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Addiction, Health Policy, In the News

Increasing access to an anti-overdose drug

In the past decade, the U.S. has experienced a surge of fatal opioid overdoses, driven partly by increased heroin use but mostly by the greatly expanded availability of prescription medications (e.g. Oxycontin). One important tool in combating this epidemic is naloxone, a drug that rapidly reverses the respiration-suppressing effects of opioids.  Expanding its use has been a goal of President Obama’s drug policy from the first days of the administration, and an increasing number of community members, health and social care workers and police have been trained how to administer it.  Some New York police officers give a powerful account of their experiences with the rescue drug in the video above.

However, with the increased demand for naloxone has come an increase in its price. It’s an off-patient medication, so in absolute terms costs are low (up to $40 for the nasal administered naloxone kits that police tend to carry and much less for the injected version distributed by many non-profit service organizations). But even low costs can be a barrier particularly if a drug is provided to cover an entire population (most of whom will never need it) rather than employed to treat an identified individual in need.

That’s why it’s encouraging that The Clinton Foundation has announced that it will attempt to lower the cost and increase the accessibility of naloxone, presumably using the same strategies that were employed successfully to achieve the same goals with HIV-related medications. Another potentially important effort, under consideration in the California legislature, is to allow naloxone to be distributed by pharmacists rather than requiring an individual prescription for everyone to whom it is provided.  Although the impact of this policy on public health can’t be known in advance, naloxone does not appear to have serious or common side-effects to weigh against it potentially life-saving benefits, which makes it more reasonable to have it be available over the counter.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and Prescription drug addiction: How the epidemic is shaking up the policy world

Addiction, Public Health, Research

What the experience of Swedish snuff can teach us about e-cigarettes

snusA new study in JAMA Internal Medicine suggests that e-cigarettes don’t help tobacco smokers quit.  This study will no doubt attract enormous attention because it relates to the hottest debate in tobacco control: Whether e-cigarettes are a boon or bane to public health. E-cigarette proponents see them as a way for cigarette smokers to transition to a less damaging way of consuming tobacco; opponents worry that e-cigarettes will entice non-smokers into using a product that will ultimately be a gateway to cigarette smoking. Until more definitive data are gathered on e-cigarettes, participants in this debate would do well to examine the experience of Swedish snuff (also known as “snus”).

Snus is a smokeless tobacco that is mainly used in Scandinavia. Its use is damaging to health, but because it is not smoked and contains a low level of cancer-causing nitrosamines, the damage to users and those around them from snus is less than that of tobacco cigarettes. The fundamental question at play in the current e-cigarette debate was also raised regarding snus: Would it be a net harm or a net benefit to public health?

A study of 15,000 Swedish males examined snus use and smoking among a younger (age 16-44) and older (age 45-84) cohort. About 18 percent of tobacco smokers had previously been snus users. This gateway effect from snus to cigarettes was more common for older than younger individuals.  However, in both cohorts, the reverse pattern was far more common, leading to an overall drop in tobacco smoking. Among the younger cohort, snus accounted for six smoking quitters for each smoking starter.  In the older cohort, the benefit was less: About two smoking quitters per starter. Given the size of these effects and the prevalence of snus use, it is entirely credible to argue that snus has contributed to the declining lung cancer rate in the Swedish population.

The Swedish results would seem to make a conclusive case for the public health benefits of snus. However, a subsequent study of 1151 Finnish men had starkly different results. Only 22 participants in the study had replaced tobacco smoking with snus use. The norm in this population was to use snus to supplement rather than replace cigarette smoking, tending to increase the physical dependence of tobacco users. Although not able to draw a definitive conclusion, the authors noted that “it is likely that snus use complicates the attempts to quit smoking”.

The science on snus is thus unsatisfying for those desiring a simple answer regarding the public health value of putatively less harmful forms of tobacco. In one context, snus was enormously beneficial. In another, it appears to have made things worse. The effect of snus also varied across historical time periods as younger and older people used it in distinct ways.

