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Drug and Alcohol Dependence 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. We divided the time period into “pre-warning”, “post-warning: immediate”, and “post-warning: late.” Unadjusted analysis using chi-square tests and adjusted analyses using logistic regressions were conducted to evaluate the change in bupropion and varenicline use before and after the BBW. Secondary analyses using piecewise regression were also conducted. On an average, 49.04% of smokers were advised by their physicians to quit smoking.

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The government had been quick to implement excise tax that constitutes roughly half of retail price today. However, the same speed did not apply to FCTC’s guidance on tobacco control programmes. The revenue collected from cigarette sales was used to finance local smoking cessation programmes like  mQuit . From the year 2016 to 2019, the Health Ministry targets to help 390,000 smokers quit the habit. The targeted quantity of smokers is only equivalent to 7.8% of the current smoking population, and resources allocated are evidently insufficient. Malaysia’s current minimum legal age for smoking is 18 . Countries like Singapore and Sri Lanka have made progress to raise the age requirement to 21 while Malaysia is still debating on its 2018 tobacco bill . Although the government has designated non-smoking zones , there seemed to be negligible enforcement and issuance of fines. Is Malaysia’s government just too incompetent? The government may have been aware of the possible consequences in hasty cigarette tax hikes. It decided tax hikes were necessary to meet its budget deficit target.

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