Unequal Treatment in Smoking Cessation Trials for Mental Health Disorders

Aug.12.2022
Unequal Treatment in Smoking Cessation Trials for Mental Health Disorders
Clinical trials on smoking cessation drugs exclude those with mental health disorders, hindering representation and understanding.

Data consistently shows that individuals with mental health disorders are more likely to smoke than those without, making it crucial to include them in clinical trials related to smoking cessation. Unfortunately, the reality seems to be the opposite. The article, titled "Inequities in smoking cessation clinical trials testing pharmacotherapy: excluding smokers with mental health disorders," aims to investigate the practice and reasons for excluding smokers with mental health disorders from such clinical trials.


A research team analyzed the Cochrane systematic review database as of September 2020 to obtain an evaluation of drug therapy for smoking cessation. "We included 279 RCTs from 13 Cochrane reviews. In all studies, 51 (18.3%) explicitly excluded participants with any MHD, 152 (54.5%) conditionally excluded based on certain MHD criteria, and 76 (27.2%) provided insufficient information to determine inclusion or exclusion. The study found that the likelihood of conditionally excluding smokers with MHDs was 3.33 times higher (95% CI 1.38 to 8.01, p=0.007) in studies on anti-depressant drugs for smoking cessation compared to studies on nicotine replacement therapy," the researchers reported.


In fact, their conclusion was that clinical trials examining the safety and effectiveness of smoking cessation medications lacked sufficient representation from smokers with MHD, but there was not enough data collected to explain why. The study emphasized the importance of promoting participation of this minority group in trials.


Meanwhile, other studies have found that individuals with mental health issues are more likely to smoke and have a harder time quitting compared to those without such conditions. As a result, they benefit greatly from additional support in quitting and accessing safer alternatives, at minimum decreasing their risk of smoking-related illnesses.


However, an article in the Psychiatric Times discusses important factors mental health professionals should bear in mind when using e-cigarettes, noting the presence of dangerous elements such as zinc, lead, chromium, manganese, and copper in various e-cigarette products. The article, written by Dr. Catherine Striley, Associate Professor and Director of Psychiatric Epidemiology at the University of Florida, explains that while the majority of ingredients in e-liquids may be safe to ingest, they could potentially harm the lungs and cardiovascular system.


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