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Smoking: tobacco harm-reduction approaches

About

What is covered

The recommendations in this pathway are particularly relevant to people who are highly dependent on nicotine and groups where smoking prevalence is higher than average. Examples include: people with mental illness, people from lower socioeconomic groups and people from lesbian, gay and bisexual and trans-gendered groups. They are also relevant to people who are less likely to use services focusing on abrupt cessation.
They are for: everyone with public health as part of their remit; education and training organisations involved with healthcare; manufacturers and retailers of licensed nicotine-containing products; and all those involved in providing advice about stopping smoking.

Updates

Updates to this pathway

3 July 2015 Smoking: harm reduction (NICE quality standard 92) added to this pathway.
3 September 2014 Minor maintenance updates
26 July 2013 The pathway was updated to reflect the Medicines and Healthcare products Regulatory Agency (MHRA) decision that all nicotine-containing products should be regulated. See Raising public awareness of licensed nicotine-containing products and Advising on the use of licensed nicotine-containing products.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Tobacco: harm-reduction approaches to smoking

What is covered

The recommendations in this pathway are particularly relevant to people who are highly dependent on nicotine and groups where smoking prevalence is higher than average. Examples include: people with mental illness, people from lower socioeconomic groups and people from lesbian, gay and bisexual and trans-gendered groups. They are also relevant to people who are less likely to use services focusing on abrupt cessation.
They are for: everyone with public health as part of their remit; education and training organisations involved with healthcare; manufacturers and retailers of licensed nicotine-containing products; and all those involved in providing advice about stopping smoking.

Updates

Updates to this pathway

3 July 2015 Smoking: harm reduction (NICE quality standard 92) added to this pathway.
3 September 2014 Minor maintenance updates
26 July 2013 The pathway was updated to reflect the Medicines and Healthcare products Regulatory Agency (MHRA) decision that all nicotine-containing products should be regulated. See Raising public awareness of licensed nicotine-containing products and Advising on the use of licensed nicotine-containing products.

Sources

NICE guidance and other sources used to create this pathway.
Tobacco harm reduction (2013) NICE guideline PH45

Quality standards

Smoking: harm reduction

These quality statements are taken from the smoking: harm reduction quality standard. The quality standard defines clinical best practice for smoking: harm reduction and should be read in full.

Quality statements

Offering harm-reduction approaches

This quality statement is taken from the smoking: harm-reduction quality standard. The quality standard defines clinical best practice in smoking: harm-reduction and should be read in full.

Quality statement

People who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking.

Rationale

The best way for a person to reduce illness and mortality associated with smoking is to stop smoking in one step see the NICE quality standard on smoking cessation: supporting people to stop smoking. However, not everyone who smokes feels able to, or wants to, stop, or they may want to stop but without giving up nicotine. It is important that these people are encouraged to try a harm‑reduction approach to smoking. In addition, it is important to raise the option of harm‑reduction approaches as widely as possible – that is, outside 'stop smoking' services, because people who are unwilling or not ready to stop smoking are less likely to access these services.

Quality measures

Structure
Evidence of local arrangements and written protocols to ensure that people who are unwilling or not ready to stop smoking are offered a harm‑reduction approach to smoking.
Data source: Local data collection.
Process
a) Proportion of people identified as being unwilling or not ready to stop smoking who are offered a harm‑reduction approach to smoking.
Numerator – the number in the denominator who are offered a harm‑reduction approach to smoking.
Denominator – the number of people identified as being unwilling or not ready to stop smoking.
Data source: Local data collection.
b) Proportion of people who decline a referral to a 'stop smoking' service, and who are unwilling or not ready to stop smoking, who are offered a harm‑reduction approach to smoking.
Numerator – the number in the denominator who are offered a harm‑reduction approach to smoking.
Denominator – the number of people who decline a referral to a 'stop smoking' service and who are unwilling or not ready to stop smoking.
Outcome
Uptake of smoking harm‑reduction approaches.
Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to offer and explain harm‑reduction approaches to people who are unwilling or not ready to stop smoking.
Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke ensure that they understand and are able to explain harm‑reduction approaches, and offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking while still prioritising stopping smoking as the best approach to take.
Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to offer and explain harm‑reduction approaches to people who are unwilling or not ready to stop smoking.

