New cut-down-then-stop smoking strategy launched
Four-stage plan
Stage 1 (0 to six weeks): Smoker sets a target for
the number of cigarettes a day to cut down and a date by which this
should be achieved. A 50 per cent reduction is advised. Cravings are
managed using Nicorette gum or inhalator.
Stage 2 (six weeks to six months): Smoker should
continue to cut down with the aim of stopping completely.
Stage 3 (within nine months): Smoker stops all cigarettes
and continues to use Nicorette to manage cravings.
Stage 4 (within 12 months): Nicorette is gradually withdrawn within
three months of stopping smoking. |
Until now, smokers wanting to quit using nicotine replacement therapy have been advised that total abstinence from cigarettes is the only option. A new strategy to stop smoking, which involves cutting down before stopping, has been launched this week.
“Cut down with Nicorette then stop” offers the 74 per cent
of smokers who are not ready to stop abruptly a four-stage plan to stop
smoking within six to nine months.
Nicorette gum and inhalator have now been licensed for use between episodes
of smoking to prolong smoke-free intervals and with the intention of reducing
smoking as much as possible. The summaries of product characteristics
specify that professional advice should be sought if no reduction is achieved
within six weeks and no attempt to quit is made within nine months. A
quit attempt should be made as soon as the smoker feels ready but no later
than six months after starting treatment.
In a double blind placebo controlled trial of 2,424 smokers the strategy
was found to be more effective than placebo. In addition, the trial found
that most smokers who successfully cut down were more motivated to quit
and one in three of those who reduced cigarettes by 50 per cent stopped
smoking completely within one year. Data also showed that levels of nicotine
in those using NRT and placebo were similar, indicating that smokers using
the new strategy do not compensate for cutting down the number of cigarettes
smoked by inhaling more deeply.
Omar Ali, formulary development pharmacist, Surrey and Sussex Healthcare
NHS Trust, and prescribing consultant primary care, commented: “For
pharmacists this new indication will be a positive step in providing a
broader and more effective range of services to help smokers give up while
helping to meet the targets of the new pharmacy contract.”
He added that, currently, he can do nothing for the 74 per cent of smokers
who feel unable to stop abruptly and this strategy will increase the options
available.
Miriam Armstrong, chief executive of PharmacyHealthLink,
commented: “PharmacyHealthLink has been lobbying for years for the
NRT licence to be relaxed — so we are delighted to hear that the
pharmaceutical companies, along with the Medicines and Healthcare products
Regulatory Agency, have now recognised that continuing to smoke is far
more dangerous and lifethreatening than using NRT.”
The new strategy will widen the strict entry criteria required for smokers
to receive NHS support, she added.
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