Frequently Asked Questions

This page provides answers to some frequently asked questions about smoking and becoming smokefree.

Quitting Smoking

  1. Where do I go to get more training in how to help people to quit?
  2. Can I still advise people about becoming smokefree if I smoke?
  3. Where can I read about what has helped other people become smokefree?
  4. Where can my I get information/pamphlets to give clients and staff about quitting?
  5. Which medications are effected by smoking and which might be effected when someone gives up?

NRT (Nicotine Replacement Therapy) Questions

  1. Is NRT safe?
  2. How much does it cost and where can one get it?
  3. Is it possible to overdose on NRT or nicotine?
  4. Is NRT addictive?
  5. What happens if someone smokes while using NRT?
  6. I've heard NRT can give you weird dreams. Is this true?
  7. Does NRT interact with medications?
  8. Why use both patch AND gum?
  9. What if someone has tried NRT before and it didn't work?

 Smokefree Environments & Premises

  1. Do mental health and addictions services have to be smokefree by law?
  2. Where can I get 'no smoking' signs to put around our organisation's premises?
  3. Why should our organisation have Smokefree premises?
  4. What are the benefits to Smokefree sites?
  5. Isn’t the Smokefree policy is an infringement of human rights?
  6. Who will enforce the Smokefree premises?
  7. Is it best to have designated smoking areas and phase them out later?
  8. Won’t the Smokefree policy push smokers onto the street and give our organisation a bad look?

Quitting Smoking

Can I still advise people about becoming smokefree if I smoke?

Absolutely! In some ways you may feel slightly uncomfortable, but when you are working with a client your role is to look after their wellbeing.

There are no drug interactions with NRT. However smoking effects the way some medications are metabolised. For this reason, when someone stops smoking the dosage of some medications may need to be adjusted. As a general rule therapeutic drug monitoring should be carried out following smoking cessation and dosage adjustments should be made accordingly. See the NZ Smoking Cessation Guidelines for more information on medications which may be effected by stopping smoking.

Which medications are effected by smoking and which might be effected when someone gives up?

Smoking tobacco can alter the metabolism of a number of medicines. This is primarily due to substances in tobacco smoke, such as hydrocarbons or tar-like products that cause induction (speeding up) of some liver enzymes (CYP 1A2 in particular). Therefore, medicines metabolised by these enzymes are broken down faster and can result in reduced concentrations in the blood (see table below). When a person stops smoking, the enzyme activity returns to ‘normal’ (slows down), which may result in increased levels of these medicines in the blood. Monitoring and dosage reduction may often be required.

Medication Effect of smoking

Caffeine Increased clearance (by 56%)
Chlorpromazine

Decreased serum concentrations (by 24%)

Clozapine Decreased plasma concentrations (by 28%)
Estradiol Possibly anti-estrogenic effects
Flecainide

Increased clearance (by 61%)

Fluvoxamine

Decreased plasma concentrations (by 47%)

Haloperidol

Decreased serum concentrations (by 70%)

Heparin Increased clearance
Imipramine Decreased serum concentrations
Insulin

Decreased absorption due to poor peripheral blood flow

Lidocaine Decreased oral bioavailability
Olanzapine

Increased clearance (by 98%)

Propranolol

Increased oral clearance (by 77%)

Tacrine

Decreased mean plasma concentrations (3-fold)

Theophylline Increased metabolic clearance (by 58 to 100%)
Warfarin

Decreased plasma concentrations (by 13%)

Stopping smoking can result in the opposite of the effects noted above.

Health care workers should be aware of the potential for increased blood levels of some of these medicines when smoking is stopped. Blood levels of some (for example, clozapine, theophyline) may need to be monitored.

NRT (Nicotine Replacement Therapy) Questions

Is NRT safe?

Yes. NRT only contains nicotine to replace the nicotine found in tobacco which is the addictive chemical in tobacco that keeps people smoking cigarettes. Tobacco smoke however has approximately 4,000 chemicals- 43 of which are cancer causing in addition to the nicointe. Therefore, it is safe to use nicotine replacement therapy.

How much does it cost and where can one get it?

You can buy NRT at supermarkets and pharmacys but the cheapest way is when you have a quit card or prescription. This way NRT will be subsidised and cost only $5 for an 8 week supply of any one product (patches, gum or lozenge). Quit cards and prescriptions are redeemable at any pharmacy.

Is it possible to overdose on NRT or nicotine?

Nicotine overdose associated with NRT use in smokers is uncommon. Smokers are generally used to very large doses of nicotine which they receive from smoking tobacco. The most common adverse effect of too much nicotine is nausea and this is easily managed by reducing the dose.

NRT can be dangerous if consumed by children, so if this happens, contact your emergency health facility.

Is NRT addictive?

Although NRT contains nicotine it is very unlikely that someone will become addicted. This is because there is less nicotine than in cigarettes and the nicotine is released slowly from the NRT. A few people continue using the gum and lozenge long term, and there is not problem with this.

What happens if someone smokes while wearing a patch?

They may feel nauseous, however it is important that they continue to war the patch. The overall aim is for someone to become smokefree, but it is not a contraindication to smoke while using NRT. If someone is still craving while wearing the patch they may need more NRT to reduce their craving.

Why use both patch AND gum?

Studies have shown that the chance of a successful quit attempt is higher when people use a combination of NRT products eg. patch and gum or patch and lozenge. Because the nicotine in patches can take up to 2-3 hours to take effect, it can be beneficial to use lozenges or gum in combination with patches as these take effect faster (within approx. 15-20mins).

