Quitting smoking can be incredibly difficult, but there are many treatments that can help you do it.
The main treatment options are:
nicotine replacement products (such as chewing gum, lozenges, patches, inhaler and spray)
non-nicotine quit treatments (such as bupropion, varenicline and nortriptyline).
Quit smoking treatment can be effective in helping you give up smoking, but they only deal with the physical dependence. To get the most benefit, you’ll need other methods that help with the psychological (emotional and mental) part of quitting, such as a quit program (see quit smoking support).
About nicotine
People who smoke cigarettes become addicted to nicotine but it is the other components of cigarette smoke that damage your health.
Nicotine activates an important group of nerve and brain receptors, producing many effects. Smokers say it gives them stress relief, improved mood and the ability to think or concentrate better, and because nicotine is rapidly absorbed from cigarette smoke, it gives instant effects.
The addictiveness of nicotine is as strong as some 'hard drugs', it's just that the immediate effects are less extreme. About 4 out of every 5 smokers are addicted to nicotine. Smoking your first cigarette within 30 minutes of getting up in the morning is a sign of a high level of addiction to nicotine.
For regular smokers, the downside is that without nicotine the opposite sensations (withdrawal effects) are experienced. These can start a few hours after the last cigarette and include:
cravings for a cigarette
feeling irritable, anxious or depressed
difficulty concentrating
difficulty sleeping
a temporary increase in appetite and weight gain.
Nicotine replacement therapy (NRT)
NRT provides a safe, controlled way of administering nicotine without all the other harmful chemicals contained in cigarettes smoke. It is shown to double your chances of quitting successfully over going cold turkey. NRT is safe to use in pregnancy and is recommended to prevent harm to the unborn baby from smoking.
The nicotine skin patch is designed to deliver a background level of nicotine.
Nicotine chewing gum, nasal spray or inhalers deliver it more quickly and can be used when you get a sudden urge for a cigarette.
The patches and gums come in different strengths to suit you.
The objective is to stop cigarettes as soon as you start NRT and then reduce the use of NRT over about 8-12 weeks, to gently wean yourself off your dependence on nicotine.
Subsidised NRT is available from Quitline on 0800 778 778, local quit smoking providers or your doctor. (Quit Cards)
Non-nicotine quit treatments reduce the negative sensations of nicotine withdrawal so you do not miss having a cigarette so badly. It also blocks the pleasant sensations of smoking so having a cigarette is less enjoyable.
Bupropion (Zyban®) helps reduce intense withdrawal symptoms from nicotine. Available on prescription only.
Varenicline (Champix®) works by blocking the nicotine receptors in the brain, making cigarettes less pleasurable. Ask your doctor if you are eligible for a fully funded 12-week Champix course.
Nortriptyline (Norpress®) helps reduce negative nicotine withdrawal symptoms such as anxiety and stress. Available on prescription only.
Non-nicotine medications must be prescribed by your doctor. They can be useful, and your doctor will explain how to use them. Non-nicotine medications are not suitable for pregnant women.
Think you can’t afford quit treatment?
Compare your Treatment cost $ … ... per week with your Usual spend on tobacco $ … ... per week
smoking cost calculator (Health Promotion Agency)
When treatment stops you will save all of your weekly spend on tobacco, so even if the treatment costs more than the cigarettes it will not take long to get back the cost of your treatment.
The following information on Smoking cessation advice is taken from 3D HealthPathways, accessed January 2020:
About smoking cessation
Stopping smoking is one of the most important health changes a patient can make.
Smoking increases the risk of many conditions: ◊ respiratory ◊ cardiovascular ◊ diabetes ◊ cerebrovascular ◊ peripheral vascular ◊ cancer – lung, laryngeal, oro-pharyngeal, stomach, pancreatic, renal cell and bladder cancers ◊ adverse pregnancy outcomes eg, low birth weight, spontaneous abortion, perinatal and neonatal mortality.
Smoking cessation will have virtually immediate effects on the risk of cardiovascular events.
The major risks can reduce within 2–5 years of stopping smoking but for some conditions the risk never returns to that of non-smokers.
80% of adult smokers begin as children. Ensuring young people avoid smoking is important as nicotine addiction can occur rapidly at this age.
For every year that smoking cessation is postponed after the age of 40, life expectancy will decrease by 3 months.
Health professionals play an important role in educating, motivating and helping smokers to quit.
Assessment (ABC)
Ask – Ask about current and past cigarette smoking at every opportunity and document the response.
Brief advice – Give clear personalised advice and document advice given.
Cessation – Offer Nicotine Replacement Therapy (NRT) and refer to a quit programme as below.
Management
Recognise and address why people smoke and the barriers to quitting: • Addiction to smoking cigarettes • Withdrawal causes unpleasant symptoms • Strong behavioural rewards associated with smoking cigarettes • Smoking is perceived to help with stress • Concern about weight gain.
Medications • 1st line - Nicotine replacement therapy (NRT) ◊ NRT should be considered safe in all people who smoke. ◊ Use enough NRT products to relieve withdrawal symptoms. ◊ Use a combination of products in high dependency smokers – this is safe and increases the odds of quitting. ◊ A longer course of treatment can be used. • 2nd line: ◊ Varenicline (Champix) ◊ Bupropion (Zyban) ◊ Nortriptyline.
Be prepared to offer smoking cessation support and advice about vaping. • Vaping carries much less health risk than smoking tobacco and there is some evidence that it may aid successful smoking cessation. • Specialist vape stores can advise on appropriate nicotine dose and device. • See Vaping Facts for more information for both health professionals and patients who smoke.
Promote engagement with behavioural support as this has been shown to improve quit rates regardless of the quitting method: • Tākiri Mai Te Ata Regional Stop Smoking Service – face‑to‑face support • Quitline – phone‑based support.
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
