NICE issues new guidance in anti-smoking fight

Landmark guidance to reduce tobacco-related harm for people struggling to kick the habit is the first to recommend that licensed nicotine-containing products can be used to help people cut down on the amount they smoke.

People targeted by the advice include those who may not be able to give up in one go, those who want to stop smoking without giving up nicotine and those who might not be ready to stop but want to reduce the amount they smoke.

The guidance, issued by the National Institute for Health and Care Excellence (NICE), recognises that although stopping completely is the best way to reduce harm, many people are unable to do so.

Professor Mike Kelly, director of the NICE centre for Public Health, opened a press briefing about the guidance with a Mark Twain quote: “Giving up smoking is the easiest thing in the world.

“I know because I’ve done it thousands of times.”

Professor Kelly said the guidance endorses cutting down on smoking with the help of licensed nicotine products such as patches and gum to help reduce the harm caused by tobacco.

He pointed out that while nicotine is a “relatively harmless” substance, there is a lack of clarity over the safety of nicotine replacement therapy (NRT) and what substance actually causes death.

“Put simply, people smoke for the nicotine but die because of the tar in tobacco.

“However, smoking tobacco is highly addictive, which is why people find it so difficult to stop smoking,” he said.

Sarah Woolnough, Cancer Research UK’s executive director of policy, welcomed the guidance. She said: “Smoking still accounts for one in four cancer deaths and nearly a fifth of all cancer cases, so helping those smokers who want to quit or reduce the harm from smoking remains vital.

“While stopping smoking in one go is most likely to be successful, the use of licensed nicotine containing products provide 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.”

Prof Kelly acknowledged that the new guidance is very different to previous advice: “The message in the past has been a very simple one. It has been ‘Stop’,” he said.

Electronic cigarettes were not included in the guidance as they are not a licensed nicotine product and have no “guarantees”, Prof Kelly said

Though Professor Paul Aveyard, NICE guidance developer, GP and Professor of Behavioural Medicine at the University of Oxford, said “I think the guidance is clear that using an e-cigarette is safer than smoking.”

Professor John Britton, chair of the Royal College of Physicians’ tobacco advisory group, said the new guidance is welcome.

“We would encourage all smokers to take up the opportunities presented by this guidance, and if they can’t quit using nicotine altogether, to switch as much as they can to an alternative nicotine product.

“This guidance has the potential to change millions of lives for the better. We commend it,” he said.