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Pharmacists Can Help Smokers Quit Under California Law

Posted by Megan Maddox

Jun 9, 2017 12:05:02 PM

SB 493 Expands Scope of Practice for Licensed Pharmacists

Pharmacist-Patient-Image.jpgIn 2013, Governor Jerry Brown signed into law Senate Bill 493, authored by Senator Ed Hernandez, which for the first time ever, acknowledged pharmacists as legitimate healthcare providers and had also expanded the scope of practice for pharmacists to offer more patient care services beyond their most familiar function of drug dispensing. SB 493 was introduced in the Legislature as a response to the State’s physician shortage, especially after California had expanded coverage to millions of people under the Affordable Care Act.

One of the critical expanded authorities that came from SB 493 was the ability for all licensed pharmacists in the State to provide and offer nicotine replacement products for smoking cessation. Prior to SB 493, providing nicotine replacement therapy was limited to pharmacists who worked in either an inpatient setting or an integrated system.

Pharmacists Can Better Assist Patients with Smoking Cessation

Pharmacists who provide nicotine replacement therapy are not just selling the nicotine replacement products themselves, but they are also assisting patients with tobacco cessation using patient specific interventions, including referring patients to quitlines, such as the California Smokers’ Helpline, and other resources that are available within the community. Before a pharmacist even offers nicotine replacement therapy, they will evaluate their patients for any specific factors including precautions or contraindications for medication therapy. In addition, extensive counseling is done by the pharmacist with their patient on the appropriate use of smoking cessation medications such as dosing amounts, how to administer the product, and any possible adverse effects.

SB 493 opened the doors for retail and community pharmacists to be able to transform their business model by offering more preventative healthcare services, like nicotine replacement therapy. Most importantly, pharmacists have an opportunity to be leaders in the fight against nicotine addiction by decreasing the use of tobacco products and promoting smoking cessation especially since they interface with patients frequently throughout the day.

The health benefits for patients who participate in a smoking cessation program are incredible considering the damaging effects of nicotine addiction. Smoking tobacco products increases the chance of lung cancer, chronic obstructive pulmonary disease, coronary heart disease, stroke, and peripheral vascular disease among others.

Patient Access to Care Increased

Patients are particularly at an advantage of receiving nicotine replacement therapy from their community pharmacist because the service can be provided more accessibly, rather than having to make an appointment to see their primary care physician which can take several weeks.  Patients who want to quit smoking and begin a smoking cessation program with their local pharmacist will see major improvements in their health and will significantly reduce the risk of premature death. 

The California Pharmacists Association was instrumental in advocating for SB 493 (Hernandez) and were sponsors of the legislation. CPhA’s CEO, Jon Roth recalls that the timing of this legislation was impeccable. “SB 493 was looked upon by the pharmacy profession as the perfect storm. For years, pharmacists had been overlooked as healthcare providers who could play a significant role in improving health outcomes and reducing overall healthcare spending through their expertise in medication management. After the Affordable Care Act had passed, California’s Medi-Cal program grew to over 13 million beneficiaries, which is about a third of the state’s population. Physicians became overwhelmed and we saw that many were no longer accepting Medi-Cal patients. So the need for pharmacists to bridge this gap in care was not only imperative, but it just made sense.”

Protocol for Pharmacists Furnishing Nicotine Replacement Products

Once the bill was signed into law, the California Board of Pharmacy and the Medical Board of California were responsible for developing protocols for pharmacists to follow when providing the authorized services outlined in SB 493 and determining the appropriate training requirements.

