welcome to health matters a show about what matters in your health here in worcester county this is a show that's a collaborative effort of the worcester district medical society and w c c a t v now channel one ninety four on the cable and my name is jay brought her some a family doctor here in worcester and i'm going to be your host for the show and i'm delighted that as we are now in the fall it makes me think about the great american smokeout well i'm a family doctor and i guess you have to give me a break about that but the great american smokeout is a day the week before thanksgiving that has been  going now for years and i'm going to have my guests talk a little bit about that as well as how stopping smoking can best be achieved by having the right kind of support so let me turn to my guests and my immediate right is to she is the central mass she is part of the central most tobacco free community partnership and her spare time works in the department of psychiatry at the us medical school and to her right is nicole de who is a certified tobacco treatment specialist also based at the u s medical school welcome to you both thank you so much thanks for having us pleasure and remind me if you will about the great american smokeout well it's exciting because both nicole and i have been doing some media lately and we've been talking about the great american smokeout which started in one nine hundred seventy s and  day quitting just to quit for one day and maybe that would help somebody think about quit making a long time quite a tent and honestly given what we know about smoking in the effects of smoking we sort of were saying before the show started that you know this is one the one or perhaps one of the only products when used as directed is frankly likely if not guaranteed going to have adverse health consequences for a person so here we are in a season of thanksgiving where she if someone in who is a smoker and they can stop for one day perhaps they will be able add a second day of that and then another day after that then we also like to say around thanksgiving is something to be thankful for that you have a loved one who could make a quick attempt or help someone who can make a quick temptin and we know so much more about how to do that well that's what i was hoping we could get into a bit was this the science i mean some people regard cigarette smoking as a bad habit or whatever but we've certainly learned a great deal about health consequences but there is a science around smoking and what how it affects the brain i hope could you help our audience understand more about what's the science of quitting smoking it's a great question well quitting smoking it varies on individual on individual basis it depends on the person where you're out at the time but there's a lot of science including as in support there are seven there are actually seven f d a approved medications will assist a person in their quit attempts so there is the nicotine patch we have the nicotine gum we have to get to nicotine loss and the control inhaler the nasal spray and a two prescription pill wise as well and then also on top of that there's also now therapy counseling wise one on one counseling whether you can get it through of the phone you can go see people individually and it's more of support and figuring out how to address your tobacco use not only with the habit but behaviorally socially chemically psychologically and it's just all wrapped up in one but it's conducive to the individual so i think the tobacco industry would like as you said to make it seem like it's a habit and so what we really want to understand is that it's an addiction to the nicotine right deval so we really want to talk about that piece and and how to help someone with their addiction so that there's a science you know counseling people as as nicole said she label it as an addiction understand it as an addiction what's happening with the brain and i would think many of our listeners have understand about the fact that nicotine is a critical role here and as you were listing the medications renewable the vast majority focused on nicotine and i guess the idea is that in cigarette smoke you've got thousands of different chemicals but if nicotine is the one that is making the difference in your brain in terms of the addiction that if you can provide i just pure nicotine in a pharmaceutical grade state that  you can then perhaps we know off that slowly over time and allow your body to return to more normal at least in terms of the nicotine stimulation sort of the without having interference depending on the cigarette to relax you as you are go to problem solver so it helps you at least eliminate that would draw symptoms and it gives your body time to allow to adapt to the difference of the nicotine when you start or should try to taper their serve a sort of a guideline about there is the f d a put you can do it in twelve weeks you can go on the nicotine patch for example the twenty one if you are twenty cigarettes a day you would use the twenty one milligram patch you could be on that patch the twenty one for forty six weeks and you taper down to the fourteen milligram patch for another forty six weeks and then you would go on a seven milligram patch which is another two weeks so you can use the patches as a director's twelve weeks but you can extend it a little bit if you need to or you can shorten the time it all depends on the individual and that's why counseling is so important why we know that as nicole said you have the nicotine replacement but how to use it to your best advantage and how to understand how you change your behavior at the same time that you're getting nicotine because most people think it's just replacing the nicotine and making behavior change as you know as a doctor can be really difficult whether it's  for someone to use the over the phone counseling line that we have here in the state that's free the eight hundred number to talk to a specialist to make a plan to quit smoking even before you begin to take the nicotine and to understand how to look at your behavior in different ways and understand it and i think most people don't appreciate and can't understand how that counseling can be so effective but it's so important to go along with the nicotine replacement absolutely so i want to talk much more in more detail around how that can counseling works but i was hoping just to get a quick sense someone comes to me and i will have a talk with them about nicotine and about counseling but as you said the patch is been around for a long time but you mention several of the things you mention you mention in inhaler  how do you decide or or does that individual patient tell you i think i do better if i've got something in my mouth to chew and there efore you go with the gum or how do you know it's a combination  getting the feedback from the patient because you always want to get their history as well and have they ever used any