Leading the Way in Training Pharmacists to Tackle Tobacco Dependence

Tobacco use remains the leading cause of preventable death worldwide, claiming more than 8 million lives each year. From cancer and heart disease to chronic respiratory conditions, the toll of nicotine addiction is devastating.

As habits evolve from cigarettes to other nicotine-containing formulations (vapes and pouches), urgency to educate health care providers on tobacco cessation is growing. At the UCSF School of Pharmacy, Department of Clinical Pharmacy Professor Robin Corelli, PharmD, has been taking on that urgency with academic innovation and national leadership for more than two decades.

For Corelli, public health begins in the classroom and extends through pharmacies, exam rooms, and telehealth screens. World No Tobacco Day, which takes place each year on May 31, is an occasion to reflect on UCSF’s leadership in tobacco education — with limitless potential to directly reach patients.

“Our [UCSF] efforts are grounded in education, with an eye toward research,” Corelli said. “You’re consistently evaluating and building trust in patient care relationships.”

A national model born at UCSF

In 1999, Corelli, alongside fellow Department of Clinical Pharmacy faculty members Lisa Kroon, PharmD, and Karen Hudmon, DPH, MS, BSPharm, led the creation of the Rx for Change curriculum to offer evidence-based knowledge and skills that gives students the confidence to provide effective tobacco cessation counseling.

Backed by National Institutes of Health funding, the curriculum was piloted in California’s four (at the time) schools of pharmacy, then expanded nationally through five train-the-trainer workshops between 2003 and 2005.

As of 2022, Rx for Change has become required coursework in 76 schools of pharmacy across the country, covering the epidemiology of tobacco use, the pharmacology of nicotine, drug interactions with tobacco smoke, and how to help patients quit with a combination of counseling and medications — an approach that recognizes nicotine’s powerfully addictive nature as well as the entrenched habits and routines that sustain tobacco use.

The curriculum integrates didactic content with case-based applications, including practical counseling exercises and hands-on training with nicotine replacement therapies, which ensures immediate applicability in clinical settings.

Training providers across professions

Corelli presenting UCSF Smoking Cessation Leadership Center behavioral training in Orange County, CA.

The curriculum isn’t just for pharmacists. Learners and practicing clinicians across health care disciplines — including dentistry, nursing, medicine, and respiratory therapy, along with social workers, substance use counselors, and other mental health providers — use the same training.

A collaboration with the UCSF Smoking Cessation Leadership Center draws behavioral health professionals from across California. Each year, several UCSF students participate in Fontana Tobacco Treatment Center group cessation classes, to understand the impact of evidence-based treatment approaches firsthand.

“All UCSF pharmacy students receive about 11 hours of tobacco cessation content, and it's not just lectures on nicotine and tobacco-related disease,” Corelli said. “They’re also assessed on their interactions with standardized patients in the Kanbar Center for Simulation and Clinical Skills, including their ability to screen for tobacco use, evaluate readiness to quit, and formulate personalized medication and behavior-change plans that aid patients in their quitting journey.”

Pharmacists as public health powerhouses

UCSF is a longtime advocate for expanded pharmacist prescriptive authority, and for integrating cessation services into pharmacies and outpatient clinics. Corelli said the data to support this advocacy is clear: When pharmacists are empowered to provide tobacco cessation support, patient outcomes improve.

"The beauty of having a PharmD is that your training prepares you to be launched in so many different directions,” said Corelli. “I was once an acute care, general medicine pharmacist with a PGY2 residency in infectious diseases — very much a hospital-based practice — and now I work on community pharmacy-based public health initiatives.”

UCSF’s leadership in tobacco cessation education has inspired efforts across the country, including at the University of New Mexico, where faculty adapted the Rx for Change curriculum to create a comprehensive statewide tobacco cessation program, extending the reach of UCSF’s work to rural and underserved populations.

“Pharmacists in rural areas are crucial access points for health care, but comprehensive counseling can be time-consuming,” Corelli said. “To address this barrier, we promote an abbreviated ‘Ask-Advise-Refer’ model, which involves asking all patients about tobacco use, advising tobacco users to quit, and referring them to tobacco quit lines for coaching and behavioral counseling.”

Corelli added that this model is applicable in all practice settings, including community pharmacies. “We also train community pharmacy technicians and clerks,” she said, “because you never know who a patient might listen to or connect with.”

Leading by educating

Since 2008, when San Francisco became the first municipality to ban the sale of tobacco in pharmacies, UCSF’s multipronged approach to advocacy, education, and training has been leading the way through what Corelli calls “appropriate collaboration,” for example with other health care providers, or by coaching pharmacists in retail chains to simply ask whether a patient is a smoker.

“One important aspect that often gets overlooked is how tobacco smoke can interact with prescription medications,” she said. “It’s other components in cigarette smoke, not nicotine, that can influence drug metabolism.”

She also points to “Kick It California” a program that offers a range of tobacco and vaping cessation services, from one-on-one quit coaching to text programs and self-help materials.

“We’re not in a vacuum,” she said. “We provide a way for patients to begin the process of receiving expert cessation support.”

More

• UCSF School of Pharmacy adopts broad recommendation on tobacco
• UCSF pharmacy faculty advocate for legislation banning tobacco sales in pharmacies