The entire protocol and training requirements for pharmacists to furnish nicotine replacement products is available here and summarized as follows:

  • Pharmacists have the authority to furnish nicotine replacement products approved by the FDA.
  • The purpose is to provide timely access to nicotine replacement products and to ensure the patient receives the appropriate information to initiate smoking cessation medication therapy. When a pharmacist initiates or receives requests for smoking cessation treatment he or she must:
    • Review the patient’s current tobacco use and quit attempts
    • Ask the patient a series of screening questions outlined in the protocol
    • Review instructions for use with every patient
    • Recommend additional assistance and resources such as helplines or local programs
    • Answer any questions the patient may have
  • A pharmacist may select any nicotine replacement product (alone or in combination) from the list of therapies specified by the Board of Pharmacy which shall be updated and maintained on the Board’s website.
  • The pharmacist shall notify the patient’s primary care provider of any prescription drugs or devices furnished to the patient for smoking cessation treatment.
  • The pharmacist must document each nicotine replacement product provided and securely store this information in a patient medication record for at least three years.
  • Before initiating any smoking cessation treatment, a pharmacist must complete a two hour continuing education program specific to smoking cessation therapy and nicotine replacement therapy.
  • Pharmacists must complete ongoing continuing education focused on smoking cessation therapy every two years. Pharmacists must ensure that patient confidentiality and privacy are maintained. 

Pharmacy Education for Furnishing Free NRT

Purdue College of Pharmacy has a 2.5 hour, home study course that fulfills the training requirement needed before initiating smoking cessation treatment. The course - Behavioral Counseling & Pharmacotherapy - has been approved by the Board of Pharmacy and can be accessed by visiting Rxforchange: https://rxforchange.ucsf.edu/continuing_education.php

Participants who complete the online program and successfully pass the post-test will receive 2.5 hours of Continuing Pharmacy Education Credit. 

New Fact Sheet from the California Smokers' Helpline

In addition, pharmacists can utilize the latest fact sheet provided by the California Smokers Helpline on furnishing nicotine replacement therapy for smoking cessation.

Top 10 Tips for Quitting Smoking in the New Year!

Posted by Kristin Harms

Nov 28, 2016 4:08:18 PM

The New Year is a perfect time to encourage your patients and clients who smoke to make a quit attempt. To help smokers stay quit, the California Smokers' Helpline is offering its Top 10 Tips to Help Smokers Quit flyers in six languages.

Download Now!

Quit attempts are vitally important to population-based cessation as most tobacco users must try repeatedly to quit before they succeed. Fortunately, 70% of smokers say they want to quit. And, asking and advising a patient to quit can actually double the chance that he or she will try. 

So, take this opportunity before the New Year to ask all your patients if they smoke, advise them to quit, and provide them with our Top 10 Tips to Help Smokers Quit flyer. For smokers who need additional support, refer them to 1-800-NO-BUTTS (1-800-662-8887) our to our online registration form for free help and a plan to quit.


Free Webinar & CE Credits: Smoking Cessation and Pregnancy

Posted by Kristin Harms

Mar 29, 2016 3:59:32 PM


The California Smokers’ Helpline is pleased to host this free webinar, How to Talk with Patients about Smoking Cessation and Pregnancy, on Wednesday, April 20th from noon to 1pm PST.

The relationship between pregnancy and smoking is a significant concern among health professionals. Smoking during pregnancy can cause low birth weight, sudden infant death syndrome (SIDS), learning and behavior problems, and lung problems. Quitting smoking while pregnant can increase the chance of having a healthy baby. This webinar will address key strategies to help pregnant smokers to quit.

The following continuing education credits are being offered for this course: CA BBS, APA, CCAPP, CAADE, and CME.

Sign Up Now

Target Audience

This course is designed for primary care providers and behavioral health professionals interested in the most current research surrounding smoking cessation and pregnancy.


