First Global Guidelines for Quitting Tobacco
 Some 750 million people globally want to quit smoking but most lack access to help to do so.

Digital cessation programmes, behavioural support, and medication for tobacco cessation in adults are some of the measures contained in first-ever guidelines to help people quit smoking published recently by the World Health Organization (WHO). 

One in five adults – 1.25 billion users worldwide – consume various tobacco products such as  cigarettes, heated tobacco products, water pipes, smokeless tobacco products, or cigars. 

Even though more than half of them – around 750 million – want to quit, only 30% have access to effective cessation services.

Among the treatments recommended to help them are counselling, teaching patients to change their smoking-related habits, dedicated apps or calls, nicotine replacement therapy and medication.

 What works best is a combined approach: behavioural support and pharmacotherapy, WHO states. Member states are encouraged to provide quitting help for no or low fee to make it as accessible as possible.

The guideline marks a “crucial milestone” in combatting tobacco addiction, WHO Director-General, Dr Tedros Adhanom Ghebreyesus said in a press release. “It empowers countries with the essential tools to effectively support individuals in quitting tobacco and alleviate the global burden of tobacco-related diseases.”

Tobacco smoking affects nearly every organ of the body, causing over 20 types of cancer, increasing the risk of heart disease, stroke, and many other conditions. According to the WHO, tobacco kills half of its users and affects non-smokers through second-hand exposure.

Health system change, medication and behavioural support

The guidelines feature advised changes in the health systems: tobacco use status and implemented cessation interventions should be included in the patient’s medical records; it is also recommended that health care workers are trained on the appropriate therapies and provide a short behavioural support talk to smokers who want to quit. 

Treatments included in the guidelines: counselling, digital support, pharmacotherapy, and embedding smoking cessation in the healthcare system are key recommendations.

Pharmacotherapy using nicotine replacement therapy and drugs such as varenicline, bupropion, and cytisine, especially when combined with behavioural support. This may include skills and strategies for changing behaviour as well as more general counselling. 

Traditional, complementary and alternative therapies are not recommended due to insufficient evidence for their effectiveness.

Varenicline, but not vapes

While the guidelines strongly recommend the use of varenicline, they do not mention a possible role for vapes in quitting traditional cigarettes, more harmful than their e-cigarette alternative. 

A recent study published by the JAMA Network suggests vaping can be as efficient as varenicline in helping smokers quit – although, as WHO argues, it has little effect at the population level. 

WHO states that “e-cigarettes are beyond the scope of this guideline because the potential benefits and harms of using these products are complex, and are addressed in a separate body of literature. These products may be addressed in the future as evidence accumulates.”

The tobacco industry is highly invested in marketing vapes, framing them as a safer alternative to traditional smoking even though they are also addictive and harmful. The WHO might be more cautious to promote e-cigarettes knowing its statements can be used by tobacco firms to promote their products.

“We need to deeply appreciate the strength it takes and the suffering endured by individuals and their loved ones to overcome this addiction,” said Dr Rüdiger Krech, Director of Health Promotion at WHO, in a press release. “These guidelines are designed to help communities and governments provide the best possible support and assistance for those on this challenging journey.”

Image Credits: Sarah Johnson, WHO.

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