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The efficacy of nicotine replacement therapy (NRT) as a smoking cessation aid has been convincingly demonstrated in a large number of studies, including many randomised trials.1 Findings from these studies have prompted suggestions that widespread access to NRT could substantially increase quitting in a population, thereby reducing population smoking prevalence.2 Hence when NRT became available over-the-counter in pharmacies in the USA (rather than by prescription only), a large increase in quitting activity was expected.3 However, Thorndike and colleagues4 found that in Massachusetts the switching of NRT from prescription only to over-the-counter availability did not result in increases in either quitting activity in the population, the use of NRT in quit attempts, or the success of quit attempts overall. The authors argued that there are barriers to NRT use, other than having to visit a doctor to obtain a prescription. …