Local man pushes smoking cessation for veterans

Sen. Brown joins Urbana resident in fight against nicotine addiction.

Thousands locally are struggling to fight nicotine addiction, including an Urbana man whose struggling to quit smoking recently led to legislation ensuring military families can pay for prescription medications that might help.

Ohio Sen. Sherrod Brown recently included a provision in the National Defense Act that, if approved, would ensure military retirees and their families can receive coverage for FDA-approved smoking cessation prescription drugs.

Terry Levesque, of Urbana, has tried to quit smoking only to find his insurance did not cover prescription medication that would have helped him quit.

In the meantime, military members across the state often suffer from the affects of smoking. Nicotine addiction brings more veterans to the Cincinnati VA Medical Center for treatment and counseling than depression and post-traumatic stress disorder. About 17 percent of the 43,000 patients who visit the Cincinnati VA each year are treated for tobacco use disorder, using a handful of evidence-based therapies, said Dr. Shannon Miller, acting director of addiction services.

“Of all the addictions treated, tobacco is the most likely to kill (the patient),” Miller said.

In Urbana, Levesque said he contacted Brown after learning his TRICARE For Life military benefits did not cover Chantix, a prescription medication that helps adults stop smoking. Levesque served 20 years in the U.S. Navy, but began smoking in boot camp.

He has tried other methods to quit, including counseling, gum and lozenges. But the lozenges gave him constant hiccups, and none of the other methods were effective.

“I really believe kicking nicotine is harder than drugs or alcohol,” Levesque said.

Levesque’s doctor eventually prescribed Chantix, which seemed to work. Levesque soon learned that his TRICARE insurance did not cover the cost of the drug, meaning he had to pay out of pocket. That eventually became unaffordable, and Levesque has been trying to quit since.

TRICARE is a health insurance program for active-duty military members, but Medicare often takes over for retirees once they age into that program. TRICARE then fills most gaps in coverage. But TRICARE is currently barred from covering the cost of precription smoking cessation medication.

“The U.S. should not continue to sell discounted tobacco products on military bases but fail to provide our veterans with all the tools they need to quit tobacco,” Brown said. “We should ensure that adequate support is always available to all military personnel — both active duty and retired — who are seeking to quit tobacco use, including counseling, prescription drugs and other tobacco cessation products and services.”

Levesque said he’s happy with his medical coverage overall, but believes it would be beneficial to make the prescription drugs more attainable for retirees and veterans.

“I’ve been blessed, and maybe this is a way to give something back by making some noise,” Levesque said.

National impact

Veterans aren’t the only ones affected by nicotine addiction. Nationally, half of all hospital beds occupied are for tobacco-related diseases that kill 488,000 people per year. It’s the No. 1 preventable death, but still kills more than suicide, fires, drugs and crashes combined, according to Miller.

“When you look at all the medical problems that come from tobacco, the scope is so wide,” Miller said. They include cardiovascular disease, lung cancer, diabetes, asthma and infection.

Tobacco costs the U.S. more than $300 billion annually, including $170 billion in direct medical care for adults and $156 billion in lost productivity, according to the Centers for Disease Control and Prevention. Roughly $5.6 billion of that total is due to second-hand smoke exposure.

The tobacco industry spends more than $9 billion a year on cigarette advertising and promotion. In 2014, 264 billion cigarettes were sold in the U.S. — down from 273 billion in 2013, according to CDC.

While the rate of smokers continues to decline, it’s still tough to quit once you’ve started. It takes a smoker between four and eight attempts at quitting before sustained success, according to local addiction experts.

Miller said about 85 percent of smokers have reported trying to quit. At least one-third of smokers attempt to quit each year, with about 3-7 percent having success long term.

Miller also said the success rate is so low because many attempts are “unaided.” He added that for smokers who try to quit on their own, eight out of 10 will relapse within one month.

“We provide both therapies and medications, individual and group approaches,” Miller said, referring to the Cincinnati VA’s a staff of over 50.

Other programs at the VA include nicotine replacement therapy for detoxification; technology-based therapies such as a tobacco-specific text messaging service and video telemedicine; and relapse-reduction medications such as Chantix used in combination with talk therapy.

The rate of smokers in America continues to decline. In 1955, half of all adults were smokers. Awareness has helped to bring that rate down to below 20 percent.

In 2014, CVS/pharmacy announced it would stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide.

Data shows the number of opioid overdose deaths is 44,000 per year in the U.S. The rate of smoking-related deaths is more than 10 times that at 488,000 per year.

The number of smokers in Ohio is higher than the national rate, at about 25 percent of adults — or 1.8 million Ohioans. There were over 18,000 smoking deaths in 2010 in Ohio, according to Ohio Department of Health.

Science of nicotine addiction

Miller said the average age of first use is only 15 years old when the brain is still developing. With as little as one puff on a cigarette, a third of the brain’s receptors are occupied.

Experts say that the cigarette as a nicotine delivery system is highly effective because it hits the brain in just seconds.

“It turns on circuits in the brain that relate to pleasure,” Miller said. “The brain feels irritable and not right if you stop smoking. It turns from smoking for pleasure to smoking to relieve displeasure.”

There are three drugs approved by the Food and Drug Administration to help smokers quit. Experts say they give the person a 50 percent higher success rate by helping with the physical withdrawal. Other items such as nicotine gums, patches and lozenges play a role, too.

Smoking cessation trial

The Lindner Center of HOPE in Mason, Ohio, is one of over 15 sites in the U.S., Israel and Europe participating in a pilot study to determine the effectiveness of transcranial magnetic stimulation (TMS) technology in helping smokers quit, said Dr. John Hawkins, chief medical officer and deputy chief research officer at Lindner.

Anyone in Ohio can participate.

“We’re frequently comparing the power of nicotine and the power of opioids,” Hawkins said. “The subtleties of the drug make it stand out; you don’t even notice it (the addiction). It’s a seductive drug.”

The TMS technology by Brainsway was FDA-approved in 2008 to treat depression, and for the last year is being tested for smoking cessation and whether it helps to reduce cravings and use of cigarettes.

The trial includes a total of 18 TMS treatments that each last 18 minutes. During that time, 1,800 pulses of electromagnetic energy go to two parts of the brain. But Hawkins assures it’s nothing like shock therapy and the only reported sensation is the feeling of a rubber band tapping on the forehead in rapid succession.

The electromagnetic energy is “more targeted and better tolerated,” Hawkins said.

The addiction and mental health center is actively recruiting participants through the end of 2015. There are some stipulations. You must:

•commit for six weeks and want to quit smoking,

•have smoked at least 10 cigarettes a day for the last year,

•be a nicotine-only user,

•not have any head trauma issues or mental illness,

•be between the ages of 22 and 70.

Participants will also write a diary of the number of cigarettes used and their level of cravings. Nicotine levels are also tracked by urine analysis.

If you meet those requirements, call 513-536-0721 to start the telephone screening process.

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