UCSF School of Pharmacy adopts broad recommendation on tobacco

The UCSF School of Pharmacy and the Purdue University College of Pharmacy have become the first U.S. pharmacy schools to adopt a broadly worded new professional practice recommendation aimed at reducing tobacco’s public health burden.

“This was born out of our position against tobacco sales in pharmacies, but we decided that the recommendation should be broader,” says Robin Corelli, PharmD, vice chair for professional affairs in the School’s Department of Clinical Pharmacy. She provided input on wording first developed and adopted at Purdue, then brought it to the attention of Dean B. Joseph Guglielmo, PharmD, for consideration at UCSF.

The recommendation was approved by the School’s Faculty Council in April 2013, by its leadership group in May, and presented at a full faculty meeting in June. It not only opposes tobacco sales in pharmacies and stores with pharmacies, but goes significantly further, endorsing evidence-based strategies, regulations, and legislation that help to prevent smoking initiation among youth, increase the likelihood of quitting among current smokers, and reduce exposure to second-hand smoke.

The recommendation could potentially bring the School’s institutional weight to bear on issues such as tobacco taxation and insurance coverage for smoking cessation medications, Corelli notes. It is the latest example of the School’s highly active role on tobacco-related issues that has included:

• Leading the development of the Rx for Change curriculum that trains pharmacists and other clinicians to provide evidence-based tobacco cessation counseling. Since its development in 1999, the curriculum has been adopted by more than 90 schools of pharmacy across the country. Versions of the program have been translated into Spanish and Chinese and there are more than 7,500 registered users on the program website, from 46 countries and all 50 U.S. states.
• A partnership with Safeway to use Rx for Change to train its store pharmacists and technicians to provide brief tobacco cessation counseling, with referrals to the California Smokers’ Helpline. The initial program and evaluative study, which began earlier this year in 20 California supermarkets, is expected to expand across the chain nationally in early 2014.
• Corelli and colleagues, including Lisa Kroon, PharmD, chair of the School’s Department of Clinical Pharmacy, and former faculty member Karen Hudmon, DrPH, MS, RPh, now at Purdue, have published dozens of papers on tobacco cessation, evaluating new models of care for pharmacists and the training of health professionals.
• In 2008, when San Francisco was considering a first-in-the-U.S. ban on tobacco sales in pharmacies, both then-Dean Mary Anne Koda-Kimble, PharmD, and several faculty members publicly expressed support.

The latter effort included co-authoring a position paper drawing on faculty research and summarizing evidence in support of the prohibition that was presented in testimony by Kroon at City Hall. The paper noted that pharmacists and pharmacy students overwhelmingly opposed tobacco sales in pharmacies (which take place mainly in chain pharmacies) and that such sales are in direct conflict with the American Pharmacists Association’s code of ethics: specifically, avoiding “actions that compromise dedication to the best interests of patients.”

The law was enacted in 2008 and revised in 2010 to include grocery and big box stores with pharmacies. But San Francisco, Richmond, and parts of Santa Clara County in California, plus Boston and numerous cities and towns in Massachusetts are currently the only municipalities in the U.S. with tobacco-free pharmacy laws.

And despite the local victory, “at the time, we weren’t able to say that the UCSF School of Pharmacy was against tobacco sales in pharmacies,” says Corelli. “We were speaking as individual faculty members. A statement endorsed collectively by the faculty is significantly more impactful from a policy perspective.”

“I am hopeful that during my professional career, we will look back and say, ‘Can you believe they used to sell tobacco in pharmacies?’ As the number-one cause of preventable death in this country, it’s just so completely inconsistent with our professional mission,” she says. “But this new recommendation is also much bigger than that.”

This week Corelli and Hudmon are attending the annual meeting of the American Association of Colleges of Pharmacy (AACP) in Chicago, presenting a study on tobacco policies of state and national pharmacy associations, and seeking to build a coalition of institutions interested in adopting the new resolution.

Policy on reducing the health burden associated with tobacco

School of Pharmacy, University of California, San Francisco

WHEREAS, tobacco is the primary known cause of death in the U.S., contributing to the onset and exacerbation of numerous diseases, be it resolved that the School of Pharmacy at the University of California, San Francisco (henceforth referred to as “School,” defined as the School administration and faculty) shall:

FURTHERMORE, because the sale of tobacco products is not consistent with the role of pharmacists as providers of health services or as advocates for public health, and because the sale of tobacco products is in direct violation of the pharmacist’s code of ethics, the School shall:

1. Endorse policies, regulations, and legislation that aim to reduce the public health burden associated with tobacco.
2. Endorse widespread dissemination of evidence-based strategies to prevent the onset of tobacco use, increase tobacco cessation rates, and reduce exposure to second-hand smoke.
3. Oppose the sale of and use of tobacco products in any facility or establishment where health care services are rendered.
4. Endorse policies to eliminate the sale of tobacco products in all pharmacies and stores that contain a pharmacy.