2 Recent trends indicate a significant increase in exclusive vaping, as well as dual smoking and vaping, particularly among people under 35 years of age.² Nicotine dependence can be a chronic, relapsing condition.³ Advice from pharmacists to patients about stopping smoking helps people to stop.⁴

These guidelines are applicable to all practice settings in which pharmacists provide nicotine dependence support, including providing medicines available without a prescription. These guidelines focus on the management of nicotine dependence that may have developed as a result of smoking or vaping.

Providing support to a patient with nicotine dependence can vary based on the service delivery model of the pharmacy or health service and the education and training of the pharmacy or health service staff. Regardless of the service delivery model of the pharmacy or health service, pharmacists should offer brief advice to all people who smoke or vape.

When providing nicotine dependence support consultations, pharmacists should establish the patient’s needs and work with the patient to consider all options to develop the most appropriate management plan. Management plans should be tailored to the patient and their individual needs.

First-line pharmacotherapy options for smoking cessation include nicotine replacement therapy (NRT), bupropion and varenicline.³ Pharmacotherapy for smoking cessation can also be considered to manage nicotine dependence from vaping.⁵ Therapeutic vaping goods are not first-line pharmacotherapy for smoking or vaping cessation.³

Storing, prescribing, dispensing and compounding unapproved therapeutic vaping goods involves additional considerations relating to compliance with applicable legislation and access to therapeutic vaping substances and vaping devices.

References to legislation included in this document are current at the time of publishing.

Purpose

These guidelines describe the professional obligations of pharmacists when providing nicotine dependence support. This guidance includes (where relevant):

• appropriate and effective processes
• desired behaviour or minimum expectations of good practice
• how duties and responsibilities may best be fulfilled.

These guidelines are not definitive statements of correct procedure. They are intended to provide advice and guidance to assist pharmacists to:

• meet their professional responsibilities
• exercise professional judgement in individual circumstances
• manage risks associated with providing nicotine dependence support.

Clinical guidance specific to providing nicotine dependence support is covered in Appendix 1 Treatment guidelines for pharmacists: nicotine dependence.

It is important that pharmacists read these guidelines in conjunction with relevant professional practice standards⁶, particularly those mentioned in Table 1.