Nicotine patches (Nicorette,15 mg per 16 hours) were authority listed on 1 December 2008 for nicotine dependence in Aboriginal and Torres Strait Islander people. This is the only nicotine replacement therapy subsidised for people who identify as Aboriginal and Torres Strait Islanders. The listing is part of the 2004–05 Budget measure to improve access to medicines for Aboriginal and Torres Strait Islander people.*

Up to 2 courses per year — one strength only

The authority-required listing allows for up to two courses per year.¹ The maximum duration of a course is 12 weeks, with the aim being to stop the patches within this period.^2,3 The listing is for the 15 mg per 16 hours strength of nicotine patches only. Although the manufacturer recommends gradual withdrawal after 8 weeks using lower-strength patches ⁴, trials found no benefit of tapering over abrupt withdrawal.⁵

Supporting readiness to quit

Before starting nicotine patches, a person must be motivated to quit and must stop smoking.⁴ There are specific barriers to quitting for Aboriginal and Torres Strait Islander people (for example, social pressures in communities⁶ and stressful life events⁷). Resources for smokers who wish to quit are available from Quit (The National Tobacco Campaign) at www.Quitnow.info.au. Further support materials and contact details for tobacco-control programs for Aboriginal and Torres Strait Islander peoples are available from the Centre for Excellence in Indigenous Tobacco Control at www.ceitc.org.au.

Prescribing nicotine patches

When a person starts nicotine patches, ensure that support services are provided to improve the outcome of treatment.^2,8 Advise them of the following before prescribing⁴:

• avoid smoking while using nicotine patches; smoking at the same time can cause nausea, vomiting, palpitations, chest pain and other symptoms
• local skin reactions, such as redness, itch or rash, are common with nicotine replacement therapy
• apply the nicotine patch to an area of clean, dry hairless skin on the upper part of the body and change the site each day to reduce the risk of skin irritation
• smoking cessation with or without nicotine patches can cause dizziness, headache and sleep disturbances and other symptoms; these usually resolve within a couple of weeks of quitting.

High prevalence of smoking among Aboriginal and Torres Strait Islander people

The prevalence of tobacco smoking among Aboriginal and Torres Strait Islander people is twice that of other Australians, and consequently the rates of tobacco-related disease are higher.⁹ The effectiveness of nicotine replacement therapies in Aboriginal and Torres Strait Islander people has not been established; small studies indicate that nicotine patches in combination with counselling may benefit some individuals^8,10,11, but quit rates are likely to be lower than those reported in major trials with other populations.¹⁰

*For details of all listings on the PBS for Aboriginal and Torres Strait Islander people and how to prescribe these items, refer to the page Information for PBS prescribers on pbs.gov.au and follow the link.

References

1. Pharmaceutical Benefits Advisory Committee. March 2008 PBAC outcomes — positive recommendations. Canberra: Department of Health and Ageing, 2008. http://www.health.gov.au/internet/main/publishing.nsf/Content/pbacrec-mar08-positive (accessed 22 May 2008). 
2. Rossi S, ed. Australian Medicines Handbook [online]. Adelaide: Australian Medicines Handbook Pty Ltd, 2008.
3. Respiratory Writing Group. Respiratory. In: eTG complete [CD-ROM]. Melbourne: Therapeutic Guidelines Limited, 2005.
4. Johnson & Johnson Pacific Pty Ltd. Nicorette Patch product information. 4 September 2007.
5. Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2008:CD000146. [PubMed]
6. Guideline Development Group. Smoking Cessation Guidelines for Australian General Practice: Practice Handbook. Sydney: Australian Government Department of Health and Ageing, 2004. http://www.health.gov.au/internet/main/publishing.nsf/Content/6F8B2F83E439599BCA256F1900045114/$File/smoking_cessation.pdf (accessed 12 September 2008).
7. DiGiacomo M, Davidson PM, Davison J, et al. Stressful life events, resources, and access: key considerations in quitting smoking at an Aboriginal Medical Service. Aust N Z J Public Health 2007;31:174–6. [PubMed]
8. Ivers RG, Castro A, Parfitt D, et al. Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities. Aust N Z J Public Health 2006;30:132–6. [PubMed]
9. Briggs VL, Lindorff KJ, Ivers RG. Aboriginal and Torres Strait Islander Australians and tobacco. Tob Control 2003;12 Suppl 2:5–8. [PubMed]
10. Ivers RG, Farrington M, Burns CB, et al. A study of the use of free nicotine patches by Indigenous people. Aust N Z J Public Health 2003;27:486–90. [PubMed]
11. Mark A, McLeod I, Booker J, et al. The Koori Tobacco Cessation Project. Health Promotion Journal of Australia 2004;15:200–4.