What the quality statement means for service users

People who smoke but aren’t ready or don’t want to quit are offered ways to reduce their harm from smoking that don't necessarily mean having to give up nicotine. These are called 'harm‑reduction approaches', and include things like cutting down, using licensed nicotine‑containing products (such as patches, gum and tablets) and stopping smoking for a while.

Source guidance

Definitions of terms used in this quality statement

Harm-reduction approach
Harm‑reduction approaches to smoking include:
  • Stopping smoking, but using 1 or more licensed nicotine‑containing products for as long as needed to prevent relapse.
  • Cutting down before stopping smoking (‘cutting down to quit’):
    • with the help of 1 or more licensed nicotine‑containing products (which may be used for as long as needed to prevent relapse) or
    • without using licensed nicotine‑containing products.
  • Smoking reduction:
    • with the help of 1 or more licensed nicotine-containing products (which may be used for as long as needed to prevent relapse) or
    • without using licensed nicotine-containing products.
  • Temporary abstinence from smoking:
    • with the help of 1 or more licensed nicotine-containing products or
    • without using licensed nicotine-containing products.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, box 1]
People who are unwilling or not ready to stop smoking
This includes people who:
  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.
Stop smoking in one step
Stopping smoking in one step is the standard approach to stopping smoking currently offered by most ‘stop smoking’ services. The person makes a commitment to stop smoking on or before a particular date (the ‘quit date’). This may involve the use of nicotine replacement therapy (NRT) products or medication (varenicline or bupropion) in the lead up to the quit date and for a short amount of time afterwards.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups.

Advice about nicotine

This quality statement is taken from the smoking: harm-reduction quality standard. The quality standard defines clinical best practice in smoking: harm-reduction and should be read in full.

Quality statement

People who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

Rationale

Nicotine is the main addictive chemical that makes stopping smoking difficult, but it is primarily the toxins and carcinogens in tobacco smoke – not the nicotine – that cause illness and death. People who smoke often have misconceptions about the role of nicotine in causing harm, and this can act as a barrier that prevents them from considering the use of licensed nicotine‑containing products.

Quality measures

Structure
Evidence of local arrangements and protocols to ensure that people who are unwilling or not ready to stop smoking are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Data source: Local data collection.
Process
Proportion of people identified as being unwilling or not ready to stop smoking who are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Numerator – the number in the denominator who are advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Denominator – the number of people identified as being unwilling or not ready to stop smoking.
Data source: Local data collection.
Outcome
Awareness of people who smoke that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.
Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to advise people who are unwilling or not ready to stop smoking that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine.

What the quality statement means for service users

People who aren’t ready or don’t want to quit smoking are advised that nicotine isn’t the primary cause of health problems associated with smoking.

Source guidance

Definitions of terms used in this quality statement

People who are unwilling or not ready to stop smoking
This includes people who:
  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups. 

Advice about nicotine-containing products

This quality statement is taken from the smoking: harm-reduction quality standard. The quality standard defines clinical best practice in smoking: harm-reduction and should be read in full.

Quality statement

People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products.

Rationale

People can be unsure about the safety of using nicotine‑containing products and about the difference between licensed and unlicensed nicotine‑containing products. It is important to explain the potential benefits of and issues about using nicotine‑containing products, and also to ensure that licensed nicotine‑containing products are readily available to people who want to use them to reduce harm from smoking.