The experience of e-cigarettes may very well follow the same pattern – or perhaps it is better said – the same lack of a pattern. An empirically grounded, universally valid judgment on the impact of e-cigarettes may be difficult to attain. Whether they are a net positive or negative for public health will depend on the context in which they are used, the degree to which different generations adopt them, and the regulations society sets regarding them.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: E-Cigarettes: The explosion of vaping is about to be regulated
Photo by Ole C Eid

Addiction, Health Policy, In the News, Mental Health, Stanford News

We just had the best two months in the history of U.S. mental-health policy

We just had the best two months in the history of U.S. mental-health policy

For decades, descriptions of the status of U.S. mental health services have included references to service cuts, funding constraints and poor access to care. That makes it only more astonishing and important that the past two months have witnessed the most expansive support for mental-health services in U.S. history. Three critical pieces of federal legislation are responsible for this remarkable turn of events.

Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level

In early November, the Obama Administration released the final regulations for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPEA) of 2008. One of the very last laws passed during the George W. Bush Administration, MHPEA affects the more than 100 million Americans who receive their health insurance through large group employers. It mandates that any insurance plan that offers benefits for the treatment of mental-health disorders must make those benefits comparable to those for other medical disorders. In other words, the higher co-pays, more intensive utilization review requirements and lower benefit caps historically applied to mental health care are now illegal.

Just seven weeks after the final MHPEA regulations were issued, Medicare ended its decades-long practice of reimbursing outpatient mental-health care at a lower rate than care for all other disorders. Historically, Medicare had covered 80 percent of all outpatient care except for mental health care, which was reimbursed at only 50 percent. Due to the final implementation of the Medicare Improvements for Patients and Providers Act of 2008 (.pdf), this disparity was eliminated on January 1, 2014. That’s good news for the approximately 50 million Americans who are covered by Medicare.

Last but not least, as everyone knows the remaining provisions of the Affordable Care Act also came into force over the past month. The ACA had already helped families facing mental illness by allowing parents to keep their children on their insurance policies until the age of 26. That was critical because addictive and psychiatric disorders almost always have onset in adolescence or young adulthood. But an even more influential feature of the law is to define substance use disorder and mental-illness treatment as essential health care benefits, and, to specify that those benefits be at parity with benefits for other disorders, such as is specified in MHPEA. This standard will apply to all plans issued through state and federal health insurance exchanges and the Medicaid expansion, as well as to insurance plans to be issued in the future that are subject to ACA regulations. The HHS Office of the Assistant Secretary for Planning and Evaluation projects the impact of these changes as improving mental-health care coverage for more than 60 million Americans.

Of course, while the above changes all were implemented in the past two months, they each were the product of many years of advocacy by office holders, political activists, grassroots organizations, clinicians and researchers. These laws coming to fruition in such a compressed time window was fortuitous in some respects, but it also reflects a new political reality in Washington: Bipartisan support for mental-health services has probably never been this strong before at the U.S. federal level. That augurs well for American families who will face the challenge of mental illness in the coming years.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys

Previously: Managing primary care patients’ risky drinking, Full-length video available for Stanford’s Health Policy Forum on serious mental illness and How states will benefit from Medicaid expansion

Addiction, In the News, Patient Care, Public Health

Managing primary care patients’ risky drinking

Centers for Disease Control Director Thomas Frieden, MD, wants more physicians to screen patients for risky alcohol consumption. From a public health viewpoint, this makes great sense. Even at levels of consumption well below what are common among people whom we think of as “alcoholic,” heavy drinking is a risk factor for injuries, accidents and assaults. Ethanol can also interact dangerously with medications a doctor may prescribe (e.g., ibuprofen and other pain relievers, sleeping pills).

