National Institute for Health and Clinical Excellence (NICE)
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Nicotine products can help people to cut down before quitting smoking
Licensed nicotine products, such as patches and gum, should be offered to people who smoke and are struggling to quit to help them cut down on cigarettes, NICE says.
The best way to reduce the harm of smoking is still to stop completely and in one step, but for many smokers this can be difficult to achieve, especially for those who are highly dependent on nicotine.
One in five adults in England smoke, and around two-thirds of people who smoke say they would like to quit.
NICE recommends that stop smoking advisers and health professionals advise people to stop smoking in one go, but for those who aren't ready or are unable to stop in one step, they should suggest considering a harm-reduction approach.
Using licensed nicotine products, often in combination, can not only help people reduce the amount they smoke but also increase their chances of giving up smoking all together.
However, they are often not used correctly so NICE advises that health professionals and advisors explain to people how to use them properly to control cravings. They should also reassure people that it is better to use nicotine products and reduce the amount they smoke than to continue smoking at their current level.
Nicotine products should be offered on prescription by GPs and other healthcare professionals to help encourage greater uptake. The cost of this to the NHS is greatly offset by the cost of treating smoking-related illnesses which is around £2.7 billion a year.
Professor Mike Kelly, Director of Public Health at NICE, said: “This is the first time anywhere in the world that national guidance will endorse cutting down on smoking with the help of licensed nicotine products as a way to help reduce the harm caused by tobacco.
“Over 79,000 deaths in England each year are due to smoking tobacco, or in other words that's roughly 1,500 deaths a week from cigarette smoking. These people smoke for the nicotine but die because of the tar in tobacco.”
Professor Paul Aveyard, a GP and Professor of Behavioural Medicine at the University of Oxford who helped to develop the guidance, said: “Advisors should reassure people that licensed nicotine-containing products are a safe and effective way of reducing the harm from cigarettes, and that nicotine replacement therapy products have been shown in trials to be safe for at least 5 year's use.
“There are no circumstances when it is safer to smoke than to use licensed nicotine containing products and experts believe that lifetime use of these products will be considerably less harmful than smoking.”
Professor Linda Bauld, Chair of the guidance development group and Professor of Health Policy at the University of Stirling, added: “People who find it hard to stop smoking in one step are more likely to stop smoking in the longer term if they cut down, and are more likely to successfully stop if they use nicotine replacement therapy when they cut down.
“The harm reduction approach may be more appealing to groups of people who are more likely to smoke such as those with mental health problems, and for those who wish to cut down on smoking on their own without NHS support.”
The guidance does not recommend the use of electronic cigarettes as they are not currently regulated by the Medicines and Healthcare products Regulatory Agency (MHRA).
“This guidance is about licensed products. There are no guaranties at present of the safety, efficacy and quality of e-cigarettes. We don't know what else is in them,” said Professor Kelly.
“The MHRA will make an announcement on e-cigarettes sometime in the spring and NICE will then look again at the use of e-cigarettes,” he added.
The guidance coincides with a report from Cancer Research UK which highlights the unanswered questions surrounding the safety and effectiveness of e-cigarettes.
Sarah Woolnough, Cancer Research UK's executive director of policy and information, said: “We need to understand much more about what these products contain, how they are being used, and how they are being marketed.
“The use of licensed nicotine containing products provides a useful addition to the smoker's quitting tool-kit, and we support ready access to these products for people wishing to cut down or stop smoking. We believe the NICE guidance will help smokers get the right support and advice in using these products.”