Cigarette purchases at pharmacies are taking place by a small but alarming percentage of patients with a high-risk of smoking-related illness, according to a research letter published Oct. 20 in JAMA Internal Medicine. 

It has been shown that cigarette smoking can make managing chronic ailments significantly more difficult, increasing acute exacerbation of patients with respiratory conditions, raising blood pressure in patients battling hypertension and coronary heart disease, and even increasing the risk of serious adverse drug events. Still, as principal author Alexis Krumme, MS, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, points out, “a visit to the pharmacy to fill a prescription is, paradoxically, often an opportunity to purchase cigarettes.”

Using a de-identified database of linked retail pharmacy purchases and prescription data, Krumme and her co-authors estimated the incidence and frequency of cigarette purchases made in retail pharmacies by individuals filling prescriptions for asthma or chronic obstructive pulmonary disease (COPD), hypertensions, and oral contraceptive medications between January 2011 and June 2012. Results showed that of 38,939 patients taking a medication in a class of interest, 6 percent of asthma or COPD medication users, 5.1 percent of antihypertensive medication users, and 4.8 percent of oral contraceptive medication users had a least one cigarette co-purchase. Data also showed that across all medication classes, patients with a cigarette co-purchase made an average of twice as many monthly store visits. Among patients who purchased cigarettes, 25 percent of asthma and COPD medication users had four to 53 visits, oral contraceptive users had four to 94 visits, and antihypertensive predication users had four to 135 visits. Statistically, about 10 percent of patients with cigarette purchases were taking medications in two or three of the classes.

Demonstrating that there individuals out there that are negating the treatment they seek in a single trip to the pharmacy, Krumme and her colleagues conclude “our results highlight an opportunity to improve outcomes for patients receiving widely used treatments. The decision of some pharmacies, including CVS, to stop selling cigarettes has been met with widespread support from public health and medical organizations. Similar actions by other pharmacies may help prevent cigarette purchasing by individuals at greatest risk.”

Keywords: Risk, Contraceptives, Oral, Asthma, Antihypertensive Agents, Drug-Related Side Effects and Adverse Reactions, Pharmacies, Coronary Disease, Blood Pressure, Smoking, Public Health, Pulmonary Disease, Chronic Obstructive, Schools, Medical, Hypertension