At the conclusion of this activity, participants should be able to:

  • Discuss the evidence regarding tobacco use among pregnant women
  • Talk with patients or clients about the relationship between pregnancy and tobacco cessation
  • Identify and implement evidence-based treatment for treating tobacco dependence


John McHugh, MD

John-McHugh.jpgDr. McHugh is an Obstetrician & Gynecologist (OB/GYN) at the St. Bernardine Medical Center in San Bernardino, CA. He serves as Co-Chair of the Preconception Health Care Council of California. In addition, Dr. McHugh is an Assistant Professor at University of California, Irvine. He received his MD from Harvard Medical School and Massachusetts Institute of Technology. Since then, Dr. McHugh has worked in the medical field for over 20 years in various positions, such as Department Chair of Obstetrics and Gynecology at Scripps Mercy Hospital.

Robert Felix

Robert-Felix-Headshot.jpgRobert is currently President of the Organization of Teratology Information Specialists (OTIS) Board of Directors. He is a Senior Teratogen Information Specialist and Community Outreach Coordinator with MotherToBaby California, responsible for increasing awareness about the value of MotherToBaby’s services and cultivating new partnerships with healthcare providers and community‐based organizations.


University of California, San Diego School of Medicine Accreditation Statement
The University of California, San Diego School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

University of California, San Diego School of Medicine Credit Designation Statement
The University of California, San Diego School of Medicine designates this live webinar activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Mental Health Credit Designation Statements
CE Learning Systems designates this live webinar for a maximum of one credit (1.0), available for members belonging to:

  • American Psychological Association (APA)

  • California Association for Alcohol/Drug Educators (CAADE)

  • Individuals belonging to California Board of Behavioral Sciences (CA BBS) may earn credit based on the APA approval

The California Smokers' Helpline is a provider approved by California Consortium of Addiction Programs and Professionals (CCAPP-EI), Provider # - 1S-16-241-0118 for 1.0 continuing education hours (CEH).


Make 2016 Your Year to Quit Smoking

Posted by Gary Tedeschi, PhD

Dec 29, 2015 11:09:53 AM

Quit smoking to start your year off right.

2016-New-Years-Sunset.jpgEvery January 1, people all over the world make New Year's resolutions, according to the Centers for Disease Control. If you're one of the nearly 7 in 10 U.S. smokers who want to quit, why not make a resolution to get started? Smoking is still the number one cause of preventable death and disease in the United States. Quitting now can cut your risk for diseases caused by smoking and leave you feeling stronger and healthier.

Tiffany, a former cigarette smoker, was 16 when her mother—also a smoker—died of lung cancer. Despite her loss, Tiffany started smoking. She finally decided to quit when her daughter Jaelin turned 16 because she could not bear the thought of missing out on any part of Jaelin's life, like her own mother did. Her effort to quit began with setting a specific date to quit smoking and reaching out to family and friends for support. In the video "Tiffany's Decision" from CDC's Tips From Former Smokers (Tips) campaign, she talks about the "aha" moment that sent her on a different, healthier path for her own life.

Most smokers who want to quit try several times before they quit for good. The most important thing is to never give up. There is help available for you to reach your goal of quitting smoking once and for all.

Free, Effective Resources

FemaleHispanicCounselor.jpgThe California Smokers' Helpline offers a variety of free quit smoking resources in English, Spanish, Chinese, Korean, and Vietnamese, proven to double a smokers chance of successfully quitting:

  • Telephone Counseling. One on one support over the phone from a trained, caring counseler who will help you make a quit plan, send you free materials, or refer you to other resources in your area. To get started now, call 1-800-NO-BUTTS (1-800-662-8887) or register online.
  • Texting Program. This free 24/7 texting program sends encouragement, advice, and tips to help you quit smoking for good. Register online to get started.
  • Online Help. A wealth of online tips and resources for quitting smoking are available in English, Spanish, and Asian languages (Chinese, Korean, and Vietnamese).

Quitting Aids

patch.jpgBecause cigarettes contain nicotine, a powerfully addictive drug, when you first quit, your body may feel uncomfortable until it adjusts. This is known as withdrawal, and there are quitting aids that can help lessen this feeling and the urge to smoke.

Studies show that smokers who use quitting aids to help control cravings, along with coaching from a quitline, in a group, or from a counselor, are much more likely to succeed than those who go it alone.

