Nice | Tobacco: harm-reduction approaches to smoking

12th August 2013 by Louise Hudman

Nice | Tobacco: harm-reduction approaches to smoking

This guideline will really change how we manage smoking cessation. Until now the emphasis has been on getting patients to stop smoking. This guideline recognizes the fact that although the nicotine is the addictive part of the cigarette, it is not the really harmful part.

Many patients will be ready to try to stop smoking and that is still what we should promote as a first-line. However, many patients do not want to give up nicotine, or want to cut down instead. Cutting down can then induce ‘compensatory smoking’ where patients increase the amount of toxins they inhale from each cigarette, so although they are smoking fewer cigarettes, they are not reducing their toxin intake that much.

So what options can we promote?

  • Stop smoking!
  • Cut-down. To avoid compensatory smoking, consider using NRT alongside cigarettes. Patients can cut down with an intent to stop smoking, or without an intent to stop completely. Both can be encouraged as all patients who cut down have a higher chance of stopping smoking in the long term, even if they don’t initially intend to.
  • Temporary abstinence. Patients can use NRT for short breaks off cigarettes.

What products can be advised?

MHRA regulated NRT. Electronic cigarettes aren’t regulated at the moment (but will be in the future). We can advise patients who wish to use them that as they are not regulated, their quality and safety can not be guaranteed, though it is likely that they are better than smoking.

So what should we do?

  • Use NRT and keep using NRT for as long as it is needed. There is safety data for up to 5 years of use and expert opinion is that it is likely to be safe for the longer term too.
  • It is cost-effective to prescribe the NRT, rather than have people smoking, even in the long term.

Read more

No credit card details needed – it takes two minutes.

Join free trial

Login

Already a member? Login to view this content.

Login

"Without the support of LocumDeck, I would have struggled to get it all organised. Ali and her team were extremely supportive and patient with me; they explained how to use it, made it flexible for my needs and allayed all fears regarding various invoicing issues. The ongoing support is also fantastic with educational webinars, NASGP Locum Chambers meetings and a quick response to any queries. I would recommend it to anyone starting out as a GP locum. It takes away the administrative stress and allows you to focus on clinical work."

Dr Himanka Rana, GP, Isle of Wight

See the full list of features within our NASGP membership plans

Membership