New standard to help reduce the harm from smoking

NICE’s latest quality standard sets out advice to help reduce tobacco-related harm for people who are unwilling or not ready to stop smoking.

Smoking is the single greatest cause of preventable illness and early death in England. Around half of all life-long smokers die prematurely losing about 10 years of life on average.

In 2012-13 smoking is estimated to have led to 460,900 NHS hospitable admissions in England alone among people aged 35 or over. This accounts for 5 per cent of all hospital admissions in this age group, and costs the NHS an estimated £2 billion per year.

The best way to tackle the health problems associated with smoking is to stop, and stopping in one step offers the best chance of success. However, not everyone who smokes is either able or willing to stop in one step. In such cases, a harm-reduction approach may be effective.

A harm-reduction approach

NICE’s latest quality standard contains four quality statements which together set out the best care that should be offered to people who want to take a harm-reduction approach to smoking.

The first statement says people who are unwilling or not ready to stop smoking should be offered a harm-reduction approach to smoking. Such approaches include:

  • Stopping smoking, but using 1 or more licensed nicotine-containing products for as long as needed to prevent relapse. Such products include patches, gums and sprays
  • Cutting down before stopping smoking
  • Smoking reduction
  • Temporary abstinence from smoking

Licensed vs unlicensed nicotine products

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.

Examples of licensed nicotine containing products include patches, gum, inhalation cartridges and spray. Electronic cigarettes are widely available, yet 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, statement 3 says that 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.

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

The final statement calls for stop-smoking services to offer harm-reduction approaches alongside existing approaches to stopping smoking in one step.

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.”

This 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.

Professor Gill Leng, Deputy Chief Executive of NICE