Talk to your doctor, pharmacist, or other health care provider before using any quitting aids if you:

  • Are pregnant or nursing
  • Have a serious medical condition
  • Are currently using other medications
  • Are younger than 18

For More Information

Visit our website or download one of our free fact sheets.

As the start of a new year approaches, isn't now the perfect time to quit smoking? Start off 2016 by taking control of your smoking.  Use the free resources available to you and make a plan to quit for good.  Even if you don't smoke yourself, you can share the information here to help a friend or family member become smokefree in 2016!

Free Smokers' Helpline Services

La Línea de Ayuda Ahora Ofrece Asistencia para Dejar de Fumar por Web en Español

Posted by Jesus Calleros

Nov 4, 2015 11:54:21 AM

Hispanic CoupleLa Línea de Ayuda para Fumadores de California, el único servicio gratuito en California para dejar de fumar, ha introducido una sección especial en su página web con información en español para los usuarios del tabaco y sus familiares. Los usuarios del tabaco también se pueden inscribir en línea para recibir asesoría gratuita por teléfono en español. Visite la página web en español aquí.

Esta información también es un recurso valioso para los proveedores de servicios médicos que prestan sus servicios a pacientes y clientes que hablan español. La comunidad hispana tiene una tasa más baja de fumadores que otros grupos étnicos y son más propensos a ser fumadores ligeros o de no fumar a diario. Sin embargo, ya que fumar no es seguro a ningún nivel, los proveedores de servicios médicos deben preguntar rutinariamente a todos sus pacientes si ellos fuman y referirles a programas para dejar de fumar.

“Hemos ayudado a miles de fumadores hispanos a dejar de fumar desde 1992, y nos complace ofrecer este servicio adicional para los hispanohablantes y sus familiares,” comenta Jesus Calleros, Supervisor Clínico de la Línea de Ayuda para Fumadores de California. “Recibimos muchas solicitudes de información de personas que quieren ayudar a sus familiares a dejar de fumar y de proveedores de servicios médicos quienes necesitan acceso fácil a materiales culturalmente apropiados para sus pacientes y clientes que fuman.”

Fundada en 1992 por investigadores de la Universidad de California en San Diego, Moores Cancer Center, la Línea de Ayuda para Fumadores de California ofrece servicios gratuitos, personalizados y confidenciales a más de 40,000 personas de comunidades diversas de todo el estado de California. La asistencia para dejar de fumar se ofrece en español (800-45-NO-FUME), ingles (800-NO-BUTTS), coreano (800-556-5564), vietnamita (800-778-8440, y mandarín y cantonés (800-838-8917). También hay servicios especializados para fumadoras embarazadas, mascadores de tabaco y adolescentes. El horario de servicios es de lunes a viernes, de 7 a.m. a 9 p.m., sábados y domingos de 9 a.m. a 5 p.m. La línea de ayuda es financiada por el Departamento de Salud Pública de California y por First 5 California.

Helpline Now Offers Online Quit Smoking Help in Spanish

The California Smokers' Helpline, California's only free, statewide telephone counseling service for quitting smoking, has launched a special section on its website with information in Spanish for tobacco users and family members. Tobacco users can also enroll online for free telephone counseling in Spanish. Visit the Spanish website here.

This information is also a valuable resource to health care providers who provide services to patients and clients who speak Spanish. Hispanics generally have lower rates of smoking than other ethnic groups and are more likely to be light or non-daily smokers.  However, smoking is not safe at any level so health professionals should routinely ask all their patients if they smoke and refer them to resources for quitting smoking.

"We have helped thousands of Hispanic smokers quit smoking since 1992, and are pleased to offer this additional resource to Spanish-speakers as well as their family members," says Jesus Calleros, Counseling Supervisor with the California Smokers' Helpline. "We get many requests for information from family members who are concerned about their loved ones who smoke, as well as from health professionals who want easy access to culturally appropriate materials for their patients and clients who smoke."

