Cut down if you can't quit: Doctors concede that some smokers just can't stop - and that gum and patches are safe alternative



National Institute of Health and Care Excellence issued the landmark advice

Said those who find it difficult to quit can reap benefits if they cut down



NICE also recommend the use of nicotine replacement therapies such as chewing gum and patches to help reduce daily tobacco intake

Some experts also believe e-cigarettes could be a helpful therapy although they were not included in the guidance



Smokers should cut down on cigarettes if they can't give up, according to new guidance from British health professionals.

The National Institute for Health and Care Excellence (Nice), has finally conceded that although stopping completely is the best way to reduce health risks, many people are unable to do so.

The landmark guidance has been issued to reduce tobacco-related harm for people struggling to kick the habit.



It is also the first official endorsement of nicotine-containing products which can be used to help people cut down on the amount they smoke.

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The National Institute of Health and Care have said that smokers can reap benefits if they cut down and do not quit their habit. They say that substituting some cigarettes with nicotine replacement therapies should help

Those targeted by the advice include people who may not be able to give up smoking immediately, 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.

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 added that 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.

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

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.



E-cigarettes are an increasingly popular NRT option but they are controversial because they have not yet been licensed as safe and effective by drug watchdogs.



The devices provide a nicotine ‘hit’ to the user without the tar but there are fears they may pose a different health hazard.

But the guidance from the National Institute for Health and Care Excellence says doctors seeking to help smokers can advise ‘these products are likely to be less harmful than cigarettes’.



Professor Aveyard said he will tell patients that using e-cigarettes is ‘better than smoking.'

‘The safest thing is to use licensed nicotine replacement products - but a lot of people don’t want to use nicotine gum’ he added.

The cost to the NHS in England of treating smoking-related illnesses is an estimated £2.7 billion a year

Concern has been raised that propellants used to produce the vapours from e-cigarettes may be potentially harmful.



The UK watchdog, the Medicines and Healthcare Products Regulatory Agency is currently producing guidelines which are expected shortly.



The latest Nice guidance says nicotine replacement therapy, which includes patches and gum, can be safely used even when the patient continues to smoke.



Nicotine Replacement therapies such as patches are now endorsed as a healthy alternative

There is no possibility patients will overdose on nicotine, which is a ‘relatively harmless substance’, it says.

Prof Aveyard said when someone smokes cigarettes combined with NRT (Nicotine Replacement Therapy) they are more likely to stop smoking and smokers who eventually want to quit should start using them.

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.



‘Experts believe that lifetime use of these products will be considerably less harmful than smoking.’



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.”



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



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.

