How can pediatric providers prescribe nicotine replacement therapy (NRT) to parents of their patients if the parents are not the patients themselves?
An American Medical Association (AMA) policy “supports efforts by any appropriately licensed health care professional to identify and treat tobacco dependence in any individual, in the various clinical contexts in which they are encountered.”
A 2015 policy statement from the American Academy of Pediatrics (AAP) recommends that all pediatricians screen for secondhand smoke exposure, and should utilize both the state Quitline and pharmacotherapy in treating nicotine dependent parents.
Many pediatricians prescribe medications for adults in certain clinical scenarios – pertussis prophylaxis, meningitis prophylaxis, and scabies – to name a few. You should check with your medical liability before prescribing to a parent.
Note that an adult can buy NRT over the counter, so you are prescribing what they would be able to buy themselves – the benefit to them is that their insurance will cover the NRT if you prescribe it. Additionally, smoking a cigarette releases over 7,000 chemicals, so using NRT is much safer since there are no associated poisons released from tobacco combustion.
There are a very few people who may not be able to use the patch/gum (see below), but it’s good to keep in mind that using the patch/gum is MUCH safer than smoking a cigarette, both for parent and child.
Are there any contraindications to the patch/gum?
Yes – there are a few. You should make sure to screen for any relative contraindications to NRT, namely:
- Pregnancy/lactation (gum only – refer to the OB caring for the patient)
- Heart attack within the last 2 weeks
- History of angina, chest pain, or any cardiac condition requiring medication
- Severe skin condition (for patch)
Does health insurance cover NRT?
The patch/gum may be covered by the parent’s insurance. Coverage varies by county, but most insurance companies do cover at least a portion of NRT. Thanks to the Affordable Care Act and expansion of Medicaid, more people will have health coverage, and smoking cessation therapy should be covered as a preventive health service.
We can help you investigate coverage in your area. Please see our Medi-Cal managed care plan page for more information.
How much does NRT cost if someone doesn’t have insurance?
Some parents don’t have health insurance and will need to purchase the patch/gum. For 4 weeks of treatment with the patch and gum for someone who smokes 1 pack/day, the cost ranges from $90-150, depending on products chosen. (A July 2013 online shopping comparison showed that Target seems to have the least expensive gum and patches when compared to CVS, Costco, Walgreens). Cigarettes for that same smoker over that same time period would cost $200.
How do I figure out which patch is right for my patient?
We review prescribing NRT in the online training. Essentially, each cigarette is equivalent to about 1mg of transdermal nicotine, so if someone smokes 1 pack (20 cigarettes)/day, they should start with a 21 mg patch and wean down from there.
Why use the patch and the gum?
Dual therapy is now the standard of care for smoking cessation, which means you should prescribe both the patch and the gum. The patch provides a steady level of nicotine to blunt withdrawal symptoms, and the gum provides nicotine spikes during times of craving.
Can my practice bill for smoking cessation counseling?
YES! Here is a link to some great resources to help you get paid smoking cessation counseling.
Does the CEASE training cost anything?
No, it’s FREE! Thanks to our major funder First 5 California, this training is provided at no cost to you.
How long is the training?
- The total training time is about 1 hour:
- The first part is an online training module that participants complete by themselves on a computer (25 minutes)
- The second part is a meeting facilitated by a clinic staff person (the facilitator) to discuss implementation of the CEASE program (35 minutes)