Smoking Cessation - Tobacco Dependency Service

A helping hand to be smoke-free

Smoking Tobacco & Nicotine: The Truth

• Smoking tobacco is highly addictive and extremely harmful to health
• Half of all smokers will die from smoking related diseases
• For every person that dies from smoking, around 30 others will live with serious health conditions caused by it
• The addictive substance in tobacco smoke is nicotine. Nicotine has feel-good effects in the brain including feelings of calm and relaxation, but this leads to a powerful dependence on nicotine
• Smoking tobacco delivers a fast and strong hit of nicotine to the brain and creates a very powerful addiction to cigarettes. However, Nicotine itself is not a harmful chemical
• The most effective way to quit smoking is with effective products, such as a combination nicotine replacement, vaping, non-nicotine-based medications, and the support of a Tobacco specialist
• You are THREE times more likely to quit for good with the expert guidance of the Treating Tobacco Dependency team and an appropriate treatment
• The hospital is a 'smoke free site', meaning you cannot smoke/ vape inside or on hospital grounds

Introduction to the Treating Tobacco Dependency Team (TTD Team)

Our service is a hospital-based team, who are specifically trained to assess your dependency to tobacco and provide appropriate medication to relieve your cravings.

We also offer behavioural support throughout your hospital stay and offer further support and referrals to local stop smoking services or pharmacies after discharge.

Together we will assess your dependency to smoking and set realistic goals for helping you take this step in the right direction.

We don’t force anyone to quit smoking, and we understand that not everyone wants to quit, but while you are in hospital it is a great time to see what we can provide and a chance to try the medications, relieve your cravings and manage your nicotine withdrawals.

Many fear it will take a long time to see improvements in their health and well-being, but the timeline for real benefits is faster than most people realise.

Withdrawal Symptoms

Some people may struggle with withdrawal symptoms, especially during the first week. These can include difficulty sleeping, headaches, temporary cough, anxiety, restlessness and irritability.

Nicotine replacement therapy helps to replace some of the nicotine you would normally get from a cigarette, which helps to relieve some of these symptoms. The Treating Tobacco Dependency Team can help make sure you are on the right dose for as long as needed to relieve those symptoms.

Pre and post-operative quit help

There is very strong evidence that quitting smoking before surgical intervention improves surgical outcomes, decreases wound healing time and reduces the risk of complications post- surgery. For maximum benefit, a quit attempt needs to begin 4-8 weeks prior to surgery but stopping immediately around the time of surgery and continuing the quit attempt afterwards still has worthwhile benefits.

Using Nicotine replacement therapy pre and post-surgery is associated with greater long term quit rates.

If you want to quit before your surgery, the pre-operative team can refer you to your local stop smoking service or you can refer yourself using the phone numbers at the end of the leaflet. The Treating Tobacco Dependency Team can then continue to support you while you are an inpatient.

All the hospitals are smoke free sites, but the Treating Tobacco Dependency teams are here to support you however we can.

Nicotine Replacement Therapy

You cannot overdose on nicotine, but like having too many cigarettes in a short period of time, it can cause mild symptoms such as headaches and nausea when you have too much. Having too little nicotine will affect how well the nicotine replacement therapy helps to alleviate your cravings. The Treating Tobacco Dependency team will work with you to find the right dose to suit your level of dependency.

Evidence shows the best way to quit with Nicotine Replacement, is to use BOTH a nicotine patch AND a fast-acting nicotine product that you can use whenever you need.

Long-Acting Nicotine Product

• Nicotine Patches - These come in 24 hour or 16-hour options, with different strengths of nicotine. They are placed on a dry, clean area of skin and give a constant ‘drip’ of nicotine through the day

Fast-Acting Nicotine Products

• Nicotine Chewing Gum - Chew the gum until you feel a hot and fiery taste, then rest the gum between your cheek/lip/gums and let the nicotine be absorbed
• Nicotine Oral Spray/QuickMist - This is a fast-acting solution absorbed through the mouth, 1-2 sprays per hour under the tongue, or inside of the cheek. Let the liquid rest in the mouth before swallowing to absorb the nicotine
• Nicotine Inhalator - Looks like a small white cigarette. It keeps your hands busy and recreates the hand to mouth action. You suck it, like a straw and let the nicotine rest in the mouth. It does not need inhaling like a cigarette for it to work. Each cartridge provides 40 minutes of use, this can be divided into four 10-minute sessions or eight 5-minute sessions. 10 minutes of use is approximately equal to one cigarette. The maximum number of cartridges is 6 per day, please change the cartridge when needed
• Nicotine Microtab - A small tablet that rests under the tongue and dissolves in about 20 minutes
• Nicotine Lozenges - Sucked like a sweet but rest it in your mouth between the gum and cheeks, to allow the nicotine to be absorbed
• Nicotine Nasal spray - A quick acting nose spray, it may take some time getting used to, but it does work very quickly

It is recommended that fast acting nicotine products be used 'ON THE HOUR EVERY HOUR' and in between if needed.

