Anti-smoking clinics low on medicine

Students from Liaocheng University demonstrate the harm caused by smoking during a street performance in Shandong province in October. Zhao Yuguo / for China Daily

Clinics to help smokers kick the habit are facing medication shortages.

A combination of behavioral intervention and medication can significantly increase the chances of a person quitting cigarettes, health experts said.

"Many can quit through just intervention, such as consulting a doctor or calling a hotline," said Fu Dongbo, a specialist with the World Health Organization.

"But for those heavily dependant, medication is an option, including nicotine replacement therapy."

Not many opt for the latter, though, judging by the 2010 Global Adult Tobacco Survey of China.

Based on 13,354 interviews nationwide, the study found 36.4 percent had tried to stop smoking in the previous 12 months, but less than 9 percent of them had used assistance, such as medication.

Part of the reason could be that Chinese smokers do not fully understand cessation therapy, according to a report by the WHO Collaborating Center for Tobacco or Health, based at Beijing's Chaoyang Hospital.

Another obstacle is that the medication is not covered by public health insurance.

"Unlike traditional medication, such as antibiotics and anti-asthmatics, smoking cessation medicine is used to prevent disease," said Hu Xuejun, a doctor with the smoking cessation clinic at China Medical University's First Hospital in Shenyang, Liaoning province.

"As public health insurance doesn't cover the cost, people will not buy it, even if doctors prescribe it."

The collaborating center said studies show two years after an insurance system reimburses the price of cessation medication, the smoking rate drops 1 to 2 percent.

If the full cost of the cessation therapy is reimbursed, the number of people who successfully quit after six months will triple, the report added.

At a conference in September, WHO experts urged China to include the medication in its public health insurance system.

Price is an important factor that prevents people from turning to medication, Fu told China Daily.

"An average pack of cigarettes in China costs the equivalent of $1.90, while a nicotine patch costs about $3.50," he said.

"The government should include some cessation medicine on the list of essential medicines or reimburse the difference."

The move will not only encourage smokers to buy the medicine, but will also likely attract more manufacturers into the domestic market, easing the shortage experienced by clinics, WHO experts said.

Xiao Dan, a researcher with the collaborating center, said China had more than 1,000 cessation clinics nationwide in 2010, usually within hospital respiratory units, yet few had sufficient stocks of cessation medication.

"People addicted to tobacco in some areas don't even have access to cessation medication," she said. "Some clinics ask our hospital to mail it to them because supplies are limited.

"No nicotine replacement medicine is available (on the mainland), and we dare not buy generic products for safety reasons, so we need to buy from abroad if we want to prescribe them to patients."

Hu, at China Medical University's First Hospital, said no hospital or pharmacy in Liaoning province sells smoking cessation medicine.

"Our clinic used to have Pfizer's varenicline and Novartis' nicotine patches, but we ran out two years ago," she said. "Now we can only advise patients and suggest they get the medicine in large cities, such as Beijing."

An industry insider said manufacturers have been forced to reduce production due to limited demand.

A product manager for a major international pharmaceuticals company making cessation medication said he often received e-mails from clinics with orders.

"But it's not cost effective for us to just mail a small amount every now and then," he said on condition of anonymity.

"Our company makes more than $1 billion from selling our product, but the China market accounts for almost zero."

Two rival companies have already pulled out of the market, he said, before blaming a lack of strong legislation encouraging smokers to quit.

Hu said the reluctance among pharmaceutical giants to sell more medicine in China is further hampering the work of doctors to cut smoking.