Tobacco: harm-reduction approaches to smoking

NICE guidelines [PH45] Published date:

This guidance partially updates and replaces NICE public health guidance 10 (published in February 2008).

Nicotine inhaled from smoking tobacco is highly addictive. But it is primarily the toxins and carcinogens in tobacco smoke – not the nicotine – that cause illness and death. The best way to reduce these illnesses and deaths is to stop smoking – ideally, stopping in one step (sometimes called ‘abrupt quitting’). (See the NICE pathway on smoking)

However, there are other ways of reducing the harm from smoking, even though this may involve continued use of nicotine. This guidance is about helping people, particularly those who are highly dependent on nicotine, who:

  • may not be able (or do not want) to stop smoking in one step
  • may want to stop smoking, without necessarily giving up nicotine
  • may not be ready to stop smoking, but want to reduce the amount they smoke.

It recommends harm-reduction approaches which may or may not include temporary or long-term use of licensed nicotine-containing products.  

The guidance is for: commissioners, managers and practitioners with public health as part of their remit, organisations that provide education and training, manufacturers and retailers of licensed nicotine-containing products.

It is especially aimed at those involved in providing advice about stopping smoking, including those working in smoking cessation services. 

The recommendations cover awareness-raising, advising on, providing and selling licensed nicotine-containing products; self-help materials; behavioural support; and education and training for practitioners.

This guidance does not cover ‘reduced exposure cigarettes’, ‘smokeless tobacco’ or any other products containing tobacco. In addition, it does not provide advice for women who are pregnant or maternity services.

The guidance was updated in July 2013 to reflect the MHRA decision that all nicotine-containing products should be regulated. This is expected to come into effect in 2016. For further details, see the MHRA website.

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