MPS: Cigarette “kiddie packs” will not help anti-smoking efforts
“Opt for smaller cigarette packs to counter illegal cigarettes”, ran an article in The Malay Mail Online on 26 August 2017. In response to the ensuing debate over the topic, the Malaysian Pharmaceutical Society (MPS) issued an official statement, reproduced below; in reaching out for further comment, MIMS Pharmacy received an additional overview of smoking cessation services from an MPS representative. The contents of that overview have been summarized in the second half of this feature.
Referring to the Malaysia Singapore Coffee Shop Proprietor’s General Association’s suggestion to restore pack sizes to less than 20 sticks (kiddie packs) to the Malaysian market in order to reduce circulation of illegal cigarettes, the MPS adopts a grave view of this suggestion as the MPS believes there are two separate issues at play here, namely the issue of cigarette pack size and the issue of illegal cigarettes.
In light of the government’s efforts to reduce smoking across the nation, the restoration of the “kiddie pack” would be a step backwards and does not carry any benefit for the people or for the country.
As one of the key stakeholders in the efforts to reduce smoking in Malaysia, the MPS believes that efforts implemented by the government in 2006 to ban “kiddie packs” should be carried on and supported by all.
Accordingly, the government is committed to make Malaysia a smoke-free country by 2030 or some other reasonable year. There are indeed other countries in the world which have already set such a target, such as New Zealand, Singapore and Bhutan.
The MPS also recommends that the government conduct closer surveillance on the smuggling of illegal cigarettes into the country by unscrupulous parties. In terms of overall usage, 60% of cigarettes in the country come from the illicit cigarette trade. This indicates that Malaysia is severely plagued by an illicit cigarette pandemic. Due to the lower sale price of illegal cigarettes, the number of underage smokers has in turn increased.
The MPS also appeals for stricter laws so that heftier penalties may be imposed on those involved in the illegal cigarette supply chain, whether this be in the form of longer jail terms or larger fines.
The MPS will work closely with the government to facilitate efforts to reduce cigarette- and electronic cigarette-addiction in the country.
According to the 2015 National Health and Morbidity Survey (NHMS), an estimated 5 million Malaysians, 22.8% of the population, are smokers. Meanwhile, according to the World Health Organization, approximately 600,000 people die each year as a result of exposure to cigarette smoking or passive cigarette smoke, with 28% of these being children.
The MPS is one of the key stakeholders in the campaign against cigarette- and electronic cigarette-dependence. Pharmacists who have been trained in mQuit activities are always prepared to provide smoking cessation services to patients and consumers.
Helping smokers quit and helping others to help smokers quit
The mQuit programme is the national smoking cessation programme by the Ministry of Health (MOH) for current smokers under the larger national strategic plan for tobacco control, which aims for a tobacco-free country. As such, mQuit is a joint effort involving both public and private sectors. Collaborative partners include the Universiti Malaya (UM), Universiti Sains Malaysia (USM), the Malaysian Academy of Pharmacy (MAP) and Johnson & Johnson (J&J).
Objectives of the mQuit programme include enlarging coverage and access to smoking cessation services for those who want to quit smoking; conducting equivalent training and accreditation for such services in the public and private sector; carrying out comprehensive promotion of such services; involving employers in carrying out related value-added programmes and activities; and developing a monitoring system that enables integration of the public and private sectors.
As part of mQuit services, phone counselling services known as Quit Lines are available under the Ministry of Health and USM. Both services refer patients to public or private accredited smoking cessation services when drug treatment is required based on personal choice.
Promotional and advocacy activities are also being carried out with collaboration between the MOH and J&J to promote smoking cessation among the community, encourage employers to support employees who wish to stop smoking and promote accredited services.
In addition to these, the MOH checks and endorses mQuit accreditation requests, while technical expertise for training purposes is provided by UM and the MAP.
For a privately-run smoking cessation service to be mQuit-accredited, it must adhere to five conditions. First, the service must have a dedicated area or counselling room to carry out counselling sessions; it must have available CPG (clinical practice guidelines) reference materials; it must have a documentation and monitoring system as required; it must make available basic promotional materials endorsed by the MOH and it must provide pharmacological services and follow-up treatment according to CPG.
The MPS, working with the MAP, conducts competency level assessment using the Objective Structured Clinical Examination (OSCE) approach for assessment of smoking cessation-related competencies among community pharmacists through workshops.
These workshops train participants in providing clear and accurate information about strategies for quitting tobacco addiction; demonstrating effective application of counselling theories and strategies to establish a collaborative relationship and facilitating client involvement in treatment and commitment to reverse their dependency.
In addition, the workshops cover techniques such as conducting comprehensive assessment interviews for effective treatment planning; developing an individualized treatment plans using evidence-based treatment strategies; providing clear and accurate information about pharmacotherapy options available and their therapeutic use; providing available methods to reduce relapse and provide ongoing support for tobacco-dependent persons and methods for tracking individual progress, record keeping, program documentation, outcome measurement and reporting.
Training is divided into two parts, with the first part consisting of a Certified Smoking Cessation Service Provider (CSCSP) programme, available online. The second part involves face-to-face training updates to the CSCSP programme and the OSCE, which assesses the competency level of participants. The first round of training began in February 2016 and is ongoing in coordination with the MPS Area Committee for suitable dates and venue.
To date, there are approximately 90 mQuit-trained providers. However, over 1,500 pharmacists have been trained in total through the CSCSP programme, and they continue to provide smoking cessation services in locations throughout the country, including public health clinics.