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State will fund remedies for quitting smoking

Wed., July 2, 2008

Brent Seeberger spent half his life smoking cigarettes.

He tried quitting, turning to hypnotism and an antidepressant drug.

Not even peer pressure, applied by his co-workers at the Spokane Regional Health District, could make him stop.

But the motivation to quit a habit that was costing upward of $150 a month led him to varenicline, a prescription drug developed and marketed by Pfizer under the brand name Chantix.

Seeberger went to the doctor, collected a prescription, paid a couple hundred dollars in drug and clinic bills and “Bang! I was smoke-free within three weeks.”

He hasn’t smoked in 15 months, although cravings arise. “I’m not going to call it a miracle pill,” he said. “But for me, as someone who never really liked the patch or gum, it sure worked.”

While nicotine replacement remedies have been subsidized by government health programs for years, the cost of smoking-cessation drugs such as Chantix has been a barrier for smokers, especially low-income smokers, said Jennifer Hansen, a public health educator for the district.

But that’s changing.

Washington state will now pay for such drugs for Medicaid recipients, 160,000 of whom smoke. In a county such as Spokane, where one in four adults smokes, the new benefit could bring that number down. “We know that as income levels go down, smoking goes up,” Hansen said. “That’s why the Medicaid benefit can be so encouraging.”

Spokane’s smoking rate is higher than state and national averages. Perhaps more troubling: 19.4 percent of pregnant women smoke, compared with 10.2 percent statewide.

In real numbers, 1,050 infants were born to mothers who said they smoked during pregnancy. Hansen said officials suspect the number is actually higher.

Smoking during pregnancy is tied to higher rates of Sudden Infant Death Syndrome, premature birth and health problems.

The state will dig deeper to pay for the new benefit, expecting 8,000 people to take advantage of the changes within the first year.

And it doesn’t look like subsidizing smoking-cessation prescription drugs will save money by reducing health care costs, at least not immediately.

Although Washington spends $2.6 billion a year on Medicaid – including $651 million on smoking-related problems – a 2002 cost-benefit analysis found that most Medicaid patients who stop smoking take up the habit again.

The poor success rate led to the Washington State Institute for Public Policy to conclude that cessation programs do not save money in the short term. Long-term savings weren’t included in the study.

Problems with quitting afflict people at all income levels.

Gwen Dutt, a county worker who claims her truck won’t start unless there’s a cigarette burning in the cab, has tried it all: gum, patches, hypnosis, acupuncture, counseling, leaving her smokes in the truck during the cold of winter and quitting cold turkey.

She has even taped her fingers together.

“I used Scotch tape. Maybe I should have used strapping tape,” she said.

Nothing worked, so she tried Chantix.

That failed, too. “You know, I’m happy-go-lucky and then I turned into this person who just wanted to go home and kick the dog,” she said.

“I just wasn’t fully aware or prepared,” she added, acknowledging that three decades of smoking 1 ½ packs a day has left her with a nagging cough. Climbing stairs leaves her short-winded.

“There isn’t a day that goes by that I don’t think of quitting,” Dutt, 57, said. “I quit drinking and swearing a long time ago. But this is hard. Maybe I’ll try Chantix again.”

While Chantix enjoys popularity for its effectiveness, it has gained a degree of notoriety for its possible side effects, including depression, nausea, constipation, gas and vomiting.

Seeberger said he had weird dreams while taking the cessation drug.

Hans Rollema, the scientist credited with leading Pfizer’s development of Chantix, said during a June visit to Spokane that the drug “takes the fun out of smoking.”

That’s because Chantix is not a nicotine replacement drug. Rather it helps keep the addictive nicotine from reaching key receptors in the brain, eliminating the pleasurable buzz.

There are more than 7 million prescriptions for Chantix; about a third of people who take it have reported success.

“It’s not for everyone,” Rollema said, “but I am happy that it has helped so many people.”


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