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Can't quit smoking? Minimise harm by using nicotine-containing products instead

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harm reduction approaches to smoking

The University of Stirling’s Professor Linda Bauld has been involved in developing new public health guidance for reducing tobacco-related harm when people feel unable to stop smoking in one step.

The guidance, published today (5 June) by the National Institute for Health and Care Excellence (NICE), is the first in the world to recommend that licensed nicotine-containing products can be used to help people to reduce the amount they smoke, especially those who are highly dependent on nicotine.

Professor Bauld, Chair of the NICE guidance development group, and Professor of Health Policy at the University of Stirling, said: “This guidance provides an important opportunity to reduce the harm associated with smoking tobacco.

“The cost to the NHS in the UK of treating smoking-related illnesses is over £3 billion a year. 21% of adults aged 16 and over in the UK are current smokers and around two thirds of people who smoke say they’d like to quit.

“NICE public health guidance doesn't apply to Scotland but it is reviewed by the Scottish Government and Health Scotland. All previous NICE guidance on smoking has been adopted in Scotland in some shape or form.

“Scotland has higher rates of smoking than in other parts of the UK, particularly in our most deprived communities where more than four in ten adults are smokers.  It is therefore particularly important that we continue to find new ways to reduce smoking rates.

“Implementing this guidance in Scotland would be a very positive step forward, and increase choice for smokers who find it hard to quit using current methods.”

The new guidance acknowledges, whilst the best way to reduce the harm from smoking is to stop completely in one step, for people who’ve been unable to stop using this standard method, other approaches can help. 

The guidance could also encourage more smokers to consider reducing how much they smoke, with the support of licensed nicotine-containing products (such as nicotine replacement therapy (NRT) patches and gum) and advice from stop smoking services, both of which are proven to be effective.

Professor Bauld said: “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 NRT when they cut down.

“Harm reduction approaches also provide an alternative choice for those who are not currently interested in quitting smoking. Although existing evidence isn’t clear about the health benefits of smoking reduction, for some people this reduction can kick-start a gradual change in behaviour that eventually leads them to quit, especially if they use licensed nicotine-containing products.”

She added: “People should ideally do this with support from stop smoking services, but there are also harm reduction options for those not using services. The key thing is to take action to reduce the harm that smoking tobacco causes, and this guidance provides people with new choices about how to do that.”

Professor Mike Kelly, Director of the NICE Centre for Public Health, 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, such as patches or gum, as a way to help reduce the harm caused by tobacco.

“Put simply, people smoke for the nicotine but die because of the tar in tobacco. However, nicotine inhaled from smoking tobacco is highly addictive, which is why people find it so difficult to stop smoking.  

“This guidance recommends harm reduction as an additional new option particularly for those who are highly dependent on smoking who want to quit, but can’t just stop in one go.”

The NICE recommendations include:

  • Organisations responsible for tackling tobacco use, such as stop smoking services and local authorities, should provide public information which highlights that licensed nicotine-containing products are an effective way of reducing the harm from tobacco for both the person smoking and those around them.  
  • Stop smoking advisers and health professionals should advise people to stop smoking in one step, but for those who aren’t ready or are unable to stop in one step, suggest considering a harm-reduction approach 
  • Advisers and health professionals should offer all types of licensed nicotine-containing products to people who smoke, as part of a harm-reduction strategy, either singly or in combination, according to the individual’s preference and level of dependence. For example, patches could be offered with gum or lozenges.  Advise people that using more than one product is more likely to be successful particularly for more dependent smokers
  • Advisers should discuss reduction strategies, which may include increasing the time interval between cigarettes, delaying the first cigarette of the day or choosing periods during the day, or specific occasions, when the person will not smoke. Follow up appointments to review progress should also be offered
  • Tobacco retailers and retailers of licensed nicotine-containing products should display licensed nicotine-containing products in shops and supermarkets, and on websites selling cigarettes and tobacco products
  • Health professionals and advisers should explain to people how to use licensed nicotine-containing products correctly to control cravings, prevent compensatory smoking when trying to stop smoking or reduce the amount they smoke. They should also reassure them that it is better to use these products and reduce the amount they smoke than to continue smoking at their current level
  • Advisers should tell people who smoke that some nicotine-containing products (for example, electronic cigarettes and topical gels) are not currently regulated by the Medicines and Healthcare products Regulatory Agency and so their effectiveness, safety and quality can’t be assured. Also advise them that these products are likely to be less harmful than cigarettes.


The guidance ‘Tobacco: harm-reduction approaches to smoking’ is available at


About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what NICE do, visit their website: and follow on Twitter: @NICEComms.


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