Ask the Pharmacist

Q. Now that we are in the midst of a new year, I thought I would try to take better care of myself and attempt to quit smoking. I know some people that can quit easily on their own yet I am so unable to stop smoking so easily. Why is that?

A. About 16% of Canadians are smokers. It should not come as a surprise to learn that smoking is the leading cause of preventable morbidity and mortality.

About half of them will die prematurely due to tobacco use and for each of those deaths, 30 more tobacco users will be inflicted with a smoking related illness such as respiratory (breathing) disease, cardiovascular (heart) disease and a variety of cancers. Smoking kills over 37,000 Canadians each year which surpasses car accidents, suicides, homicides, AIDS and other substance abuse issues put together.

Many smokers do not need to be reminded of these facts. Despite knowing the downsides of smoking, it is tobacco dependency that is getting in the way. Tobacco dependency is defined as being unable to stop smoking despite being fully aware of all of its health consequences.

As you may already know, nicotine is a stimulant which thereby increases our heart rate and blood pressure, improves our level of alertness and our sense of well-being. The mesolimbic pleasure-reward system is activated within 7 to 10 seconds after nicotine use which helps explain its highly addictive nature. After continued use, as with many chemicals, changes are seen in the brain which leads to tolerance and thereby nicotine addiction.

Craving nicotine leads to continued smoking and increasing the amount used in order to try and reduce the symptoms of withdrawal such as depressed mood, irritability, anxiety, lack of concentration, headache, sleeplessness and restlessness among others. These withdrawal symptoms can appear anytime after your last cigarette but most find that it reaches its peak 24 to 72 hours after. These symptoms often diminish and go away about two weeks later, providing you did not give in to the symptoms and consume more nicotine. Don’t be alarmed if the actual cravings do not seem to subside as they can be a problem for many years unfortunately.

It is thought that these cravings are likely due to how our nicotine habit relates to our behaviour and psychological well-being. It is not surprising then to understand how difficult it is to “kick” the habit or to learn that someone has restarted smoking once again after any period of time abstaining. If you are a smoker and you are considering to quit, ask yourself if now is a good time.

There are various stages smokers often go through before quitting:

1. Precontemplation stage: Perhaps you are thinking about quitting in the next 6 months or a year and not seriously enough to make that commitment today.

2. Preparation stage: You have made the decision to quit.

3. Action stage: You actually do quit smoking.

4. Maintenance stage: You are abstinent for 6 months or more and continue to be smoke-free.

You may have heard some people utter that they were successful at quitting by stopping “cold turkey” while others cannot get through an hour let alone a day, a week, a month with trying that method. This might be explained best by the degree of physical dependence you have to nicotine. Those with a lower physical dependency may have much better luck quitting without any pharmacological assistance.

To learn where you stand with your physical dependency to nicotine, answer the following questions from the Modified Fagerström Nicotine Tolerance Scale. Remember to answer truthfully!

1. How soon after you wake up do you smoke your first cigarette?

a. After 60 min? score 0
b. Within 31–60 min? score 1
c. Within 6–30 min? score 2
d. Within 5 min? score 3

2. Do you find it difficult to refrain from smoking in places where it is forbidden?

a. No? score 0
b. Yes? score 1

3. Which of all the cigarettes you smoke in a day is the most satisfying one (the hardest one to give up)?

a. Any other than first one in the morning? score 0
b. First one in the morning? score 1

4. How many cigarettes per day do you smoke?

a. 10 or less? score 0
b. 11–20? score 1
c. 21–30? score 2
d. 31 or more? score 3

5. Do you smoke more during the morning than during the rest of the day?

a. No? score 0
b. Yes? score 1

6. Do you smoke when you are so ill that you are in bed most of the day?

a. No? score 0
b. Yes? score 1

Total: ___

A score below 5 suggests a low nicotine dependence
A score of 5 suggests moderate nicotine dependence
A score of 6 or 7 suggests a high nicotine dependence
A score of 8 to 10 suggests a very high nicotine dependence

Non-pharmacological (non-drug) therapy might be considered for people who are light smokers. On the other hand, for anyone who scored a 6 or higher, pharmacotherapy should be considered which will help you to be successful longterm. All the moderately dependent smokers who scored in between will vary as to the needs required to assist them.

Stay tuned for future columns to learn about both non-pharmacological therapy and pharmacotherapy methods to help you be successful and quit the habit. For more information on this or any other health related topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.