But historically, three barriers have stood in the way of physicians screening more patients for risky drinking:

  • Knowledge: There’s an old joke that using metal detectors to stop people from carrying guns (e.g., into schools) seems like a great idea up until the moment the detector goes off. If you screen for something, you’ll find it at least some of the time and be expected to respond. Some doctors don’t screen for risky drinking because they wouldn’t know what to do if they found it. Fortunately, over the past 20 years a brief counseling intervention has been developed and proven effective in multiple clinical trials. It’s an easily learnable technology that physicians find they can use across a range of patient health behaviors. But still, like any other clinical practice, it takes a long time to make these effective interventions a routine part of medical education and front line care
  • Reimbursement: Primary care doctors typically have a lot of work to do with each patient in a short amount of time. It was therefore hard to persuade them for many years to address risky drinking by patients, particularly as it was not a compensated activity. That has now completely changed with the creation of billable codes for screening and brief intervention for heavy drinking, the provision of a problem drinking screening benefit in Medicare and the Affordable Care Act’s inclusion of these interventions as an essential preventative healthcare benefit.
  • Psychological discomfort: The late Barry Rosen, MD, an outstanding addiction specialist and teacher, once listened to a psychiatric resident in my addiction medicine course say that asking patients about how much they drank was “too invasive, even rude.” Barry responded, “You think that’s invasive and rude when we are both part of the one profession that tells total strangers to ‘go into that examination room and take off all your clothes?’” Medical training should help doctors overcome their reticence by pointing out that if you can give a stranger a digital-rectal exam, draw their blood, tell them to take powerful medications and ask them about their safe sex practices, you can also ask them how much alcohol they drink.

In the future, as medicine becomes a team sport, doctors may oversee the care of risky drinking patients but not provide it directly themselves. One potential model of primary care is to have the team include a “habit specialist” who would use motivational counseling, behavioral change planning and monitoring to help patients with health behavior problems. This would certainly include heavy drinkers trying to cut consumption, but would include people attempting to lose weight, quit smoking and adhere to their diabetes care regimen. The VA is using psychologists in this role; Geisinger Health is using nurses. Both models seem a promising way to manage heavy alcohol consumption and other problematic health behaviors; it remains now to see whether they reduce the need for the acute care sufficiently for them to be economically viable across the entire health care system.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Photo in featured entry box by jenny downing

Addiction, Health Policy, Public Health

Breaking Good: How to wipe out meth labs

Breaking Good: How to wipe out meth labs

methlabEarlier today I testified about methamphetamine laboratories to West Virginia Governor Earl Ray Tomblin’s Advisory Council on Substance Abuse. Like more than a dozen other states in the “meth belt,” my home state is suffering from a wave of explosions, fires, burns, poisonings and environmental destruction stemming from laboratories operated by small-time “meth cooks.”  Fortunately, as I told the Advisory Council, this is a problem that we already know how to solve.

Meth cooks make their drug using pseudoephedrine (PSE), which they extract from certain cold medicines such as Sudafed. The precise proportion of these cold medicines that are purchased to produce methamphetamine is not known, but it is clearly very large. A recent study published in JAMA found that per-capita consumption of PSE-containing medicines in counties with meth labs exceeds that of counties without labs by as much as 565-to-1.

In light of this connection, the states of Oregon and Mississippi returned PSE-containing products to prescription-only status, which was how they were regulated until 1976. Meth labs have virtually disappeared in both states.

Most state legislatures in the meth belt have introduced legislation to copy Oregon and Mississippi’s approach, but these bills have all failed. Part of the reason is intense lobbying by the companies that produce PSE-containing products, but another part is that some voters and legislators believe that cold and allergy sufferers will have a hard time getting relief if a prescription for PSE-containing medications is required.

This worry is not usually well-founded, as there are more than 100 over-the-counter cold medications available which provide relief to almost all people with stuffy noses, fevers and the like. However, in the rare case of an individual who truly needs a PSE-containing medication, innovative biochemistry has come to the rescue with the development of medications that contain PSE that is harder for meth cooks to extract.

These companies created cold medications (e.g., Zephrex-D) which use polymers or lipids to bond with PSE in a fashion that reduces the possibilities for conversions to meth. Even if the possibilities for PSE extraction are reduced by only two-thirds by these new medications, meth cooks would effectively be put out of business because their required materials would exceed the value of the drug they make. Meanwhile, consumers with chronic allergies do not suffer reduced access to PSE-containing products.