of these products in the past and they can tell you what worked what didn't work or if they they all say it didn't work and i still had cravings when you find out well what was the milligrams that you used so it's a really good open discussion and dialogue with the patient so i think primarily goal is to design it together and most of these are over the counter yet so they're easy for people could you just briefly talk about the two pills that you mentioned well we have chant x rays veronica which is a prescription only and it builds up in your system so you start off at a point five milligrams in the morning one day one day for three days and then you go to point five twice a day then you go to one and it's really blows up in your system you can smoke on the first week or maybe two weeks on it depending on your level of confidence and cia and throughout the whole process but you set a quit date at the same time i c so by that with the combination of therapy got the ongoing support at the same time to work out this plan even working on for the behavior changes to successfully quit so that chant x and the other one is well putra right or is our band or people around it's a mood stabilizer but they found that it does two things one to help stabilize your mood but also it also helps with the cravings helps reduce the desire to smoke so they found and that this medication does do all why not it's because it helps eliminate or take away per se the withdrawal of nicotine because depression is part of the withdrawal sadness is part of it also why not use this method to help you stay at a baseline and quit smoking at the same with any of the over the counter medicines and i packed the gum the last inch you can use them as a great combination you can use the pattern last inch together you can use a patch and the gum together including with well putrid text there's a lot of research out there showing that you can and you can't but it also depends on the person and also i always refer them back let's talk to your primary care doctor first because they know you better and and a lot of times they'll sign an agreement and i will talk with their primary care doctors as well ok great to make sure ok what do you think what is the best approach with this i c so i think we've got a pretty good idea about that medication piece but as you're pointing out and tina you've really emphasize this the medication piece is only a piece in what sounds like is much more important or certainly equally if not more important is the counseling side and certainly there are professional counselors like yourself nicole  but i imagine there are a number of different areas places that a person can get support i wonder of if either one of you would be willing to talk about that sort a little bit more the detail of counseling how that works what a person would expect if they came to see you but also were the other places that a person might get support in this journey from being a smoker to quitting well at this at the level of every day person in who is looking for help and they want to just pick up the phone and dial a eight hundred number we have that available than twice as likely to have a successful quit attempt the other piece that's really important before we get into the details of the counseling which is really because expertise is that here in massachusetts mass health will cover the cost of the health program will paid ok great so there's the phone counseling there's tobacco treatment specialist in some hospitals and we're lucky here you mass to have them  and then some community health centers have either community health workers or nurses who have got through some level of tobacco training so that they can help again with the basics of counseling and then help a person decide on what kind of medication would be the best to pursue for individual counseling if you're an inpatient at a hospital let's say you have to have surgery and you're a smoker then  that's the benefit of having someone like me call it u mass because then they can help a person to make a quit attempt because they're forced to because they're in the hospital you can't smoke in hospital and then to call can go on and speak to them about well gee you you you could not smoke for a day or two while you had your surgery are week while you've been in the hospital which is a long time and how to make use of that right as they go and get discharged and become an outpatient let me just take a moment and say to   this is the time of year of the great american smokeout so we're hoping that if you know an individual who is a smoker and might consider quitting or perhaps you're one of those folks who might consider quitting we're hoping that the show is helpful to you so now to call it like to get back in would you maybe talk about that patient in the hospital that you've been asked to see on a consultation perhaps came into the hospital they needed surgery they are a smoker what how do you help them i'd like to meet the patient where they're at and go into their room and i obviously i introduce myself and i really talk about how are they feeling right now are they experiencing any cravings or urges and a lot of times right after surgery now well they've got all kinds of other medications is how about it for that and and it's very interesting how it opened up possibly could consider quitting and i'm like and then i go into the studio have you ever quit before and i'll say either yes or no if they've done it have they ever used the medicines before so it's really having an open dialogue and then really fantasizing in the support that's out there talking about it if you don't want the medication but there's a list of support that are out there there's not only individual counseling over the fall but there's great web sites there's nicotine anonymous meetings just to throw out a couple more that are there to really support the patient while even in the hospital or when they are discharged so it's really meeting them where they're at and if they want any of the medications and they don't have any i'll actually go and talk to their treatment team and say hey this person does meet the qualifications there two days in they are experiencing withdrawals and let's see what we can do about getting them the nicotine patch when we're going to actually start that in the hospital and then potentially be able to continue that they were destroyed yet and if they want to the doctor can write them a prescription or to leave and pick it up when they get their pharmacy simple that and then i can also hook up with the linkage if they want outpatient counseling with me or other colleagues around the community or set them up with there's a group that's in some other town that you might be able to go to there's the other really nice  feature these days is that a lot of people who are you know smoking are people who use other substances so we know that it increases your sobriety or your chance to