Nicotine Replacement Therapy and Pregnancy

Protecting your baby from tobacco smoke is one of the best things you can do to give your child a healthy start in life.

Stopping smoking during pregnancy will reduce your risk of complications and reduce the risk of stillbirth.

Nicotine replacement therapy can be used during pregnancy if it will help you stop smoking, and you are unable to stop without it.

Missing a dose

If you forget to replace a patch, use it as soon as you can. Only use one patch at a time and do not leave on the skin for longer than directed. If a patch falls off, you can replace it but keep to your schedule and remove the patch at the right time.

If you miss a dose of a fast-acting nicotine product, take the does as soon as you can. Do not double up or use extra doses.

Side effects

Side effects are listed in the leaflets found inside each of the medications.

If you have any side effects such as severe and radiating skin rashes, severe itching, hives, swelling of the face, lips or tongue. Stop using the medication and inform the Treating Tobacco team, and your consultant or GP.

If you experience any side effects, you can report them through the Yellow Card Scheme. This is a voluntary reporting of problems and side effects to the Medicines and Healthcare Products Regulatory agency.

Report your side effects on their website at: www.yellowcard.mhra.gov.uk

Vaping

Vapes, also known as e-cigarettes, are a dramatically less harmful way of using nicotine and are very effective at helping people stop using tobacco products.

There is no tobacco in vaping, there is no burning and there is no smoke.

A liquid containing nicotine is heated to create a vapour, the vapour is then inhaled into the lungs giving a ‘hit’ of nicotine.

It is not 100% safe, but experts agree that it is much safer than smoking.

A Vape can also be used alongside nicotine replacement products to aid in quitting smoking tobacco completely. The aim is to give the body enough nicotine so there is no need to smoke tobacco.

Do Vapes cause Popcorn Lung?

Vaping does NOT cause “Popcorn Lung”, the common name for a rare disease called Bronchiolitis obliterans. The disease was found in a group of factory workers exposed to a chemical called Diacetyl. Whereas Diacetyl is found in cigarette smoke, it is banned as an ingredient in UK-regulated nicotine vapes and e- liquids.

What about flavours?

Some people want something that tastes and smells completely different to tobacco, whilst others want to keep the tobacco taste and smell. There is no right or wrong answer. Flavours are there to help improve the experience of vaping if needed.

Different types of Vapes

There are many different types, some look like cigarettes, others have a penlike shape or a box shape with a mouthpiece.

Talking to a licenced vendor in a vaping shop or talking to a member of the Treating Tobacco Dependency Team, can help you decide which vape would suit you best.

How long should I vape for?

Vaping should be used to stop smoking, and ultimately the goal should be to stop vaping as well, but not if it means starting to smoke again.

Is there any risk to others from the vapour?

Vape flavouring is made of the same substances from smoke machines (propylene glycol or glycerine), the risk to others is likely to be extremely low. The vapour can be a nuisance to bystanders, like tobacco smoke, but it poses no significant risks, unlike secondhand tobacco smoke.

Can you vape if you are pregnant?

Risks of vaping to the unborn child are yet unknown, but the risk is substantially less than the well-known risks of smoking (stillbirth, miscarriage, birth defects, premature birth).

Vaping remains an effective way to stop smoking, for those that are pregnant, and for anyone else.

Nicotine Poisoning

There have been cases of young children accidentally ingesting the liquid. Vapes and Vape liquids should always be kept out of the reach of children.

Fire Risk

There have been reports of house fires caused by faulty vape batteries and chargers. Always use the proper charger and never leave vapes charging unattended. You cannot vape or charge a vape inside a hospital building because of the fire risk, and close proximity to Oxygen.

Use with Oxygen therapy

Just like smoking cigarettes, using vapes near homecare oxygen presents a serious fire and explosion hazard and should be strictly avoided. Even charging a vape device can pose an ignition risk and must not be done in the presence of oxygen.

Illicit e-liquid/Fake Vapes

In the UK vapes are highly regulated for safety and quality. All products must be registered with the Medicines and Healthcare products Regulatory Agency (MHRA) with details including a list of all ingredients.