Established in 1992 by researchers at the University of California San Diego, Moores Cancer Center, the California Smokers' Helpline provides free, personalized and confidential services to more than 40,000 Californians each year from diverse communities throughout the state. Quitting assistance is provided in Spanish (800-45-NO-FUME), English (800-NO-BUTTS), Korean (800-556-5564), Vietnamese (800-778-8440), and Mandarin and Cantonese (800-838-8917). Specialized services are also available for pregnant smokers, tobacco chewers and teens. Hours of operation are Monday to Friday, 7 a.m. to 9 p.m., and Saturdays and Sundays, 9 a.m. to 5 p.m. The Helpline is funded by the California Department of Public Health and First 5 California.  

Guest Commentary-How to Motivate Patients and Clients to Quit Smoking

Posted by Dean Schillinger

Jun 2, 2015 3:59:00 PM


DeanSchillinger 288x314

Dean Schillinger, M.D. is UCSF Professor of Medicine in Residence, and a primary care physician at San Francisco General Hospital (SFGH). He serves as Chief of the UCSF Division of General Internal Medicine at SFGH, and directs the Health Communications Research Program in the UCSF Center for Vulnerable Populations.

The 4 Rs to Success

Recently, Dr. Steven Schroeder, national leader on smoking cessation from UCSF, and I had the privilege of performing in a short video encouraging clinicians to ask, advise and refer their patients to the California’s Smoker’s Helpline.

As is true for most instructional and motivational videos, a certain degree of oversimplification was required, or, as in this case, a decision was made to present a clinical interaction that compressed the time course of smoking cessation conversations into a shorter period of time than is often required.

In reality, seasoned clinicians know that successful smoking cessation conversations—ones that not only motivate patients but also lead to cessation---often (but not always) require “the long view”. That is, success sometimes requires what I call the 4 R’s to success:

  • Relationships
  • Repetition
  • Resilience
  • Responsiveness

Putting Theory into Practice

This point came home to me this week during one of my morning clinic sessions. On my schedule was a middle aged African-American man with severe diabetes, a disease we had been struggling with together for many years. Management of his diabetes was made worse by the fact that his work as a security guard often involved night or “graveyard” shifts, making the timing of insulin administration challenging and even potentially unsafe. However, because of the strong synergies between tobacco use and diabetes with respect to early mortality (some studies suggest that the combination can reduce lifespan by as much as 18 years!), I always was mindful of the need to spend at least half of my visit focused on smoking cessation.

Because of my long-standing and trusting relationship with him, he was able to listen to my repeated advice without feeling judged and to respond in truthful ways that revealed the numerous barriers he felt to quitting, and the several issues that could be motivators to quit. One of his barriers had always been the fact that his wife also smoked. My gentle invitations to have her join him in his next visit with me were always rebuffed; I always made an effort to suggest that he share the 1-800-NO-BUTTS phone number with her.

For 8 years, our counseling sessions, while appearing to be authentically engaging, felt like they fell on deaf ears. He had never called the Helpline, had never filled the prescriptions I provided to him to aid with cessation, and had never set a quit date. Nevertheless, I remained resilient, mindful that nicotine addiction is a powerful foe, yet hopeful that this patient would be able to conquer this addiction under the right circumstances. So I did not give up, and I refused to get discouraged. Eighteen years is a lot of life to be saved. And this week, it happened -- albeit in a surprising way.

As we were closing our visit----one in which I did not bring up smoking cessation, as we were focused on his hypoglycemic episodes at night---he let me know that he had something to tell me. I already had my hand on the doorknob, and I had 3 patients waiting for me, so I was ambivalent about the idea of diving into another discussion. But I knew I needed to be responsive to him, a man usually of few words. He proudly told me he had finally called the Helpline. I was shocked, but delighted, and I took my hand off the doorknob, signaling to him that I was all ears. Then he also told me he just filled the prescription of the Nicotine Patch and pulled his collar down to show me that he was wearing a 21 mg patch right now. I practically swallowed my tears with my smile, and he smiled back.