stay in recovery and be successful in your recovery if you also quit using nicotine so a lot more treatment specialists in the other substances users for recovery are also trained or at least have more thinking now that they're going to help somebody quit smoking to maintain their sobriety and not just let them keep smoking so that's really important we also know that people who have perhaps other mental health issues are also people who are smokers and a lot more mental health counselors or psychiatrists or psychologists have also been trained to think more about helping a person to make a quit attempt who has a mental health issue because again keeping someone off of those medications will help them in their every day functioning  aged tell us a little bit about electronic cigarettes because they've come onto the scene there is been a certain amount of talk from the folks who make them that they're really designed to help potentially people quit it's hard for me as a physician to think that if you're creating bubble gum flavors and pineapple flavors and stuff that you're really serious about trying to help that middle aged smoker quit as opposed to you know getting that younger person who looked have it so you can see where my feelings are on this subject but i am interested what information is available about the role of isa grads who are fading in in this period right it's so great to hear you talk about that because we really want doctors especially pediatricians  family doctors to be well versed in thinking about electronic cigarettes especially for youth but also for adults and know that first of all they're they haven't been intel very recently approved by the f d a because we don't really have a history of their use we don't know what's in them scientifically they've not been regulated so we tell people that they're not a good choice for quitting and getting off nicotine and that's the problem because even if you quit smoking and you use electronic cigarettes you're still an addict to the nicotine are they less harmful than regular combustible cigarettes in the long term we know they probably are because there's nothing burning in and there's no tar right but we still don't know the long term effects certainly for youth we know that we don't want young people starting in nicotine addiction the other piece is that as you mentioned the flavors that they used to manufacture them and put them in there it's well documented that these are not flavors that the average adult would want and it mask the tastes of the tobacco flavor so we say we don't want you getting into electronic cigarettes especially the other pieces that you can use them to put t h c in so that many kids are using it for smoking raping marijuana there's no smell when you use the t h c in electronic cigarette and  again it it it you get more of it there's a stronger hit and it's certainly not the marijuana that people of my generation spoke to back in the sixty's so that's a real concern using them to say well i've i mean i'm now moving to the cigarettes and i think that's going to work for me yes there is a lot of folks that i run into whether they're inpatient or i've seen them on an outpatient basis they talk about using the electronic cigarettes how they've tried them how they use it or they enjoy them they're using more for trying to quit smoking have i had success with them yes good people did quit but it's actually about their pure intentions are they using it for to quit smoking and they slowly taper down or they're using it as a supplement so you really get into that discussion with the patient and a lot of times most if not all patients that i run into they know that it's not f d a approved they know it's an alternative but not necessarily it's going to be the magic bullet to quit smoking it's not really medication that's prescribed but rather a product which is being marketed  dollars to five hundred dollars depending on what you're building if you're building a vapor with the rig it's a very intricate piece and a lot of patients are telling me how much their rake which is the vapor how much it costs and how much they're putting together plus their oil and so forth there so we can it's sometimes it's not cost effective sometimes it's not cheaper than smoking a pack of cigarettes a day and from a safety point of view i don't you know it's hard to say that cigarettes are safe in the sense that you something that's actually burning but for the cigarettes you do have a very hard electronic heat source and i know that i've seen anecdotal reports about failures and you know break which is not an electronics that i but it's the vapor where it because it turned on and it burned everything like a burn to his jeans and a burnt it to his skin ok so it's it's also the person's responsibility so that really brings us now to the issue of prevention because we've got a you know disease problem and how this is going to be at the end of our show unfortunately so we don't have a great deal of time but what how how do we go about helping youth not start well that's so important and you know it shows like this continually getting information out in front of the public which are so important so so wonderful that you do the show and that we have to continually expose the tobacco industry tactics that the industry uses to attract young people back in two thousand and eight two thousand and nine the industry realized that you can't make flavored cigarettes so they had to come up with other devices and products that would help people start a nicotine addiction because all their former consumers were dying off and the  their stockholders so they have to make more products to attract youth so we know that and we have to teach and educate young people as well as parents that it's so important to see what the industry is doing and we have to  look at passing local policies as you know you've been involved here at the local level which will restrict the use access to these products and to increase and  reduce the veil ability of them in the marketplace and then on a statewide level if enough communities and towns pass these local policies then the legislators will take a look and say well i guess there's enough towns are interested in it we can look at it at statewide level so it takes it takes multi pronged approach to do this kind of prevention with a such a predatory industry and you think nickel no i think be very well and i agree with that it is on a local and state level and community level it's a community issue yes it's not just an individual it's not just a parent it's not just the child it's a community issue and i think if we all work together and provide education and knowledge and support we'll be able to make changes well because de i want to thank you both for joining us today on this issue on this segment of health matters i hope it's been helpful to thank you again for watching and we'll see you again next time on health matters