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Drug and Alcohol Dependence Volume 177 , 1 August 2017, Pages 187-193 Trends in utilization of smoking cessation agents before and after the passage of FDA boxed warning in the United States Author links open overlay panel DrishtiShaha The FDA issued a black box warning (BBW) on bupropion and varenicline in 2009. We examined the trends in use of bupropion and varenicline before and after the BBW. We observed a significant decline in the use of varenicline after the passage of BBW. The BBW was not associated with decline in the use of bupropion. Passage of BBW may have a substantial impact on the utilization of certain medications. In 2009, the FDA required a black box warning (BBW) on bupropion and varenicline, the two commonly prescribed smoking cessation agents due to reports of adverse neuropsychiatric events. We investigated if there was a decline in use of bupropion and varenicline after the BBW by comparing the percent using these medications before and after BBW. We conducted a retrospective observational study using data from the Medical Expenditure Panel Survey from 2007 to 2014. The study sample consisted of adult smokers, who were advised by their physicians to quit smoking.

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Another critical area of consideration is economics. Tobacco use reduces overall national incomes by up to 3.6%. At the society level, direct costs are estimated from public and private medical costs of treating cigarette-related diseases. According to a study reported by Bernama in 2007, three smoking-related diseases – ischemic heart disease, lung cancer and chronic obstructive pulmonary disease – consumed about RM3.5bil of Malaysia’s healthcare budget. 5. More importantly, a 2007 study demonstrated that retailer compliance with laws limiting sales to minors appears to be significant in reducing youth access to cigarettes. In fact, the Government’s 2012 International Tobacco Control Report stated that tobacco taxes and prices have not increased at a rate high enough to offset income growth, so cigarettes are becoming more affordable to consumers. We must persist with the Government’s recommendation that the price be kept high through taxation as this works as a measure to help smokers quit and also as a deterrent to young people. As a nation, we simply cannot turn our backs on the responsibility of protecting our youths and children from any threat to their lives. Evidence from several studies suggest that the observed decline in many countries in coronary heart disease mortality, one of the most important non-communicable diseases in terms of burden of disease, is through prevention rather than treatment.

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