“So what finally made you turn that corner?”,  I asked him. A long pause. His face changed, and his smile collapsed into a look of anguish. “My wife. She was just told that she has…cancer…..lung cancer, actually.  She’s been a smoker too y’know. Now I know I need to quit for her, because my smoking would be bad for her cancer. Plus, I need to quit so that I can be there for her when she needs me.”

I put my arm around his shoulder, feeling the patch under his T-shirt, and told him how sorry I was, but let him know that I was sure his making this effort meant a lot to her. He nodded and nodded, and I could see tears forming in the corners of his eyes.

Keep Up the Good Fight

Sometimes it takes a dramatic health event such as this one to shift patients’ motivation to quit to the next level. Other times it takes careful listening on the part of a clinician so as to identify inroads into motivation. But nearly always it requires the 4 R’s: Relationships (even brief ones can be meaningful), Repetition (do it again and again), Resilience (don’t get discouraged) and Responsiveness (listen to your patient and truly hear what they are saying).

Good luck out there. Keep up the fight. It is worth it.

Learn More

For more practical tips on how to motivate your patients and clients to quit smoking, please join Dr. Schillinger and Gary Tedeschi, PhD, Clinical Director for the California Smoker's Helpline for a free webinar on Friday, June 19th from noon to 1 pm to hear Top Tips for Motivating Patients to Quit:

Register Now!

Listen to Recorded Counseling Calls from 1-800-NO-BUTTS

Posted by Kristin Harms

May 19, 2015 10:49:00 AM

Have you ever wanted to listen in on a counseling call of the California Smoker's Helpline to hear first-hand how our telephone-based services work? Now you can!

We have recorded a series of simulated calls to give you a better understanding of what happens when clients call 1-800-NO-BUTTS. Click on the buttons below to listen now!

The 4 Ds and 2 Rs for Dealing with Cravings and Urges

Posted by Gary Tedeschi, PhD

Feb 25, 2015 12:11:00 PM

So, you have quit smoking—congratulations! You have just taken one of the most important steps you can take to protect your health and the health of those around you.

However, you might be experiencing urges to smoke, particularly during the first few days. It’s important to remember that nicotine cravings do not last long--most last only 3 to 5 minutes. As time passes, they get weaker and come less often. You could still have some cravings, but they will just pass by. If you quit Cold Turkey, the nicotine will be out of your body after only 3 days.

Check out these tips from the American Cancer Society for dealing with cravings and urges.

The Four D’s

Try these techniques to get through those cravings:

Delay......................................Wait it out.

Distract yourself.................Do something else.

Deep breathe......................Release tension.

Drink water...........................Satisfy the craving.

For more ideas, click here.

The Two R’s:

And remember the two R’s:

Remind…………..Go over your reasons to quit.

Refuse……………Think: it’s not that you can’t smoke, it’s that you don’t want to smoke.

For More Information

For free, confidential help over the phone to quit smoking or to stay quit, please call the California Smokers’ Helpline at 1-800-NO-BUTTS (1-800-662-8887) or register online for services. For more information, download our free fact sheet:

 Download Fact Sheet Now!


1. American Cancer Society. (2014, February 6). Guide to quitting smoking. Retrieved from http://www.cancer.org/acs/groups/cid/documents/webcontent/002971-pdf.pdsf

About this Blog

The California Smokers' Helpline offers free, evidence-based tobacco cessation services in multiple languages to help smokers quit. We also offer free training and resources to health professionals to increase their knowledge and capacity for tobacco cessation.

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Contact Us

For more information about our free training and resources for health professionals, please contact the Helpline Communications Department at (858) 300-1010 or cshoutreach@ucsd.edu.

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