Quality statement 3: Advice about nicotine‑containing products

Quality statement

People who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products.

Rationale

People can be unsure about the safety of using nicotine‑containing products and about the difference between licensed and unlicensed nicotine‑containing products. It is important to explain the potential benefits of and issues about using nicotine‑containing products, and also to ensure that licensed nicotine‑containing products are readily available to people who want to use them to reduce harm from smoking.

Quality measures

Structure

Evidence of local arrangements that people who are unwilling or not ready to stop smoking are advised about using nicotine‑containing products and supported to obtain licensed nicotine‑containing products.

Data source: Local data collection.

Process

a) Proportion of people identified as being unwilling or not ready to stop smoking who are advised about using nicotine‑containing products.

Numerator – the number in the denominator who are advised about using nicotine‑containing products.

Denominator – the number of people identified as being unwilling or not ready to stop smoking.

Data source: Local data collection.

b) Proportion of people identified as being unwilling or not ready to stop smoking who are supported to obtain licensed nicotine‑containing products.

Numerator – the number in the denominator who are supported to obtain licensed nicotine‑containing products.

Denominator – the number of people identified as being unwilling or not ready to stop smoking.

Data source: Local data collection.

Outcome

Uptake of licensed nicotine‑containing products.

Data source: Local data collection.

What the quality statement means for service providers, healthcare and public health practitioners, and commissioners

Service providers (such as primary and secondary healthcare providers, pharmacies, residential and domiciliary care providers, 'stop smoking' services and providers of secure mental health services) ensure that healthcare and public health practitioners are trained to advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and to either prescribe or supply licensed products or tell people where they can buy them.

Healthcare and public health practitioners (such as pharmacists, GPs, nurses, clinicians in NHS services, mental health care staff, staff in drug and alcohol services, 'stop smoking' advisers, ophthalmic practitioners and dental professionals) who determine whether service users smoke advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and either prescribe or supply licensed products or tell people where they can buy them.

Commissioners (such as clinical commissioning groups, local authorities and NHS England) ensure that they commission services from providers that train healthcare and public health practitioners to advise people who are unwilling or not ready to stop smoking about using nicotine‑containing products to reduce the harm caused by smoking, and to either prescribe or supply licensed products or tell people where they buy them.

What the quality statement means for service users

People who aren't ready or don't want to quit smoking get advice about using nicotine‑containing products as a way of reducing the harm from smoking, both for them and for those around them. They are also helped to get hold of licensed nicotine‑containing products – for example, by being prescribed these products or being told where they can buy them.

Source guidance

Definitions of terms used in this quality statement

Advice about using nicotine‑containing products

  • Reassure people who smoke that licensed nicotine‑containing products are a safe and effective way of reducing the amount they smoke. Advise them that these products can be used as a complete or partial substitute for tobacco, in either the short or the long term. Reassure them that it is better to use these products and reduce the amount they smoke than to continue smoking at their current level.

  • Tell people that some nicotine‑containing products are not regulated by the Medicines and Healthcare products Regulatory Agency (MHRA), and so their effectiveness, safety and quality cannot be assured, but that these products are likely to be less harmful than cigarettes.

[Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, recommendation 5]

Licensed nicotine‑containing products

These are products that contain nicotine but do not contain tobacco. They deliver nicotine without the harmful toxins found in tobacco. Nicotine‑containing products that are licensed have been given marketing authorisation by the MHRA, such as nicotine replacement therapy (NRT; examples include transdermal patches, gum, inhalation cartridges, sublingual tablets and nasal spray). Nicotine‑containing products that are not regulated by the MHRA, such as electronic cigarettes, are also available (unlicensed nicotine‑containing products). For further details, see the MHRA website. [Adapted from Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

If other nicotine‑containing products (such as electronic cigarettes) gain licensing authorisation in the future, this quality statement will be reviewed.

People who are unwilling or not ready to stop smoking

This includes people 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.

[Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45]

Supported to obtain licensed nicotine‑containing products

If possible, supply or prescribe licensed nicotine‑containing products. Otherwise, encourage people to ask their GP or pharmacist for them, or tell them where they can buy the products themselves.

[Tobacco: harm-reduction approaches to smoking (2013) NICE guideline PH45, recommendation 3]

Equality and diversity considerations

Advice should be culturally appropriate and readily available to people with additional needs such as physical, sensory or learning disabilities and people who do not speak or read English, and to people in groups identified as having a higher smoking prevalence. These include lesbian, gay, bisexual and transgender (LGBT) people, people with mental health problems, people in closed institutions (such as secure mental health units and custodial sites), people who are homeless and people from lower socioeconomic groups.