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Drug and Alcohol Dependence 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. We observed a statistically significant decline in varenicline use from 22.1% in year 2007 to 9.23% in 2014 (p value < 0.001).

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Connecting decision makers to a dynamic network of information, people and ideas, Bloomberg quickly and accurately delivers business and financial information, news and insight around the world. Asia's Most Profitable Cigarette Maker Faces Cheap Cigar Flood Ceylon Tobacco says tax increases to narrow profit margins Smokers seen switching to leaf-rolled products like beedis British American Tobacco Plc ’s unit in Sri Lanka says it’s poised to lose its dominant position in the market to leaf-rolled cigars made by small local rivals. Ceylon Tobacco Co. ’s profit margin will continue to narrow as an increase in levies on cigarettes prompts some smokers to switch to the cheaper alternative, said Emma Ridley, finance director of the Colombo-based BAT unit. The company’s operating profit margin , the highest among listed Asian peers, narrowed to 64 percent in 2016 from 67 percent a year earlier in a cigarette market estimated at about $1.1 billion. The gap between the price of cigarettes and beedis, cheap tobacco wrapped in a coarse leaf, has widened after the government raised excise duties and slapped a 15 percent value-added tax last year. The lowest-priced offering sold by Ceylon Tobacco -- the only licensed manufacturer of cigarettes -- is about four times more expensive than leaf-rolled products, which are produced by a segment of the industry that’s relatively less regulated and has seen smaller increases in levies. “In 2017, we foresee the beedi industry capturing at least half the tobacco market, posing a serious threat to the legal cigarette industry,” said Ridley. “As the affordability of legally manufactured cigarettes continues to diminish, more consumers are expected to downgrade to this cheaper alternative.” Beedis accounted for about 44 percent of the total tobacco market last year, up from 20 percent in 2007, Ridley said. The share of smuggled cigarettes is expected to rise to about 8 percent this year from 2 percent in 2016, according to the company. The numbers for the market share shift being claimed for beedis are exaggerated, said Health Minister Rajitha Senaratne.

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