Next review date: TBC

This guidance partially updates and replaces NICE guideline PH10 (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.

This guideline was previously called tobacco: harm-reduction approaches to smoking.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline is not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

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