Quality measures

Structure
Evidence of local arrangements that people who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products.
Data source: Local data collection.
Process
a) Proportion of people identified as being unwilling or not ready to stop smoking who are advised about using nicotine‑containing products.
Numerator – the number in the denominator who are advised about using nicotine‑containing products.
Denominator – the number of people identified as being unwilling or not ready to stop smoking.
Data source: Local data collection.
b) Proportion of people identified as being unwilling or not ready to stop smoking who are supported to obtain licensed nicotine‑containing products.
Numerator – the number in the denominator who are supported to obtain licensed nicotine‑containing products.
Denominator – the number of people identified as being unwilling or not ready to stop smoking.
Data source: Local data collection.
Outcome
Uptake of licensed nicotine‑containing products.
Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and to either prescribe or supply licensed products or tell people where they can buy them.
Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and either prescribe or supply licensed products or tell people where they can buy them.
Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and to either prescribe or supply licensed products or tell people where they buy them.

What the quality statement means for service users

People who aren’t ready or don’t want to quit smoking get advice about using nicotine‑containing products as a way of reducing the harm from smoking, both for them and for those around them. They are also helped to get hold of licensed nicotine‑containing products – for example, by being prescribed these products or being told where they can buy them.

Source guidance

Definitions of terms used in this quality statement

Advice about using nicotine-containing products
  • Reassure people who smoke that licensed nicotine‑containing products are a safe and effective way of reducing the amount they smoke. Advise them that these products can be used as a complete or partial substitute for tobacco, in either the short or the long term. Reassure them that it is better to use these products and reduce the amount they smoke than to continue smoking at their current level.
  • Tell people that some nicotine‑containing products are not regulated by the Medicines and Healthcare products Regulatory Agency (MHRA), and so their effectiveness, safety and quality cannot be assured, but that these products are likely to be less harmful than cigarettes.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, recommendation 5]
Licensed nicotine-containing products
These are products that contain nicotine but do not contain tobacco. They deliver nicotine without the harmful toxins found in tobacco. Nicotine‑containing products that are licensed have been given marketing authorisation by the MHRA, such as nicotine replacement therapy (NRT; examples include transdermal patches, gum, inhalation cartridges, sublingual tablets and nasal spray). Nicotine‑containing products that are not regulated by the MHRA, such as electronic cigarettes, are also available (unlicensed nicotine‑containing products). For further details, see the MHRA website. [Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]
If other nicotine‑containing products (such as electronic cigarettes) gain licensing authorisation in the future, this quality statement will be reviewed.
People who are unwilling or not ready to stop smoking
This includes people who:
  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.
Supported to obtain licensed nicotine-containing products
If possible, supply or prescribe licensed nicotine‑containing products. Otherwise, encourage people to ask their GP or pharmacist for them, or tell them where they can buy the products themselves.
[Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, recommendation 3]

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups.

Integrating harm-reduction approaches into ‘stop smoking’ services

This quality statement is taken from the smoking: harm-reduction quality standard. The quality standard defines clinical best practice in smoking: harm-reduction and should be read in full.

Quality statement

'Stop smoking' services offer harm‑reduction approaches alongside existing approaches to stopping smoking in one step.

Rationale

Stopping smoking in one step is the standard approach currently offered by 'stop smoking' services, with harm‑reduction approaches to smoking being a relatively underused approach. The integration of harm‑reduction approaches to smoking into current services will ensure that they are available as an option to people who use these services and who are unwilling or not ready to stop smoking in one step. While it is important that 'stop smoking' services offer harm‑reduction approaches to smoking, this should not be the only place where these approaches are offered. As set out in quality statement 1, healthcare and public health practitioners outside 'stop smoking' services should also offer harm‑reduction approaches (when appropriate) to reach people who do not use these services.

Quality measures

Structure
Evidence of local arrangements that 'stop smoking' services offer harm‑reduction approaches to smoking alongside existing approaches to stopping smoking in one step.
Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers ('stop smoking' services) train healthcare and public health practitioners to offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking.
Healthcare and public health practitioners working in 'stop smoking' services ensure that they offer harm‑reduction approaches to people who are unwilling or not ready to stop smoking.
Commissioners (local authorities) ensure that service specifications include a requirement that providers of 'stop smoking' services offer harm‑reduction approaches to smoking to people who are unwilling or not ready to stop smoking.

