Support is often the most important factor for people when they’re trying to give up smoking and pharmacy teams can be on hand to help customers kick their habit

Stopping smoking is rarely easy, and many people go through several attempts before they quit for good. Unfortunately, there is no magic button to make a person’s cravings, enjoyment or addiction to nicotine disappear. However, support from the pharmacy team can make a significant difference to success or failure.

Research shows that a combination of professional support and nicotine replacement therapy (NRT) provides the greatest chance of success. But what is the best way for pharmacy teams to answer customers’ questions about quitting? And how can you remind customers that you are there to help without seeming judgmental or pushy?

What’s the best way to approach customers?

Brief face-to-face discussions have been shown to be particularly effective in helping people to quit smoking for good. According to a training video made by the National Centre for Smoking Cessation and Training, 30 seconds is all it takes “to ask, advise and act to inspire someone to stop smoking for good”. 

When approaching customers, the important thing to remember is not to push. Instead, you can remind customers that support is available when they feel ready to quit. Mentioning all of your pharmacy’s services, rather than just smoking cessation, may spark their interest without being too intrusive. 

“If you can smell smoke on a customer or see them smoking outside before they come into the pharmacy, use an open-ended statement to encourage them to quit, rather than one with a yes/no answer, as most people will say no,” says Sultan ‘Sid’ Dajani, independent community pharmacist and member of the Royal Pharmaceutical Society’s English Pharmacy Board. “For example, rather than asking ‘Would you like smoking cessation advice?’, try ‘If you have ever thought of giving up smoking or would like to, we can offer a smoking cessation service, NRT and a carbon monoxide test.’ Then you’re leaving it up to them to take the next step.”

Are there any particular target groups?

According to an annual report (published in December 2016)from Professor Dame Sally Davies, England’s chief medical officer, adults aged 50-69 need the greatest amount of support when it comes to quitting. However, the report notes that among current and ex-smokers, 66 per cent of men and 71 per cent of women in this age group have never been advised to stop smoking by a doctor or nurse. Pregnant women and people with mental health problems are also important target groups. 

“You can target specific customers by looking at what medication they are taking,” says Sid. “Some mental health issues, including anxiety and stress, could be making them more likely to smoke and less likely to want to quit. Put adverts in GP surgeries about the pharmacy services you offer, as quite a few surgeries have stopped their smoking cessation clinics.”

What’s the best way to motivate customers?

Most people know smoking is bad for them, but many longer-term smokers see smoking as their lifestyle choice and quitting as something they will do ‘one day’ in the future. 

Sid suggests finding out what each customer’s motivational trigger is. “It’s not just about discussing the science of smoking, as giving up is often an emotion-led decision,” he says. “A person may decide to give up because of the effects of smoking on their children, grandchildren or a pregnancy, for example, or it may be for financial or health reasons. A pre-quit consultation is important in building up a good rapport and creating realistic expectations. Help them set a quit date and stick with it. They shouldn’t smoke at all from that date and need to adjust to life without smoking straight away. 

“Once a customer shows an interest in quitting, offer a free carbon monoxide test. A carbon monoxide reading can be a wake-up call as it shows people how bad their health is because of their smoking habit. This is definitely a worthwhile first step towards encouraging them to quit,” Sid adds.

How can I offer regular support?

Any advice given needs to be tailored to the needs and lifestyle of every customer, and follow-up support and encouragement is essential. The pharmacy should aim to see customers on a weekly basis, at least to start with. They can then switch to coming in every few weeks, but this should be at a set time and with regular intervals between appointments. 

Many people find that nicotine withdrawal symptoms are the main barrier to quitting smoking, so customers should be told what to expect. You should also offer reassurance that there are many ways to keep these cravings at bay. For instance, stop smoking medicines such as varenicline and bupropion, or NRT, are useful management tools. Customers will need to decide on the best method for them, possibly with the help of a GP or pharmacist, but you can offer self care tips, such as:

• Keep the mouth busy with things like chewing gum or hard sweets
• Change a usual routine that would normally involve a cigarette
• Visit places where smoking isn’t allowed (e.g. the cinema or a shopping centre)
• Go for a walk or a jog
• Take slow, deep breaths every time a craving strikes. 

