A new guide for those who want to quit smoking: what really works

Despite awareness of the harms, millions continue to smoke because of the severe addiction. In response to this problem, the Canadian Task Force on Preventive Medicine has released a new guide that provides a variety of proven smoking cessation methods, from behavioural to medication.

The Canadian Medical Association Journal reports.

A personalised approach

"Quitting smoking is difficult. You often need to try several approaches: counselling, medication or a combination of the two," explains one of the document's authors, Calgary-based emergency physician Eddie Lang.

The guide offers a "menu" of strategies that can be tailored to personal preferences. It's designed for patients, doctors and smoking cessation specialists, and it meets international standards.

What do clinicians advise?

1. Clarify each patient's smoking status.

2. Encourage smoking cessation using the recommended methods.

3. Use shared decision making - choose an approach with the patient, taking into account their needs.

Recommended methods

Behavioural interventions:

• Advice from a general practitioner;

• Individual or group counselling with a certified professional (including by telephone);

• Therapeutic SMS;

• Self-paced educational materials.

Medication support:

• Nicotine replacement therapy: patches, chewing gum, lozenges, inhalers, sprays;

• Varenicline;

• Bupropion;

• Cytisine (natural remedy).

Combined approaches - behavioural support + medication - are particularly effective.

Acupuncture, hypnosis, laser therapy, current stimulation, ear acupuncture, St John's wort and SAMe are not recommended.

The recommendations do not address traditional tobacco use by Indigenous peoples in Canada.

E-cigarettes: only if nothing else works

Although vape devices can help with smoking cessation, their use is suggested only when other methods have failed. The devices are often not standardised, there is a lack of long-term safety data, and they don't always help with nicotine addiction.

Why it matters

In 2022, 11% of Canadians over the age of 15 smoked tobacco, of which 75% smoked tobacco daily. Smoking significantly increases the risk of lung, mouth, throat and bladder cancer, as well as cardiovascular and respiratory disease. Lonely people, LGBT+ people, indigenous people, people with mental health problems and workers without specialised qualifications remain particularly vulnerable groups.

As guide co-author Dr Donna Reynolds emphasises, "using these proven and practical methods will help people move closer to the goal of quitting smoking for good". And CMAJ editor Dr Matthew Stanbrook adds: "While Canada has made great progress in reducing smoking rates, it is important to support those who are still struggling with this addiction."