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BMJ. 2007 October 13; 335(7623): 742.
PMCID: PMC2018793

UK report calls for better access to nicotine replacement treatment for heavily addicted smokers

Heavily addicted smokers do not get enough support to help them quit, warns a UK report published last week. It calls for better access to nicotine replacement treatment as part of a harm reduction strategy.

It proposes that a new nicotine regulatory authority be established to oversee all aspects of regulation of nicotine products and to coordinate efforts to end the advantage that cigarettes currently have in the marketplace over alternative products such as gums and patches.

The report, published by the Royal College of Physicians, argues that smokers smoke mainly for the effects of nicotine, that nicotine itself is not especially hazardous, and that providing nicotine in an acceptable and effective form such as cigarette substitutes could save millions of lives. It recommends changing the regulations governing nicotine products so that substitutes are as easy to buy as cigarettes and so that they can provide a higher level of nicotine than is provided by the substitutes currently available.

Current regulatory systems governing nicotine products in most countries, including the United Kingdom, actively discourage the development, marketing, and promotion of substitute products to smokers, the report says. In contrast, cigarettes are relatively unregulated, giving them an unfair advantage in the marketplace.

John Britton, professor of epidemiology at Nottingham University and chairman of the royal college's tobacco advisory group, said, “Smokers smoke because they are addicted to nicotine, but it isn't nicotine in cigarette smoke that kills: it's the hundreds of other toxic chemicals that come with it.”

He said that much of the current effort in the UK to reduce smoking aimed to prevent people from starting to smoke and to help smokers quit completely. But he noted: “There are millions of smokers who can't quit or else who are unlikely to quit, and those people need nicotine products that can satisfy their addiction without killing them.”

Acknowledging the highly addictive nature of nicotine, Professor Britton said, “If we could provide the nicotine hit that smokers seek in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved by encouraging smokers to switch to lower risk nicotine products—ideally as a step towards complete quitting or else as a long term, less risky alternative to smoking.

He added, “We would like to see nicotine products that deliver as much nicotine as quickly as cigarettes.” These may be similar to current nicotine replacement products, such as gums and patches, but would contain higher amounts of nicotine. Higher nicotine content would make the products more addictive, so regulations would need to be changed to take this into account. To encourage smokers to choose these products they should also be more attractive and cheaper than cigarettes, Professor Britton said.

The report says that a new regulatory framework would include measures designed to provide smokers with safer sources of nicotine and effective cigarette substitutes and to encourage the development of more effective and user friendly medicinal substitutes to nicotine.

Jean King, director of tobacco control at Cancer Research UK, said, “We welcome this report, which highlights the stark fact that cigarettes—which are the most dangerous way of obtaining nicotine—are freely available and accessible, while medicinal nicotine products—which by comparison carry minimal risk—are heavily regulated and therefore much less readily available.

“We also strongly support a fully independent tobacco and nicotine regulatory authority to govern all tobacco and nicotine products. If nicotine can be provided in a form and at a price that offers a far more attractive and accessible alternative to smoking than at present, many lives could be saved.”

Notes

Harm Reduction in Nicotine Addiction: Helping People Who Can't Quit is at www.rcplondon.ac.uk/pubs/brochure.aspx?e=234.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group