Which NRT product is most effective?

No single NRT product is better than any other. The best one is the one that suits an individual customer’s needs, in terms of their smoking habits and other lifestyle choices. It is important that customers stick with their NRT choice, as a full course can last for up to 12 weeks.

“Discuss the pros and cons of the different forms of medication, including side effects,” says Sid. “Describe each form of NRT and show the customer each device and how it works, with a practical demonstration. Let them touch the NRT devices, try them out and get a feel for them so they know that they are comfortable with them before they start. Some people worry that they will become addicted to NRT, but the main problem is actually that people don’t use their NRT for long enough, which leads to a relapse. They shouldn’t give up too soon if the NRT appears to be working.” 

How can I help customers choose the right NRT?

There are many different NRT products for smoking cessation available over the counter, so it is important that customers are given advice at point of sale. Not all products will be suitable for every customer and they can cause side effects, so careful consideration is needed. Some people use a combination of products, such as nicotine patches to reduce everyday cravings and an inhalator or nasal spray to reduce sudden cravings. 

“The smoking cessation category can be difficult to shop, with lots of different brands and formats,” says Niamh McMillan, clinical development manager at Superdrug. “The section should be clearly labelled and a team member should be on hand to offer help and advice and talk through the different formats.”

The following tips can help customers with different needs:

• Customers who smoke more than 20 cigarettes a day: Those who are strongly addicted to nicotine may benefit from the higher dose (4mg) gum. The 2mg gum is suitable for people who smoke 20 or less a day. However, some people don’t like the taste of nicotine gum or the feeling of always having something in their mouth
• Customers looking for discretion: Nicotine patches can be worn easily under clothing. They are suitable for regular smokers and can be worn all day or during waking hours (16 hours a day). The 24-hour patches may cause sleep problems, but they help with early morning cravings. Some people find that NRT patches cause skin irritation. An alternative discreet method of NRT is microtabs, which are tiny tablets that dissolve under the tongue
• Customers who want something easy to use: Lozenges dissolve under the tongue and are helpful because they provide short bursts of nicotine. They shouldn’t be used by people with mouth ulcers
• Customers who like the ‘hand-to-mouth’ action of smoking: The nicotine inhaler resembles a plastic cigarette and is used in a similar way too
• Customers who are prone to cravings: Nasal sprays and inhalators work quickly, mimicking the ‘rush’ people get from smoking more closely than other forms of NRT. 

Should I tell customers about e-cigarettes?

The use of e-cigarettes is now widespread. These devices provide a nicotine dose without most of the harmful effects of smoking, and Public Health England has backed their use in its “Stoptober” campaign for the last two years. However, since no e-cigarettes are yet licensed as medicines in the UK, they can’t be prescribed as part of a stop smoking programme and many pharmacies don’t stock them. 

A study in the British Medical Journal (BMJ) in September 2016 revealed that changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. University College London senior research fellow Emma Beard, one of the authors of the study, says that knowing about these products is essential so that pharmacists can give comprehensive advice about their use.

“I don’t stock e-cigarettes, but I support their use,” says Sid. “The risks of smoking are greater than the risks of using e-cigarettes, but they should be used as part of NRT or a smoking cessation programme. Customers should be aware that they need to give up e-cigarettes at some point as well.”

How can I help customers through a relapse?

Many quitters succumb to cigarettes at least once and it may take them a few quit attempts to succeed. The important thing is that they remain positive and know that they can get back to quitting at any time. If they’ve done it once, they can do it again.

If customers relapse, they should come back into the pharmacy as soon as they are ready to try again. “It’s important to be honest – it isn’t going to be easy and not everyone quits successfully on their first attempt,” says Niamh. “However, plenty of support and the use of NRT makes the quit attempt a lot more likely to succeed.”

It’s not just about discussing the science of smoking, as giving up is often an emotion-led decision