The public policy option available to meth belt states is thus something that should satisfy all parties. PSE-containing cold medications would be returned to prescription-status, with an exemption for such medications that independent laboratories prove yield only a de minimus amount of PSE for meth preparation.

It’s a rare opportunity for a clear win-win in public policy. That’s why I strongly encouraged Governor Tomblin’s advisors to pursue it with courage and enthusiasm.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. Dr. Humphreys has no financial or personal connections to any company that produces cold medications (extraction resistant or not).

Previously: Examining how addiction in the U.S. has changed over the last decade, Can an antidepressant help meth addicts stop using?, The Florida Governor’s questionable actions on drugs and Stanford Health Policy Forum focuses on America’s methamphetamine epidemic
Photo by 16 Miles of String

Addiction, Media, Research, Science

The disturbing trend of science by press release

The disturbing trend of science by press release

The Washington Post, Christian Science Monitor and Time were among the respected media outlets that recently covered the sensational alleged scientific finding that Oreos are as addictive as cocaine. Some journalists contacted me for my reaction, and I said I would get back to them after I read the study. I searched on PubMed and it wasn’t there. I looked through the “on line early” section of leading journals and it wasn’t there either. Neither could I find it in the published proceedings of any conferences.

Relapsing to a simpler approach, I Googled “Oreos and cocaine” and found the sole source of information available: A press release about an undergraduate research project at Connecticut College in New London, Connecticut. It is to the credit of the mentor on the project, Joseph Schroeder, PhD, that he’s teaching bright young people how to do science. I wish, however, he had also taught them something else: The role of peer-review in the promotion of scientific quality and credibility.

Putting out a sensational press release before experts in your field have had a chance to evaluate your scientific work is bad for science and bad for society

A leading scientist in the addiction field, Edythe London, PhD, of UCLA, was able to identify fatal flaws in the Oreo research even on the basis of the limited information in the press release. You can read Dr. London’s discussion of those problems if you wish, but my purpose here is to address a larger point: Putting out a sensational press release before experts in your field have had a chance to evaluate your scientific work is bad for science and bad for society.

The Oreo news stories were upsetting to people struggling with cocaine addiction as they trivialized the problem they face. Judging by the comments on many of the news websites covering the story, the study also fueled many people’s bias that taxpayer dollars are being wasted on studying silly topics. Granted, these harms are less serious than those that occurred when Andrew Wakefield, MD, intentionally deceived many journalists into reporting that the MMR vaccine caused autism, but that still doesn’t make it good practice to report initial findings as facts in the media before one’s work has been peer-reviewed.

Credibility-straining press releases are unfortunately becoming more common in science. And even when a finding is real, a press release can distort its meaning. For example, the recent Qesem cave discovery of fossils from homo sapiens was considered a genuine achievement by experts in physical anthropology and was published in a peer-reviewed journal, but the accompanying press release made wild claims about human evolution that were nowhere to be found in the article. When the shocking claims in that press release were disseminated by journalists, the public was misled and the science was cheapened.

Sensationalized press releases about scientific findings unfortunately can be much more widely disseminated today than in prior eras. Science journalists once had the time and resources to do more shoe leather reporting, conduct follow-up interviews with the scientific team, and interview independent scientists to obtain a careful critique of the findings. But today, as Paul Costello, chief communication officer for Stanford’s medical school, told the Columbia Journalism Review, the “shift to new media Web site traffic” is putting added pressure on reporters, leading some to cut corners in the name of more copy, “often writing right off press releases, even at the good papers.”

If science journalists can no longer be depended on to sort the wheat from the chaff, scientists are going to have to assume more responsibility for self-restraint when they release findings to the press. All of us would like to believe that we never make mistakes in our scientific work. All of us are capable of becoming overly enthusiastic about a pet theory before our colleagues have subjected it to criticism. And all of us can be tempted to hype our findings as a way to draw some gratifying attention to ourselves. But when we give in to those human frailties in our interactions with the media, we undermine our collective credibility and may also harm members of the public who act on the assumption that our claims have been rigorously evaluated.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: The influence of medical press releases on news coverage quality and The problem with “science by press conference”

Events, Health Policy, Mental Health, Patient Care, Stanford News

Upcoming Stanford Health Policy Forum to focus on mental illness

Upcoming Stanford Health Policy Forum to focus on mental illness

The horrifying mass murders at the Washington Navy Yard and Sandy Hook Elementary School were both committed by individuals with long-standing mental-health problems. The events galvanized a national discussion about how to improve the accessibility and quality of our mental-health system.

