Report 06, march 1.pdf

Report No. 6 of the No-Smoking By-law Task Force THE REGIONAL MUNICIPALITY OF YORK
REPORT NO. 6
OF THE REGIONAL
NO-SMOKING BY-LAW TASK FORCE
MEETING HELD ON MARCH 1, 2000
For Consideration by
The Council of The Regional Municipality of York
on March 9, 2000
Regional Councillor R. AselinRegional Councillor J. MableyCouncillor P. Hall, NewmarketCouncillor J. Hastings, GeorginaCouncillor J. Heath, MarkhamJ. Bard, Canadian Cancer SocietyH. Johnson, Whitchurch-Stouffville Chamber of CommerceA. Mackey, York Catholic District School BoardB. Scollick, Richmond Hill Chamber of CommerceS. Strelchik, Youth Representative Staff Present: Dr. Troy Herrick, R. Metcalfe, V. Morley, S. Wong and J. Williams Michael Perley, Director, Ontario Campaign for Action on TobaccoBruce Davis, Urban Intelligence Inc., Ontario Campaign for Action onTobacco The No-Smoking By-law Task Force began its meeting at 9.15 a.m. on March 1, 2000.
Report No. 6 of the No-Smoking By-law Task Force SMOKING CESSATION PRODUCTS
The No Smoking By-law Task Force recommends the adoption of the following
report, February 11, 2000, from the Associate Medical Officer of Health:
RECOMMENDATIONS
It is recommended that:
1. Regional Council endorse the resolution regarding smoking cessation products 2. Regional Council endorse the resolution for a smoke-free Ontario (Attachment 2); 3. Regional Council recommend to the Ministry of Health and Long-Term Care and the insurance industry that smoking cessation products be covered under both public andprivate health insurance; and 4. This report and the attached resolutions be distributed to area and surrounding PURPOSE
The purpose of this report is to address the issues associated with smoking cessation
products and access to these products. This report was requested by the Regional No-
Smoking Task Force at its meeting of February 2, 2000.
The report will also address the frequently misunderstood components associated withsmoking cessation products. It is anticipated that Regional Council, employers, andresidents of York Region would be interested in, and support greater access to, smokingcessation products.
BACKGROUND
Currently, some 6.8 million Canadians aged 15 and over are smokers, with a majority (86%)
of them smoking on a daily basis (Health Canada, 1999). However, access to smoking
cessation products by smokers is somewhat restricted.
Recent research concluded that smoking cessation products are safe, effective, government-
approved medications that will promote either cessation or reduction in tobacco use
(Ontario Medical Association, 1999).
Report No. 6 of the No-Smoking By-law Task Force 3.1 Prevalence of Tobacco Dependency
Across Canada, almost 25% of daily smokers consume their first cigarette within 5 minutes
of waking and 60% within 30 minutes of waking (Health Canada, 1999). Only 17% of
smokers in Canada indicated that nothing, or only their own death, would make them quit
smoking.
At present, tobacco dependence can be successfully treated by the two recognized, effectivesmoking cessation medications: nicotine replacement therapies (NRT) and bupropionhydrochloride (Zyban) (U.S. Department of Health Services, 1988). Both NRT and Zybanhave been found to approximately double the quitting rates compared to placebo (OntarioMedical Association, 1999).
Nicotine Replacement Therapies (NRT)
Nicotine replacement therapies (NRT) are regarded as one of the first cessation productsavailable in the United States and the United Kingdom to help smokers to quit.
In Canada, NRT are available in the form of nicotine gum and nicotine patches. Otherforms of NRT include nicotine inhaler and nicotine nasal spray. These products are onlyavailable in the United States.
NRT provide a safe, "clean" nicotine delivery system, as they replace some (not all) of thenicotine obtained from tobacco. Hence, NRT reduce withdrawal symptoms such as cravingsdue to tobacco abstinence without the harmful constituents found in cigarettes.
3.2.1 Common Myths about NRT
NRT provide nicotine without the dangerous chemical toxins present in cigarettes. Major
adverse effects from nicotine gum and the patch are rare. As well, they also have little or no
addictive potential (Ontario Medical Association, 1999; Benowitz, 1998).
The use of NRT do not increase smokers' risk of heart attack, as the cardiovascular effects(such as atherosclerosis, acute myocardial infarction, stroke, and sudden death) are causedprimarily by cigarette combustion components not nicotine (Benowitz, 1998). Nicotine is astimulant, as it can increase heart rate and contractility. One of the largest longitudinal LungHealth Studies (1998) concluded that there was no increase in cardiovascular risk amongthose who used tobacco and NRT together.
