Tobacco smoking is the number one cause of preventable disease and death in Canada; it is highly addictive and hard to stop. Recognizing these challenges, a new guideline from the Canadian Task Force on Preventive Health Care provides a menu of effective options to help people quit smoking, with behavioural and medication options and a natural health product that can be tailored and combined for personal choice. The guideline is published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241584 .
"Quitting smoking can be hard, and people may need to try to quit many times with a variety of options like counselling, medication or in combination," said task force member Dr. Eddy Lang, an emergency physician at the University of Calgary and a guideline coauthor. "We have created a menu of options that work to address tobacco smoking and can be tailored to personal preferences to help people quit."
Tobacco smoking increases the risk of cancers such as lung, mouth, throat and bladder cancers; respiratory disease; cardiovascular disease; and more. Tobacco contains more than 7000 chemicals and 70 carcinogens.
In 2022, 11% of Canadians aged 15 years or older smoked tobacco, and about 75% of those smoked daily. Populations at higher risk of smoking include single, separated, divorced, or widowed people; people who identify as gay or bisexual; First Nations, Inuit or Métis people; people with mental health issues or substance use disorders; and those who work in jobs that do not require specific training or education levels.
Targeted at clinicians, smoking cessation practitioners, and patients, the guideline includes tools to help people decide which options are best for them, alone or in conversation with a health care provider. It is based on the latest evidence and aligns well with international guidelines.
What should clinicians do to help patients?
- Know your patients' smoking status as part of good clinical care
- Encourage all patients who smoke tobacco to quit with one or more recommended smoking cessation options
- Engage in shared decision-making to determine the best option(s) based on patient preferences
What interventions does the guideline recommend?
- Behavioural
- Primary care advice
- Individual or group counselling by trained cessation counsellor (in person or telephone)
- Text messaging interventions
- Self-help materials
- Pharmacotherapy
- Nicotine replacement therapy (patch, gum, lozenges, inhaler or spray, used alone or together)
- Varenicline
- Bupropion
- Cytisine (a natural health product)
- Combined behavioural and pharmacotherapy interventions
The guideline recommends against acupuncture, hypnosis, laser therapy, electric current stimulation to the head, ear acupressure, St. John's Wort, or S-adenosyl-L-methionine (SAMe) for smoking cessation.
The recommendations do not apply to traditional or ceremonial tobacco use by Indigenous peoples.
The task force engaged members of the public who smoke or had recently quit smoking to help rate potential outcomes such as success in quitting and quality of life. The guideline working group also involved 2 external content experts, a physician-scientist who treats people with tobacco addiction and another physician-scientist with expertise in implementing hospital-based smoking cessation programs. Many organizational interest holders also provided input into the guideline.
What about e-cigarettes?
The guideline recommends that most people first use behavioural and pharmacotherapy options known to be effective. Although e-cigarettes may help people quit, their use should be for those who could not quit using other ways or who express a strong preference for e-cigarettes. There are important uncertainties for people to consider, including the lack of approved products with consistent formulations and lack of long-term safety information, and e-cigarettes may not address nicotine addiction.
"Using these practical, evidence-based options will help people achieve their goal to quit smoking," said task force member Dr. Donna Reynolds, a family physician, specialist in public health and preventive medicine, and guideline vice-chair. "Clinicians can use the menu of options that we've made available as a patient–clinician discussion tool for shared decision-making with patients to discuss what is best for them. Quitting smoking may be just an intervention away."
Find an infographic , patient–clinician discussion tool , podcast and more on August 25.
In a related editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251171 , Dr. Matthew Stanbrook, a respirologist at Toronto Western Hospital and deputy editor, CMAJ, writes "laudably, the guideline authors make a conditional recommendation against electronic cigarettes (e-cigarettes) for smoking cessation for most patients."
This new guideline will be helpful in supporting patients to quit tobacco smoking.
"Although Canada has succeeded in substantially reducing the prevalence and incidence of smoking over the last half century, more work remains to help people who continue to smoke. Using this new guideline, clinicians will be better equipped to partner with their patients to enable them to free themselves from Canada's leading preventable cause of death and disease," concludes Dr. Stanbrook.