I've heard NRT can give you weird dreams. Is this true?

Some people (but not all) do experience vivid dreams or disrupted sleep while using NRT overnight. If this is disturbing you, you can try taking the patch off overnight. If you are feeling cravings during the night or first thing in the morning, a lozenge or gum first thing when you wake will help before a new patch will take effect.

Does NRT interact with medications?

NRT itself does not interact with medications, but smoking can effect the way some medications (especially some medications commonly prescribed for mental illness) are processed by the body. For this reason, when someone stops smoking the way their  medications effect them. It may be that when someone stops smoking (and starts using NRT), they may need to reduce their dose of medication. It is important that when someone stops smoking, the clinical team involved with their care are informed.

What if someone tried NRT before and it didn't work?

There maybe several reasons that someone may feel that NRT didn't 'work' for them. If someone expects NRT to put them off smoking altogether, they may feel that it hasn't 'worked'. NRT should ease withdrawals and reduce cravings but it is important that they are using it correctly. Previously they may not have been using enough NRT to help with them, they may have been using it incorrectly (eg. putting a patch on a hairy arm), or not using it for long enough. Addressing these issues will hopefully help people get the best benefit from NRT.

Smokefree Environments & Premises

Do mental health and addictions services have to be smokefree by law?

The Smoke-free Environments Act (as amended by the Smoke-free Environments Amendment Act 2003) requires employees to take all reasonably practicable steps to ensure that no person smokes at any time in the internal areas of the workplace. The definition of “workplace” includes mental health  and addictions facilities, hospital care institutions; residential disability care institutions; and rest homes. However clients and residents may smoke in these workplaces if:

  • The smoking only takes place in one or more dedicated smoking rooms
  • Each dedicated room has ventilation system that takes air from the room to a place outside the workplace.
  • All reasonably practicable steps are taken to minimise the escape of smoke from the smoking rooms into any part of the workplace that is not a smoking room
  • For each smoking room there is an equivalent smokefree room

International studies on smokefree mental health facilities have found no significant increases in disruptive behaviour; ‘against medical advice’ discharges; additional seclusion or restraints; or the use of emergency or ‘as needed’ medication in smokefree environments.

                                                                        (Source: Factsheet: ASH Smoking and Mental Health)

Why should our organisation have Smokefree premises?

  • Tobacco use is the leading cause of preventable illness and death inNew Zealand and we’re helping work towards the national goal of a Smokefree Aotearoa by 2025.
  • Our organisation is committed to protecting and improving the health and wellbeing of its staff and clients.
  • Being a Smokefree organisation promotes healthy lifestyles which is important to the way we want to support our clients and staff. We recognise our responsibility as a health care provider not to promote or encourage tobacco use.
  • More people with experience of mental health and addictions smoke than the general population, and they often smoke more heavily. More staff within mental health and addictions organisations also smoke compared with the general population.
  • For these reasons, we need to look at ways to support people to be Smokefree, rather than reinforcing smoking as a ‘normal’ thing to do when it has so many detrimental effects.

What are the benefits to Smokefree sites?

  • Health gains to staff and clients
  • No exposure to cigarette smoking or second hand smoke
  • Less litter
  • Decreased fire risk
  • Promotes organisation image as a community leader in health and wellbeing.

Isn’t the Smokefree policy is an infringement of human rights?

  • The Smokefree policy is not about whether you can smoke. It’s about where you can smoke. People may not smoke on our organisation’s premises.
  • It is every staff member’s right to a workplace free from health hazards (including exposure to cigarette smoke).
  • We have a legal responsibility to provide a safe workplace and to protect staff, clients and visitors from the known hazards of second-hand smoke.

Who will enforce the Smokefree premises?

  • Most people comply in good faith with Smokefree premises, so Smokefree external spaces are generally self-enforcing. New Zealanders are now very familiar with the concept of not smoking in certain places with most people having experienced Smokefree outdoor policies in action at sports stadiums, schools, hospital grounds, marae and at outdoor cultural events.
  • All staff should be encouraged to enforce the Smokefree policy as necessary, by politely asking anyone smoking to move offsite.
  • A Smokefree policy is enforced by staff in the same manner in which they currently enforces other policies, such as property defacement, harassment etc.

Is it best to have designated smoking areas and phase them out later?

  • Designated smoking areas (such as gazebos and shelters) send a message that smoking outside is acceptable and is the norm within the organisation.
  • Smokers often perceive the presence of smoking areas as a signal that it’s okay to smoke anywhere outside and continue to smoke in non-designated areas.
  • Designated smoking areas can also tend to become ‘owned’ or ‘colonised’ by smokers and a phasing out of smoking sites can prove extremely hard with resulting  feelings of resentment amongst staff and others who might smoke.

Won’t the Smokefree policy push smokers onto the street and give our organisation a bad look?

  • It’s important to remember that our primary focus is to help those smokers who are keen to address their smoking to become Smokefree.
  • Secondly, as the Smokefree policy becomes normalised, the numbers of smokers will decrease due to successful quit attempts or because of the use of NRT as a tool to help smokers manage their nicotine dependence.
  • When people who smoke comply with Smokefree policy and smoke offsite, there is a risk smokers will congregate on crown land and that smoking will become more visual to the public, giving rise to concerns about our organisation’s image. Since the introduction of the Smokefree Environment’s Bill, which banned smoking in indoor work places, most members of the public are used to seeing people smoking in external areas without appropriating blame or guilt by association to the organisation.
  • The sight of people smoking on crown land in front of our organisation is generally seen by the public as a healthy, positive sign that we are committed to no association between health and tobacco.