The Ontario Medical Association (1999) recommended that cardiac patients, pregnantwomen, and youth under 18 years who cannot quit smoking should be among the first toconsider using NRT, and that they should be closely monitored by their physicians.
3.3 Bupropion Hydrochloride (Zyban)
Zyban was approved as a smoking cessation medication by Health Canada in 1998, in the
form of a sustained released (SR) tablet. Zyban is the first government approved, non-
nicotine based medication (available in pill form) that helps smokers to quit. It is also
Report No. 6 of the No-Smoking By-law Task Force marketed as an anti-depressant. Zyban has positioned itself along with NRT as the first-linetherapy for treating tobacco dependence (Hughes et al., 1999).
Although the exact mechanism as to how Zyban operates is unclear, a recent studydemonstrated that Zyban alleviates cravings associated with nicotine deprivation by affectingnoradrenaline and dopamine receptors (Goldstein, 1998).
The use of Zyban needs to be closely monitored by physicians. However, patients withcertain medical conditions such as seizure disorders, anorexia and bulimia, or those onmedications that contain buproprion or monoamine oxidase inhibitors should not beprescribed Zyban.
Combined NRT Gum and Patch Therapy
or NRT in Combination with Zyban
Current research on NRT and Zyban concluded that the combination of NRT gum andpatches or NRT in combination with Zyban are effective treatments for tobaccodependency.
3.4.1 Combined NRT and Patch Therapy
Recent studies reported that combined nicotine gum and patch therapy provides higher
cessation rates than gum or patch alone, without an increase in adverse effects (American
Psychiatric Association, 1996; Hughes et al., 1999). The dual therapy helps to reduce
withdrawal symptoms, as it provides smokers with a steady intake of nicotine (via the patch).
With nicotine gum, it addresses the sudden tobacco urges (Fagerstrom et al., 1993). Patients
who are on dual NRT should be closely monitored by their physicians.
In 1999, a group of prominent US smoking cessation experts revised the clinical guidelineson smoking cessation by recommending the use of nicotine gum with the nicotine patch.
3.4.2 Combined NRT and Zyban
NRT can be used in combination with Zyban. Jorenby et al. (1999) reported that some
patients considered the combined use of Zyban and NRT to be an effective strategy,
especially if single therapy is inadequate. Again, patients on NRT and Zyban should be
closely monitored by their physicians for any adverse effects.
ANALYSIS AND OPTIONS
Given that cigarettes are addictive, toxic and cause ill health, smokers should be encouraged
to either quit or reduce their tobacco use. Cessation programs should be available to
smokers in order to facilitate this.
Inaccessibility of NRT and Zyban
Currently, individuals who are nicotine dependent can obtain their nicotine via NRT ortobacco products. The purposes behind the manufacturing, marketing, and distribution of Report No. 6 of the No-Smoking By-law Task Force these two nicotine products are in total contrast. NRT and Zyban are non-addictive anddesigned for smoking cessation; tobacco promotes and maintains an addiction to nicotine.
Compared to tobacco products, NRT products are both highly regulated and inaccessible toconsumers in terms of cost and availability. Tobacco manufacturers are relatively free toalter the taste and sensory characteristics of their products, while any changes to NRTproducts (i.e. palatability or acceptance among smokers) must be approved by HealthCanada.
At present, tobacco products are widely distributed in a variety of retail outlets such ascorner stores, gas stations, supermarkets, restaurants and donut shops. In contrast, NRTproducts are only available in local pharmacies in Canada. This inaccessibility preventssmokers from replenishing their NRT supply at certain times of the day. They should havethe same opportunity to obtain NRT products as cigarettes.
Although the unit costs of NRT and cigarettes are similar, the one-time purchase of NRT(about $30 for a week's supply) is much higher than a one-time purchase cost of a packageof cigarettes. For low-income individuals, this large single expenditure is problematic. Arecent study indicated that individuals from lower socio-economic status have highersmoking rates and lower quitting rates (Shiftman et al., 1997).
FINANCIAL IMPLICATIONS
It is widely known that tobacco dependency is similar to other drug dependencies. It is aprogressive, chronic and relapsing disorder (Henningfield, 1995). In Ontario, it is estimatedthat the total health and social costs attributed to tobacco use was $3.7 billion in 1992.
Consistently, research demonstrates that there are significant economic benefits forgovernment, employers, and society if smokers quit.
Cost-effectiveness of Smoking Cessation
A recent US study reported that society would gain 1.7 million new quitters at an averagecost of $3,779 per quitter. The savings would be $2,587 per life year, and $1,915 for everyquality adjusted life year. The costs per quality adjusted life year saved ranged from $1,108to $4,542 (Cromwell et al., 1997). Cromwell et al. (1997) concluded that smoking cessationinterventions are extremely cost-effective, with more intensive interventions yielding themost benefits.
