Smoking prevalence among South African adults increased from 19% in 2017 to 24% in 2021¹ and 31 000 South Africans die annually due to tobacco-related diseases,² writes Kgabo Komape, ICPA chairman. 

It is indeed concerning that these deaths are completely preventable through effective tobacco control mechanisms and other related interventions. 

Another concern is the introduction of vaping using electronic nicotine delivery systems (ENDS), to inhale small amounts of nicotine, which is purported as a harm reduction approach aimed at the fully smoking populations. Unfortunately, due to their appeal, availability and affordability to people who do not smoke, including children and young people, they contrarily initiate new users into this habit. The dopamine-inducing effects of nicotine induces a short-lived euphoric feeling³ quickly leading to dependence and possibly to the use of conventional cigarettes or other illegal drugs to sustain the pleasurable effect. 

Stopping smoking is the single most important thing an individual can do for their health. Surveys suggest that 70% of smokers want to quit, 30% try to quit yet less than 5% each year succeed. This is evidenced by the fact that 93% of unaided quit attempts, even with Nicotine Replacement Therapy (NRT), ultimately end in failure.⁴ 

HOW CAN PHARMACISTS HELP TO IMPROVE QUIT RATES? 

Clearly dispensing NRT alone is not enough but there is an opportunity for pharmacists to provide an evidence-based smoking cessation service which triples a quitter’s chance of successfully stopping smoking. The service includes pharmacotherapy, behavioral change techniques (BCT) and support.⁵ 

Pharmacists as the most accessible healthcare professionals together with their expertise in medicines, are well-positioned to provide effective and affordable smoking cessation support. Reducing the prevalence of smoking lowers healthcare costs associated with treating smoking-related diseases and reduces economic losses due to smoking-related deaths. As trusted professionals, the involvement of pharmacists in smoking cessation can enhance community trust and engagement in public health initiatives. 

Recommendations going forward:  

• Standardise an evidence-based smoking cessation approach;  
• Train pharmacists and pharmacy nurses in BCT and motivational interviewing;   
• Encourage medical schemes to fund the service;  
• Lobby government to enact stricter nicotine regulation policies;  
• Engage Pharmacy Council to update minimum standards for smoking cessation services;  
• Initiate regular public health awareness campaigns;  
• Participate in WHO Tobacco cessation consortium initiative⁶ 

By offering clinical smoking cessation services, pharmacists in South Africa can play a crucial role in reducing smoking prevalence, improving public health outcomes, and supporting the healthcare system's sustainability. 

REFERENCES 

1. Global Adult Tobacco Survey - https://cdn.who.int/media/docs/default-source/ncds/ncdsurveillance/data-reporting/southafrica/gats2021_south_africa.pdf?sfvrsn=de5704b6_1&download=true   
2. Groenewald et al.,2022   
3. Herman & Tarran, 2020   
4. Etter & Stapleton, 2006   
5. Combined pharmacotherapy and behavioural interventions for smoking cessation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10042551/#CD008286-bbs2-0156  
6. https://www.who.int/initiatives/tobacco-cessation-consortium