At the same time, these tragedies can paint in the mind of the public a false image of the mentally ill as universally violent and dangerous rather than human beings in need of assistance and compassionate care. That may account for why a shamefully large number of mentally ill people are behind bars. L.A. County Sheriff Lee Baca has found himself heading what he calls “the nation’s largest mental hospital:” The L.A. County Jail.

While protecting public safety is a critical concern, it’s important to maintain perspective when analyzing the role of mental illness in violent crime. Harold Pollack, PhD, of the University of Chicago puts it this way:

Millions of Americans suffer from some form of severe mental illness, or SMI. It’s important to remember that the vast majority of these men and women have never committed a violent crime and never will commit one. Indeed, the mentally ill are often victims of violent crime, a social problem that has not received sufficient attention.

To dig into these important issues in a productive way, the medical school’s next Health Policy Forum will be devoted to the topic “Serious Mental Illness: How can we balance public health and public safety?” Harold Pollack and Lee Baca will come to Stanford for the forum and will be joined by our own Laura Roberts, MD, chairman of the Department of Psychiatry and Behavioral Sciences. The policy forum is open to the public and will be held this Thursday from 11:30 A.M. to 1:00 P.M, at the Li Ka Shing Center. If you’re a local reader, we hope you can attend and join in the conversation.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: Examining mental health policies in the wake of school shooting tragedy, Probing the underlying physiological causes of mental illness

Addiction, Health Policy, Public Health, Public Safety

How police officers are tackling drug overdose

police car

Drug overdose is now the most common cause of accidental death in the United States, primarily because of the vastly increased availability of pharmaceutical-grade opioids (e.g., Oxycodone, Vicodin). The size and impact of the epidemic can be lessened by a range of public policies, including one that the White House has been touting: Equipping first responders with naloxone hydrochloride.

In opioid overdose, breathing slows to a very low level or even stops completely, which deprives the brain of oxygen. Death or permanent organ damage can be the horrifying result. Enter naloxone, an old, off-patent (and hence inexpensive) medication with a powerful ability to force opioids out of brain receptors. Overdose is thus rapidly reversed.

Naloxone does not cure addiction. Nor does its effect last more than 30-90 minutes. However, that window of time can be used to get the overdosed person to a hospital and subsequently it is hoped into addiction treatment.

Police officers and fire fighters are often the people who discover people who have overdosed. They typically call for medical backup in such cases, but even if the EMTs take only 15 minutes to arrive, that can be too late. Training in how to recognize overdose and to then administer naloxone allows those first responders to save lives that would otherwise be lost.

Police in Quincy, Massachusetts began carrying naloxone in their cruisers in October of 2010, and have been reversing about one overdose every ten days since. Police and firefighters in other parts of the country are now copying Quincy’s successful approach.

The Obama Administration’s embrace of improving naloxone’s availability is one of many signs of how quickly U.S. drug policy has moved in a public health direction. Only a few years ago, drug policy officials in the G.W. Bush Administration condemned the use of naloxone. Today, Obama drug policy officials give out awards to successful naloxone access expansion programs. The result will be fewer overdose and more chances for people with addictions to receive the help they need to become healthy and productive.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: Do opium and opioids increase mortality risk?
Photo by Scott Davidson

Addiction, In the News, Public Health, Women's Health

Alcoholism: Not just a man’s problem

Alcoholism: Not just a man’s problem

empty vodka bottle - big

Updated 11:45 AM: Audio from the Forum show is now available here.

***

When I first started working in alcoholism treatment programs 25 years ago, women were a rare sight. But as with every other arena of American women’s lives, things have changed dramatically since. Far more women drink alcohol and far more end up developing alcohol problems.

