Nicotine Replacement Should be Used to Help Smokers Cut Down as Well as Quit: New Guidance

Friday 14 October 2005

Media Release: For Immediate Use, Friday 14th October 2005  
New guidance for health professionals dealing with smokers has been issued by tobacco control charity Action on Smoking and Health today. The guidance suggests that although smokers should always be advised that quitting completely is the healthiest option, they should also be helped to use nicotine replacement therapy (NRT) where appropriate if they intend to cut their consumption.

The move follows the Medicines and Healthcare Products Regulatory Authority (MHRA)’s decision in September 2005 to approve a new indication for two NRT products, nicorette gum and nicorette inhalator. They can now be used by smokers to cut down on their smoking prior to attempting to stop. Pfizer have called this new indication “Cut Down Then Stop” (CDTS) and advertising for it has already begun. Thirteen other countries, including 10 in Europe, have already approved this indication.

ASH supports this indication because the evidence shows that for smokers who are not ready to stop but who use nicotine gum or inhalator to help them reduce their cigarette consumption by at least half, around 4% will in practice stop smoking completely as a result. As about half of smokers are interested in cutting down rather than stopping at any one time, this could significantly increase the numbers of smokers that stop.

The ASH guidance states:

  • If a smoker approaches you about reducing to stop they should be reminded that stopping completely is the best thing for their health, and that support and medications are available from the NHS.
  • Smokers who are not ready to make a quit attempt should consider using NRT to help them cut down with a view to stopping later.
  • Primary Care Trusts and GPs should give serious consideration to making NRT for reduction available on NHS prescription, especially in the case of low income smokers or smokers with smoking-related diseases such as COPD.
  • When they do so, they should follow a strict protocol, only providing repeat prescriptions when there is objective evidence of reduced consumption.
  • All health professionals should be proactively encouraging this new indication to smokers who to date have been unready or unable to stop.
  • The NHS Stop Smoking Services should encourage smokers to stop completely with their support. The services should also be able to offer brief advice to smokers who ask for help with nicotine assisted reduction to stop, and indicate to smokers that when they are ready to make a quit attempt they can then get intensive specialist support from the services.

The full ASH guidance is available online as a pdf by clicking here. [1]

ASH Director Deborah Arnott states

“Although quitting altogether is obviously best for health, smokers who want to cut down first need help, and NRT can and should be used to support them. We consider this an essential measure of harm reduction for smokers, and part of an overall harm reduction strategy which, once we achieve a law to end workplace smoking, must be the next major step forward in combating the health damage done by cigarettes.”





[1] The document was developed and written by Martin Raw, Ann McNeill, Robert West, Miriam Armstrong and Deborah Arnott for Action on Smoking and Health (ASH), London.