Chemicals such as Diacetyl, Cannabis oil and Vitamin E Acetate are all illegal substances in UK vapes as they can be dangerous to health.

Always buy your vaping products from a reputable seller such as a specialist vape shop, pharmacy, supermarket or a UK based online retailer, so they are covered by UK safety and quality regulations.

Considerations with other medications

When you stop using tobacco, the absorption rate of your medication can change. While these changes may be minor, it's important to consult with your TTD team member, ward doctor, or GP to have your dosage monitored if you're taking any of the following medications. This list isn't comprehensive, so if you have any concerns or an increase in side effects, please reach out to your GP:

• Aminophylline
• Theophylline
• Clozapine
• Erlotinib
• Olanzapine
• Riociguat
• Chlorpromazine
• Flecainide
• Methadone
• Warfarin

Non-Nicotine based medications

There are effective medications that can be prescribed for Tobacco dependency. They are non-nicotine-based medications that can be prescribed while in hospital, or in the community through local support teams or your GP. The inpatient and community Tobacco Dependency teams will support you throughout your treatment. The Tobacco Dependency advisor will advise you if you are eligible for this method of treatment, this is based on medical history and current medical status. Pregnant patients cannot take either Varenicline or Cytisine.

There are a lot of changes that occur in the body when you stop smoking, with or without oral medications. If you are exhibiting any side effects with the medication, please discuss this with your Treating Tobacco Dependency Advisor, or if you are concerned and need urgent support contact NHS 111.

Varenicline

Varenicline is an oral tablet used to help adults to stop smoking. It does not contain nicotine, instead it blocks the action of nicotine in the brain helping to reduce cravings and withdrawal symptoms associated with stopping smoking.

Varenicline comes in 0.5mg and 1mg tablets and is usually taken over the course of 12 weeks. It is important to complete the full course of tablets, even if you have stopped smoking, finishing the course increases your chance of stopping smoking for good.

You can start taking Varenicline 1-2 weeks before stopping smoking, this allows you to build up the dose and gradually help your body become used to the medication.

If you forget to take a dose of Varenicline, take it as soon as you remember unless it is less than 3 hours before your next dose is due. In this case leave the missed dose out and continue with the next dose at the usual time.

Never take 2 doses at the same time, and never take an extra dose to make up for a forgotten one.

Some common side effects include headaches, heartburn, diarrhoea, difficulty sleeping, and feeling dizzy. If these side effects are bothering you, speak to your doctor or Tobacco dependency specialist.

If you take more than your recommended dose of Varenicline contact 111 for advice.

Cytisine (Cytisinicline)

Cytisine works in the same way as Varenicline, it does not contain Nicotine and blocks the action of nicotine in the brain to reduce cravings and withdrawal symptoms.

Cytisine comes in 1.5mg tablets and is usually taken over the course of 25 days. It is important to complete the full course of tablets, even if you have stopped smoking, finishing the course increases your chance of stopping smoking for good.

You can start taking Cytisine 5 days before stopping smoking, continuing to smoke while taking Cytisine will increase the severity of any side effects that you may be feeling.

If you forget to take a dose of Cytisine, take it as soon as you remember unless it is less than 12 hours before your next dose.

Never take 2 doses at the same time, and never take an extra dose to make up for a forgotten one.

Common side effects include, change in appetite, dizziness, headaches, difficulty sleeping, heartburn, constipation. If these side effects are bothering you, speak to your doctor or Tobacco dependency specialist.

If you take more than your recommended dose of Cytisine contact 111 for advice.

If you experience any side effects from any medications, you can report them through the Yellow Card Scheme. This is a voluntary reporting of problems and side effects to the Medicines and Healthcare Products Regulatory agency.

Report your side effects on their website: www.yellowcard.mhra.gov.uk

Inpatient Contact Details for further support

TTD Salford Royal - 0161 206 1779
TTD Royal Oldham Hospital - 0161 778 5782
TTD Fairfield General Hospital and Rochdale Infirmary - 0161 778 2941/3061
Smoke Free Pregnancy Service - 07966 240892

Community Services

Salford Stop Smoking Services - 0800 952 1000
Your Health Oldham - 0161 960 0255
Bury Lifestyle services - 0161 253 7554 Rochdale Living Well services - 01706 392210 Manchester Be Smoke-Free - 0300 123 1044

You can also refer yourself online to the community services through their websites.

There are phone apps available to help you through your journey.

Smoke Free-Stop Smoking Now

NHS Quit Smoking (also available as a website)
 

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