This project was conducted by Charika Muthumala, supervised by Janet Hoek. Elizabeth Fenton and Frederieke Sanne Petrović-van der Deen were advisors.
Tobacco endgame strategies aim to reduce the commercial supply of tobacco and many propose greatly decreasing retailer numbers. Recent initiatives have seen some US pharmacists delist tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, other proposals have suggested limiting tobacco sales to pharmacies as both a supply reduction and cessation support measure. To inform policy, we explored how pharmacists perceive this suggestion. Charika’s study involved in-depth interviews with 17 pharmacists, most of whom served more deprived communities, where smoking prevalence is greater. We probed participants’ views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical position. We used qualitative description to analyse data on limiting factors and employed thematic analysis to interpret the ethical arguments adduced.
Most participants noted time, space and safety concerns and had strong moral objections to supplying tobacco. These included concerns that supplying tobacco contradicted their duty not to harm patients, would reduce them to sales assistants, undermined their role as health experts, and would tarnish their profession. A minority focused on the potential benefits of a pharmacy-supply model and anticipated a role that extended their skills and the positive impact they could have on community wellbeing. Policy makers will encounter strong opposition if they attempt to introduce a pharmacy-supply model as a first-tier retail reduction measure. However, as smoking prevalence falls, adopting a health-promoting supply model via pharmacies would become more feasible and could enable better community out-reach and cessation support.
HRC programme 19/641 (2021/2022)
Coral Gartner, CREATE Centre, University of Queensland