The change is particularly stark in the college setting, including at Stanford. Once primarily a young man’s game, risky drinking at college is now as much or even more common among women.

The change is sometimes attributed to women being under greater stress today than in prior eras, but that is improbable. Women’s lives are in fact substantially better in the past few decades: Their incomes are up and sexual violence against them is down, for example. And as any female senior citizen could attest, it’s not as if life for women was stress-free until now.

More likely explanations are that alcohol companies have directed advertising much more heavily at women, and that the cultural stigma against heavy drinking by women has waned. Women have more freedom to do many “male things” than ever before, which is in most respects a wonderful thing. But there are negative consequences when women engage in dangerous behavior normally more characteristic of men, such as heavy alcohol and tobacco consumption.

Through metabolic mechanisms that are not fully understood, women experience greater physical damage from the same amount of alcohol than do men. That’s why safe drinking guidelines are lower for women than men.

I’ll discuss these issues on KQED’s Forum at 10 AM Pacific time today with Gabrielle Glaser, author of a new book on drinking problems among women. Please listen in and add your thoughts if you can.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: Examining how addiction in the U.S. has changed over the last decade, College without booze: harder than it sounds, A sobering study suggests that binge drinking may lead to permanent brain damage, Fighting binge drinking on campus and TV characters’ drinking problems: Not that funny
Photo by Peter Gene

Pregnancy, Public Health, Women's Health

Quitting smoking for the baby you plan to have together

Quitting smoking for the baby you plan to have together

My best friend finally succeeded in his efforts to stop smoking when he experienced a highly motivating life change: Fatherhood. Likewise, many women discover that wanting to have a safe and healthy pregnancy gives them unprecedented desire to kick their tobacco habit. Knowing the research and clinical evidence may be useful to parents-to-be who have some questions about smoking:

  1. Quitting smoking is very hard – does it really make enough difference to be worth it?  Yes. To get one sense of the impact of smoking on fetal development, recall the widespread panic in the 1980s about “crack cocaine babies.” Subsequent research has shown that the damage to fetuses of cigarette smoking is in fact worse than that of crack cocaine use. Even if it didn’t benefit the fetus (and later, the infant) for a mother to quit smoking, it would still be worth using the extra motivation to quit that pregnancy provides for the sake of the mother’s long term health.
  2. When is the best time to try to quit? Early. In an excellent lecture I saw last week, Professor Zachary Stowe, MD, with the University of Arkansas for Medical Sciences, pointed out that the soonest a woman can know she is pregnant is 4-6 weeks after conception, at which point fetal organogenesis is well underway. Further, Stowe and other researchers have conducted research identifying nicotine and its metabolites in the fetal compartment even after the mother has stopped smoking. Dr. Stowe therefore suggests that rather than waiting to quit until after stopping birth control or after pregnancy has been confirmed by a test, a mother-to-be should wait two weeks after quitting smoking before going off birth control. Note: Even if you didn’t do this, quitting smoking at any point later in the pregnancy is still good for the fetus (and for you too).
  3. I smoke, but I’m not carrying the baby, so why does it matter whether I quit? This isn’t just about mom. Passively absorbed smoke contributes to nicotine in the fetal compartment, meaning that even if the mother quits, smoking by her partner may affect the fetus. Also, an added benefit to a couple of quitting together is suggested by research and clinical experience in addiction treatment: Relapse is more likely when the visible, auditory and olfactory cues of substance use remain in the environment. Hence, a mom-to-be is going to have a much harder time quitting cigarettes if her partner remains a smoker. More positively, if two people quit together they can remove those cues from the environment and also have built-in social support for resisting the cravings they both may experience.
  4. Where can we get help with smoking cessation? Free resources are just a click away here. If you need extra support, consult your physician, who can help you both with smoking cessation and with other conditions you may have (e.g., depression) that make it hard to quit.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: Craving a cigarette but trying to quit? A supportive text message might help, Exercise may help smokers kick the nicotine habit and remain smoke-free, Kicking the smoking habit for good and Can daily texts help smokers kick their nicotine addiction?
Photo by YOUscription

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