This guideline covers reducing harm from smoking. It aims to help 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. 

NICE has also produced guidelines on stop smoking services and smoking: brief interventions and referrals.

In July 2013, changes were made to reflect the MHRA decision that all nicotine-containing products should be regulated. For further details, see the MHRA website.


This guideline includes recommendations on:

Who is it for?

  • Commissioners, managers and practitioners in public health, especially those involved in advice about smoking cessation
  • Organisations providing education and training
  • Manufacturers and retailers of licensed nicotine-containing products

Is this guideline up to date?

We checked the recommendations in this guideline in March 2017 and it will be amalgamated by the committee into a single tobacco guideline which combines the tobacco suite of guidelines.

See the guideline in development page for progress on the update.

Guideline development process

How we develop NICE guidelines

This guidance partially updates and replaces NICE guideline PH10 (2008).

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 and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services 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 complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)