Thursday June 01, 2023

Tobacco control efforts eclipsed by lack of policy

October 11, 2020

Islamabad : Even though some cosmetic measures are in place to encourage smokers to quit, Pakistan’s overall progress in terms of implementation of tobacco cessation interventions is, at best, sluggish. It is time the government allocates funds for sustainable implementation of tobacco control laws and announces the much-delayed National Tobacco Control Policy so that well-directed efforts can be made to control the rising incidence of smoking.

What further evidence can the government require for adoption of aggressive policy interventions in a country where there are 24 million tobacco users, where tobacco use claims 100,000 lives every year, where only 24.7% smokers make quit attempts (as opposed to 40-50% in other countries), and where a negligible 2.6% users actually succeed in quitting the addictive habit?

“Tobacco cessation is not a standalone intervention. The provision of cessation services constitutes just a fraction of the tobacco endgame package of interventions. All paradigms of tobacco control are included in the draft National Tobacco Control Policy, which the Ministry of National Health Services is preparing to announce shortly,” stated Dr. Minhaj us Siraj, Director of the Smoke-Free Cities Project.

Talking to ‘The News’ here Saturday, Dr. Minhaj recounted key tobacco cessation measures implemented under his guardianship. “We have a dedicated quit line (0336-5655654) for smokers; this number is widely publicized so that more and more smokers can be supported in their struggle to quit,” he informed. Smokers, however, believe there is room for improvement in terms of the operational readiness and efficacy of the hotline. Most of the callers are advised to visit the National Institute of Rehabilitation Medicine (NIRM), with no active guidance being extended.

Sharing specific data, Dr. Minhaj said, the quit line received 2,371 calls during the period between January 1, 2015 to September 1, 2020. Of these, 47 were international calls. Within Pakistan, 1,065 calls were received from smokers in Punjab, 832 from Islamabad, 176 from Khyber Pakhtunkhwa, 121 from Sindh, 43 from Balochistan, 58 from AJK, and 29 from Gilgit-Baltistan.

Of the 2,371 smokers registered through the quit line, 1,439 were referred to NIRM, which houses a tobacco cessation clinic, and of the 1,439 smokers referred to NIRM, only 73 succeeded in quitting smoking during the last five years. Another 932 callers availed online consultations. In a country hosting 24 million tobacco users, the quality and scale of existing cessation services leaves much to be desired.

The only other cessation clinic in Islamabad is housed within PIMS but is dormant ever since the closure of OPDs in the wake of COVID-19. Moreover, PIMS has only one psychologist as opposed to 8 in NIRM. “We plan to reopen the clinic by end-October,” Dr. Minhaj said. So, the wait will finally be over for smokers requiring psychological counseling, Nicotine Replacement Therapies (NRTs), or even admissions in case of withdrawal symptoms. Referring to the availability of NRTs, Dr. Minhaj said, “It took us three years of hard persuasion to get NRTs included in the NEDL in 2017. Since no import duty is hence levied on NRTs, their prices have automatically declined.” Dr. Minhaj also stated that tobacco use tops the checklist of parameters causing disease progression in patients suffering from NCDs.

The above facts notwithstanding, it is also true that very few smokers are aware of the existence of cessation clinics or the availability of quitting services. Respondents of an Islamabad-based study had no knowledge about any smoking cessation clinic in the capital. Most of the smokers had made at least one attempt to quit, and despite the urge to give up smoking, the attempts proved unsuccessful.

It is difficult to comprehend what is keeping the draft National Tobacco Control Policy from being finalized. One way to compensate for the delay is to ensure the inclusion of durable smoking cessation mechanisms as an integral feature of tobacco control efforts in line with Article 14 of the FCTC. Anti-smoking efforts made in the past few decades have failed to yield the desired results. Like the UK, which has successfully used harm reduction to achieve a decline in smoking prevalence, Pakistan too must join the league of countries adopting innovative methodologies to turn the tide against tobacco use.