LOCAL MUNICIPAL IMPACT
Promoting greater accessibility to smoking cessation products would have significant impactlocally, as it would enable York Region's smokers to quit or reduce their tobaccoconsumption.
Considering the health care and social costs associated with tobacco use, York Region cantake a proactive position by encouraging smokers to quit and by working collaboratively with Report No. 6 of the No-Smoking By-law Task Force the Ministry of Health and Long-Term Care, and both the pharmaceutical and insuranceindustries to ensure that smoking cessation products become more accessible.
CONCLUSION
York Regional Council can take a leadership role by advocating to the Ministry of Healthand Long-Term Care that smoking cessation products should be accessible to smokers.
Furthermore, York Regional Council should encourage the Ministry of Health and Long-Term Care to work collaboratively with both the pharmaceutical and insurance industries tomake smoking cessation products more readily available in all retail outlets where cigarettesare sold, and to include the smoking cessation products under both public and private healthinsurance plans.
It is widely recognized that tobacco is harmful to one's health. Thus, every effort should bemade to encourage current smokers to quit, as this not only reduces health care costs interms of decreased morbidity or mortality across a wide range of illnesses, but also socialcosts. At present, York Regional Council has taken a proactive position related to tobaccoprevention and education. The aforementioned recommendations are consistent with theposition taken by the Ontario Medical Association on the issue of smoking cessationproducts.
(A copy of the attachments referred to in the foregoing has been forwarded to each Member ofCouncil with the March 1, 2000 No Smoking By-law Task Force agenda and a copy thereof is alsoon file in the office of the Regional Clerk.) UPDATE – COMMITTEE PROCEEDINGS
The No Smoking By-law Task Force advises Council of the following matters
having been considered by the No Smoking By-law Task Force with the action as
noted:
PRESENTATION
The Task Force received the following presentation: Michael Perley, Director, Ontario Campaign for Action on Tobacco, made apresentation to the Task Force on ventilation technology as a solution to thesecond-hand smoke exposure problem, stating that no appropriate standard hasbeen set in any North American jurisdiction.
Report No. 6 of the No-Smoking By-law Task Force COMMUNICATIONS
The Task Force received the following communications: Amarjit Singh, International Trade & Purchasing Consultant, February 21, 2000,commending York Region’s No-Smoking By-law Task Force’s efforts to make allpublic places smoke-free under the York Region No-Smoking By-Law.
Robert Kyle, Coordinator, Central East Cancer Prevention and ScreeningNetwork, Cancer Care Ontario Regional, Central East Region, January 27, 2000,congratulating the Regional Municipality of York for establishing the York RegionNo-Smoking By-law Task Force.
Robert A. Grossi, Mayor, Town of Georgina, January 26, 2000, supporting theYork Region No-Smoking By-law Task Force.
John R. Turner, Chemical Safety Consultant, January 31, 2000, commendingHillcrest Mall, Richmond Hill, for creating a smoke-free environment.
Ruth Burkholder, President and C.E.O., Markham Board of Trade, February 8,2000, regarding the processes followed by the Task Force.
Joyce Frustaglio, Chair, No-Smoking By-law Task Force, February 17, 2000 tothe Acting Director General of the Bureau of Tobacco Control, Ottawa, in supportof the federal government’s proposal of creating new tobacco warnings on everytobacco product packaging.
COMMUNITY CONSULTATION MEETINGS
Soo Wong, Health Educator, informed the Task Force that the meetings werewell received and that there was a good turnout, plus a number of writtensubmissions. Task Force members then discussed how to amend the format ofthe public meetings so that maximum benefit can be derived from the informationgiven and received.
The last scheduled public meeting is on March 9, 2000 at the Town of GeorginaCouncil Chamber, Keswick, from 7.00 – 9.00 p.m. Chair Frustaglio urged everyTask Force member to attend if possible.
Report No. 6 of the No-Smoking By-law Task Force ‘ENVIRONMENTAL SCAN’ INFORMATION: March, 2000
Various articles and newspaper clippings were distributed for discussionpurposes, including copies of the Burlington By-law that had been requested at aprevious meeting. Received.
The No Smoking By-law Task Force adjourned at 10.47 a.m.
Respectfully submitted,
March 1, 2000
J. Frustaglio
Newmarket, Ontario
(Report No. 6 of the No Smoking By-law Task Force was adopted, without amendment, by Regional Council at itsmeeting on March 9, 2000.)

Source: http://archives.york.ca/councilcommitteearchives/pdf/report%206,%20march%201.pdf