The new VA/DoD clinical practice guideline expands treatment recommendations for tobacco dependence, including patients not ready to quit. It recommends various pharmacotherapies, notably varenicline and combination nicotine replacement therapy.
Background
Tobacco use remains a leading cause of preventable disease and death, particularly among military service members and veterans. The updated guidelines aim to provide support for tobacco cessation, addressing the needs of military personnel and veterans.
Data Highlights
The guideline includes 32 recommendations across 10 topic areas, based on a systematic review of 952 articles, with 109 studies included in the evidence base.
Key Findings
The guideline strongly recommends varenicline monotherapy over bupropion or single-agent NRT based on high-certainty evidence.
Combination NRT is strongly recommended over NRT monotherapy, with evidence from 16 trials involving over 12,000 participants.
Among patients not ready to quit, NRT or varenicline is weakly recommended.
Varenicline is recommended to increase abstinence from smokeless tobacco.
For electronic nicotine delivery systems (ENDS), either varenicline or NRT is weakly recommended.
Concurrent behavioral treatment and pharmacotherapy is weakly recommended for patients with substance use disorders.
Clinical Implications
Healthcare providers should consider the updated recommendations for pharmacotherapy in tobacco cessation, particularly for patients not ready to quit. The emphasis on combination therapies may enhance treatment success rates among military personnel and veterans.
Conclusion
The VA/DoD guideline provides updated recommendations for tobacco treatment, focusing on strategies to support cessation in military service members and veterans.
From Medicare payment updates to drug approvals and device access, these federal actions may affect reimbursement, prescribing, patient access, and clinical workflows.