What the quality statement means for service users

People who use ‘stop smoking’ services have the option of harm‑reduction approaches if they don't think they can quit smoking in one step or don't want to quit.

Source guidance

Definitions of terms used in this quality statement

Harm-reduction approaches
Harm‑reduction approaches to smoking include:
  • Stopping smoking, but using 1 or more licensed nicotine‑containing products for as long as needed to prevent relapse.
  • Cutting down before stopping smoking ('cutting down to quit'):
    • with the help of 1 or more licensed nicotine-containing products (which may be used for as long as needed to prevent relapse) or
    • without using licensed nicotine-containing products.
  • Smoking reduction:
    • with the help of 1 or more licensed nicotine-containing products (which may be used for as long as needed to prevent relapse) or
    • without using licensed nicotine-containing products.
  • Temporary abstinence from smoking:
    • with the help of 1 or more licensed nicotine-containing products or
    • without using licensed nicotine-containing products.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, box 1]
Stop smoking in one step
Stopping smoking in one step is the standard approach to stopping smoking currently offered by most ‘stop smoking’ services. The person makes a commitment to stop smoking on or before a particular date (the ‘quit date’). This may involve the use of nicotine replacement therapy (NRT) products or medication (varenicline or bupropion) in the lead up to the quit date and for a short amount of time afterwards.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]
‘Stop smoking’ services
‘Stop smoking’ services provide a combination of behavioural support and pharmacotherapy to help people to stop smoking. The behavioural support is free but pharmacotherapy may have a standard prescription charge. The evidence-based treatment is based on the National Centre for Smoking Cessation and Training (NCSCT) standard programme and involves practitioners trained to its standards or equivalent.
[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Equality and diversity considerations

Lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups have higher smoking prevalence rates than the general population. 'Stop smoking' services should be promoted, accessible and commissioned to address this need.

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Pathway information

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Harm-reduction approaches

The following harm-reduction approaches are covered in this pathway:
Stopping smoking, but using one or more licensed nicotine-containing products as long as needed to prevent relapse.
  • with the help of one or more licensed nicotine-containing products (the products may be used as long as needed to prevent relapse)
  • without using licensed nicotine-containing products.
  • with the help of one or more licensed nicotine-containing products (the products may be used as long as needed to prevent relapse)
  • without using licensed nicotine-containing products.
Temporary abstinence from smoking:
  • with the help of one or more licensed nicotine-containing products
  • without using licensed nicotine-containing products.

A harm-reduction approach

The following harm-reduction approaches are covered in this pathway:
Stopping smoking, but using one or more licensed nicotine-containing products as long as needed to prevent relapse.
  • with the help of one or more licensed nicotine-containing products (the products may be used as long as needed to prevent relapse)
  • without using licensed nicotine-containing products.
  • with the help of one or more licensed nicotine-containing products (the products may be used as long as needed to prevent relapse)
  • without using licensed nicotine-containing products.
Temporary abstinence from smoking:
  • with the help of one or more licensed nicotine-containing products
  • without using licensed nicotine-containing products.

Rationale for considering a harm-reduction approach

Nicotine inhaled from smoking tobacco is highly addictive. But it is primarily the toxins and carcinogens in tobacco smoke – not the nicotine – that cause illness and death. The best way to reduce these illnesses and deaths is to stop smoking.
In general, stopping in one step offers the best chance of lasting success (see the smoking prevention and cessation pathway for guidance on smoking cessation). Stop smoking services provide highly cost-effective interventions to help people stop smoking and any investment in the harm-reduction approaches covered by this pathway should not detract from their provision. Rather, the recommendations are intended to support and extend the reach and impact of existing services.
However, there are other ways of reducing the harm from smoking. This pathway aims to help people who:
  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.
This pathway recommends harm-reduction approaches which may or may not include temporary or long-term use of licensed nicotine-containing products.
Although existing evidence is not clear about the health benefits of smoking reduction, those who reduce the amount they smoke are more likely to stop smoking eventually, particularly if they are using licensed nicotine-containing products.

