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• Lifting the lid on Nicotine Replacement Therapy. Re: "Ending appreciable tobacco use in a nation: using a sinking lid on supply"
  Brent O Caldwell
  Published on: 13 May 2016

• Published on: 13 May 2016

  Lifting the lid on Nicotine Replacement Therapy. Re: "Ending appreciable tobacco use in a nation: using a sinking lid on supply"

  • Brent O Caldwell, Research Fellow
  • Other Contributors:
    • Julian Crane

  Thomson and colleagues present a novel radical approach for national tobacco elimination supported by cogent arguments and discussion of the various pros and cons for such a policy (Tobacco Control 2010;10:431-435). They discuss, albeit briefly, the importance of best practice cessation support. However current best practice is not especially effective, and just as they have argued for a radical policy approach, there sim...

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  Thomson and colleagues present a novel radical approach for national tobacco elimination supported by cogent arguments and discussion of the various pros and cons for such a policy (Tobacco Control 2010;10:431-435). They discuss, albeit briefly, the importance of best practice cessation support. However current best practice is not especially effective, and just as they have argued for a radical policy approach, there similarly needs to be a more radical and innovative approach to cessation treatments in terms of access, public awareness and choices of delivery.

  Firstly, cessation treatments, particularly Nicotine Replacement Therapy (NRT) must be more visible and available. Despite strong subsidy for NRT via prescription and the New Zealand Quitline it remains easier to obtain a packet of cigarettes that it does to obtain the almost harmless nicotine equivalent. Nicotine needs to be much more prominently displayed, and available wherever tobacco is legally sold. When a smoker needs nicotine they usually need it immediately at the corner shop not after an appointment with their GP and a pharmacy prescription.. Nicotine needs marketing in the same proportion that tobacco needs eliminating.

  Secondly, there needs to be better education about the relative safety of NRT compared to continued smoking. More than 50% of smokers believe that nicotine is the dangerous component of smoking, and so it is perhaps not surprising that NRT uptake is poor. The merits of NRT should be discussed at every cessation encounter and much more widely promulgated. For those unable to quit smoking, the long term use of nicotine is infinitely preferable to continued smoking, and yet to date there have been no long term studies designed to explore substitution as an alternative to cessation.

  Lastly, we need fast acting nicotine formulations delivered in a manner that is both acceptable to smokers and rapidly controls their urges to smoke. The inhalation route is the obvious one but is more difficult given the aversiveness of nicotine in the upper airway. Oral liquid formulations may prove more effective than current NRT, and we should not write off products such as snus without at least examining their potential for harm reduction. In addition to considering a sinking lid for tobacco, we need to take the lid off nicotine, convince smokers that it is not much more harmful than coffee, and provide a much improved range of products for cessation or failing that for lifelong use.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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