Smokers are encouraged to at least cut down on the habit if they are unable to stop completely in guidance which is a world-first issued by health professionals.

The landmark guidance to reduce tobacco-related harm for people struggling to kick the habit is the first to recommend that licensed nicotine-containing products can be used to help people cut down on the amount they smoke.

People targeted by the advice includes those who may not be able to give up in one go, those who want to stop smoking without giving up nicotine and those who might not be ready to stop but want to reduce the amount they smoke.

The guidance, issued by the National Institute for Health and Care Excellence (Nice), recognises that although stopping completely is the best way to reduce harm, many people are unable to do so.

Professor Mike Kelly, director of the Nice centre for Public Health, opened a press briefing about the guidance with a Mark Twain quote: “Giving up smoking is the easiest thing in the world.

“I know because I’ve done it thousands of times.”

Prof Kelly said the guidance endorses cutting down on smoking with the help of licensed nicotine products such as patches and gum to help reduce the harm caused by tobacco.

He pointed out that while nicotine is a “relatively harmless” substance, there is a lack of clarity over the safety of nicotine replacement therapy (NRT) and what substance actually causes death.

“Put simply, people smoke for the nicotine but die because of the tar in tobacco.

“However, smoking tobacco is highly addictive, which is why people find it so difficult to stop smoking,” he said.

Professor Paul Aveyard, Nice guidance developer, GP and Professor of Behavioural Medicine at the University of Oxford, said the guidance gives him another option to present to patients – and highlighted the safety and usefulness of NRT.

He said when someone smokes cigarettes combined with NRT they are more likely to stop smoking.

There is no evidence the combination of smoking and using NRT is harmful, he said.

“Advisors should reassure people that licensed nicotine-containing products are a safe and effective way of reducing the harm from cigarettes, and that NRT products have been shown in trials to be safe for at least five years’ use,” he said.

Adding: “Experts believe that lifetime use of these products will be considerably less harmful than smoking.”


Prof Kelly said that without the use of NRT, people who are trying to cut down or quit, “smoke more deeply”, adding: “They are sucking in.”

He said the difference between “clean nicotine” – such as the nicotine in NRT – as opposed to cigarette smoke, is vast.

Prof Kelly acknowledged that the new guidance is very different to previous advice: “The message in the past has been a very simple one. It has been ‘Stop’,” he said.

The providers of this guidance, which although focuses on harm reduction, still say that the best way of reducing harm is to completely stop smoking, and highlighted the negative impact the habit has on both the UK’s health and finances.

Professor Linda Bauld, chairwoman of the Nice guidance development group, and Professor of Health Policy at the University of Stirling, said: “The cost to the NHS in England of treating smoking-related illnesses is an estimated £2.7 billion a year.

“One in five adults in England smoke, and around two thirds of people who smoke say they’d like to quit.”

Prof Bauld said people tend to “under-use” NRT products for fear they are unsafe or bad for their health, but said: “You can continue to use clean nicotine for quite some time.”

Prof Aveyard said NRT is available on prescription and that a full dose for the week costs £10.

Prof Kelly described this as “a good investment from the exchequer’s point of view”.

Electronic cigarettes were not included in the guidance as they are not a licensed nicotine product and have no “guarantees”, Prof Kelly said

Prof Aveyard said though: “I think the guidance is clear that using an e-cigarette is safer than smoking.

Dan Griffin, a smoker of 25 years, said electronic cigarettes “present a good opportunity for people to quit smoking”.

Mr Griffin said he has spent in excess of £20,000 on cigarettes and said some people might argue that smoking is “as sensible as putting your fingers in a toaster”.

Mr Griffin has tried various methods to quit smoking including nicotine gum, hypnosis and going cold turkey.
“I think this new guidance is going to be particularly helpful,” he said.

Professor John Britton, chair of the Royal College of Physicians’ tobacco advisory group, said the new guidance is welcomed and echoed Prof Kelly in his differentiation of clean nicotine and cigarette smoke.

“Smokers smoke for nicotine, and since tobacco smoke is by far the most harmful available source of nicotine, switching to alternatives as a short or long-term substitute is the obvious healthier choice.

“We would encourage all smokers to take up the opportunities presented by this guidance, and if they can’t quit using nicotine altogether, to switch as much as they can to an alternative nicotine product.

“This guidance has the potential to change millions of lives for the better. We commend it,” he said.