Glossary

A secure environment where people are detained.
Inhaling more deeply or smoking more of each cigarette to compensate for smoking fewer cigarettes.
Or cut down to quit. Someone gradually reduces the amount of tobacco they smoke with a view to stopping smoking within the next few months.
The phrase 'licensed nicotine-containing products' is used in this pathway to cover products containing nicotine that have 'marketing authorisation' for use as a smoking cessation aid and for tobacco harm-reductionAt the time of publication (June 2013), only nicotine replacement therapy products were licensed by the Medicines and Healthcare products Regulatory Agency (MHRA). A decision from the MHRA on the regulation of other nicotine-containing products (for example, electronic cigarettes and topical gels) was pending. The MHRA has since issued a decision that all nicotine-containing products should be regulated once the European Commission's revised Tobacco Products Directive comes into effect in the UK (this is expected to be in 2016). In the meantime, the UK government will encourage applications for medicines licences for nicotine-containing products and will make best use of the flexibilities within the existing framework to enable licensed products to be available. For further details, see the MHRA website. from the Medicines and Healthcare products Regulatory Agency (MHRA). Authorisation by the MHRA ensures they are effective, deliver nicotine safely and are manufactured to a consistent quality.
Using these products can make it easier for people to cut down before stopping, reduce their smoking or abstain. They can also help reduce compensatory smoking behaviour, such as inhaling smoke more deeply to compensate for smoking fewer cigarettes.
Products that contain nicotine but do not contain tobacco and so deliver nicotine without the harmful toxins found in tobacco. Some, such as nicotine replacement therapy (NRT), are regulated by the MHRA (see licensed nicotine-containing products). Others, such as electronic cigarettes and topical gels, were not covered by MHRA regulation at the time of publication of this guidance.
Nicotine replacement therapy (NRT) products are licensed for use as a smoking cessation aid and for harm reduction, as outlined in the British National Formulary. They include: transdermal patches, gum, inhalation cartridges, sublingual tablets and a nasal spray.
Medication such as varenicline or bupropion, as well as nicotine replacement therapy (NRT) products.
Point-of-sale interventions take place at the point where tobacco could be sold. Primarily, they aim to deter shopkeepers from making illegal sales. In this guidance, they aim to raise smokers' awareness of licensed nicotine-containing products as a replacement for cigarettes.
In this guidance, the quality of nicotine-containing products refers to the consistency of nicotine delivery, lack of defects and structural integrity of the product.
In this guidance, safety in relation to nicotine-containing products refers to the incidence of minor and major side effects.
Any manual or structured programme, in written or electronic format, that can be used to help someone try to quit smoking or smoke less without the help of health professionals, stop smoking advisers or group support. They can be aimed at anyone who smokes, particular populations (for example, certain age or ethnic groups), or may be tailored to individual need.
Smoking reduction generally involves the person smoking fewer cigarettes than they normally would without stopping, but it can involve smoking less of each cigarette. See also compensatory smoking.
Stopping in one step (or abrupt quit) is the standard approach to smoking cessation currently adopted by the vast majority of NHS-commissioned stop smoking services. The person makes a commitment to stop smoking on or before a particular date (the quit date). This may, or may not, involve the use of nicotine replacement therapy (NRT) products or medication (varenicline or bupropion) in the lead up to the quit date and for a limited period afterwards.)
Stop smoking services provide a combination of behavioural support and pharmacotherapy to aid smoking cessation. The behavioural support is free but pharmacotherapy may incur a standard prescription charge. The evidence-based treatment is based on the National Centre for Smoking Cessation and Training (NCSCT) standard programme and involves practitioners trained to its standards or the equivalent.
Abstaining from smoking. This could be for a particular event or series of events, in a particular location, for specific time periods (for example, while at work, during long-haul flights or during a hospital stay), or even for the foreseeable future. (The latter might include, for example, abstinence while serving a prison sentence or while detained in a secure mental health unit.)

Paths in this pathway

Pathway created: June 2013 Last updated: July 2015

© NICE 2016

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