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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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smokingJuly 8 2015

Health professionals should be discussing ways of reducing the harm from smoking with smokers who do not want to quit, says NICE. It also appears willing to tolerate the use of e-cigarettes, even if not yet licensed as medicines, as they are “likely to be less harmful than cigarettes.”

NICE’s new quality standard QS92, ‘Smoking: harm reduction’, sets out four quality statements to describe what it considers to be the best care. When highlighting harm reduction approaches with smokers, healthcare professionals can discuss:

  • stopping smoking, but using one or more licensed nicotine-containing products, such as patches, gums and sprays, for as long as needed to prevent relapse;
  • cutting down before stopping smoking;
  • smoking reduction; and
  • temporary abstinence from smoking.

In addition, smokers should be:

  • advised that health problems associated with smoking are caused primarily by components in tobacco smoke other than nicotine;
  • advised about using nicotine-containing products and supported to obtain licensed nicotine-containing products; and
  • offered harm-reduction approaches alongside existing approaches to stopping smoking in one step

NICE says “there is a good deal of uncertainty about the safety of using nicotine-containing products, and about the difference between licensed and unlicensed nicotine-containing products.” While electronic cigarettes are widely available, they are not currently regulated by the MHRA so their safety, effectiveness and quality cannot be assured. “However, they are likely to be less harmful than cigarettes.

“As a result ... people who are unwilling or not ready to stop smoking should be advised about using nicotine-containing products and supported to obtain licensed nicotine-containing products.”

For health professionals, QS92 says this will mean advising smokers about using nicotine-containing products and to “either prescribe or supply licensed products or tell people where they can buy them.”

Professor Gill Leng, Deputy Chief Executive of NICE, said: “The best way to reduce the harm from smoking is to stop completely and the best chance of doing this is still to quit in one step. However, nicotine inhaled from smoking tobacco is highly addictive, which is why people find it so difficult to stop smoking – but the main harm from smoking is from the tar in tobacco.

“For people who’ve been unable to stop in one step, reducing how much they smoke with the support of licensed nicotine-containing products such as patches or gum, and advice from stop smoking services, can help.

“This approach was recommended in NICE’s guidance on tobacco harm reduction, which informed this new standard. The standard’s quality statements set out what should be offered to ensure that the best care is given to people wanting to reduce their harm from smoking.”

Links:

NICE announcement    

NICE QS92 ‘Smoking: harm reduction’    

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