Smoking cessation: comparing available approaches
This content is general information only and does not constitute medical advice. Always consult a qualified health professional regarding your individual circumstances.
The harms of combustible cigarettes (why quitting matters)
Quitting smoking is one of the most important steps a person can take to improve their long-term health. Tobacco use remains a leading cause of preventable disease and death worldwide, contributing to cardiovascular disease, cancer, and chronic respiratory conditions. For many people, however, quitting is difficult and often requires multiple attempts and a combination of strategies.
A range of evidence-based approaches are available to support smoking cessation. These include behavioural support, approved pharmacotherapies such as nicotine replacement therapy (NRT), varenicline, and bupropion, and, in some cases, nicotine vaping products under appropriate clinical or pharmacist supervision. The most suitable approach varies between individuals and should be determined in consultation with a healthcare professional.
Behavioural support and counselling
Within Australia’s medical framework, nicotine vaping products (NVPs) are considered a clinician-guided option rather than first-line therapy. Recent RACGP guidance notes that for people who want to quit but have not succeeded with first-line therapy (behavioural support plus TGA-approved pharmacotherapy), it may be reasonable to recommend NVPs within a supervised plan, with an emphasis on short-term use and staged weaning once abstinent from smoking. [2]
Nicotine Replacement Therapy
Nicotine replacement therapy provides controlled doses of nicotine without the harmful by-products of tobacco combustion. It is available in multiple forms, including patches, gum, lozenges, inhalators, and sprays.
NRT is widely used as a first-line pharmacological option and has a well-established safety profile. Combination therapy, such as using a nicotine patch alongside a faster-acting product like gum or lozenges, can be more effective than single-form use. While NRT can help reduce withdrawal symptoms and cravings, some individuals find it less effective for managing habitual or behavioural aspects of smoking.
Varencline and Bupropion
Prescription medications such as varenicline and bupropion are also used in smoking cessation. These medications act on neural pathways involved in addiction and reward.
Varenicline works by partially stimulating nicotine receptors while blocking the reinforcing effects of smoking. Bupropion, originally developed as an antidepressant, also reduces cravings and withdrawal symptoms. Both medications have been shown to improve quit rates compared to placebo, although they may not be suitable for all patients and require assessment by a doctor.
Nicotine Vaping Products in Smoking Cessation
Nicotine vaping products may be considered in certain circumstances as part of a structured smoking cessation plan. Current evidence suggests that, when combined with behavioural support, nicotine vaping products can help some people quit smoking and may be more effective than traditional nicotine replacement therapy in specific settings.
Importantly, nicotine vaping products are not risk-free. However, for individuals who would otherwise continue to smoke combustible cigarettes, completely substituting smoking with regulated nicotine vaping products is likely to reduce exposure to many harmful chemicals associated with tobacco smoke.
In Australia, access to nicotine vaping products is regulated. Depending on the product and patient factors, some products may be available through participating pharmacies following pharmacist consultation, while others require a prescription from a medical practitioner. Not all patients are suitable candidates, and these products are not recommended for non-smokers or young people.
Clinical guidance in Australia generally positions nicotine vaping products as a secondary option for adults who have not been able to quit smoking using first-line therapies, or who are unable to tolerate them. Decisions around their use should be individualised and made in consultation with a healthcare professional.
Harm reduction and complete substitution
A key concept in smoking cessation is harm reduction. Cigarette smoke contains thousands of chemicals, including many known carcinogens and toxins produced through combustion. Eliminating exposure to these combustion products is central to reducing smoking-related harm.
For individuals using nicotine vaping products as part of a quit attempt, the goal is complete substitution of cigarettes, rather than ongoing dual use. Continuing to smoke while also using alternative nicotine products is associated with less benefit and may prolong dependence.
Duration of use and tapering
The optimal duration of nicotine-based therapies varies between individuals, and evidence is still evolving. In general, treatment should be regularly reviewed, and gradual reduction in nicotine use can be considered once a person has achieved stable abstinence from smoking.
Some individuals may require longer periods of support, while others may taper more quickly. Follow-up with a healthcare professional is important to assess progress, manage side effects, and adjust the treatment plan as needed.
A Personalised Approach
There is no single “best” method for quitting smoking that works for everyone. Factors such as previous quit attempts, level of nicotine dependence, medical history, and personal preferences all influence the most appropriate strategy.
A personalised approach, guided by a healthcare professional, can help individuals navigate the available options and improve their chances of success. Combining behavioural support with appropriate pharmacological treatment remains one of the most effective strategies for achieving long-term smoking cessation.
Final thoughts
Quitting smoking is a process rather than a single event. While it can be challenging, effective support and treatment options are available. With the right approach and ongoing support, many people are able to successfully reduce or eliminate nicotine use and achieve lasting improvements in their health.
Easy Quit is a doctor-led telehealth healthcare service. This content is general information only and does not replace a consultation with a qualified health professional.
References
World Health Organization. Tobacco.
https://www.who.int/news-room/fact-sheets/detail/tobacco
Cochrane Collaboration. Electronic cigarettes for smoking cessation (living systematic review).
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub8/full
Peter Hajek et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. New England Journal of Medicine. 2019.
https://pubmed.ncbi.nlm.nih.gov/30699054/
National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. 2018.
https://nap.nationalacademies.org/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf
Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals (including nicotine vaping products). 2024 update.
https://www.racgp.org.au/getmedia/924ba55d-dc47-41f9-bf5b-7a4cf9e19963/RACGP-NVP-and-Vaping-Cessation-September-2024.pdf.aspx
Therapeutic Goods Administration. Therapeutic vapes available without prescription following consultation with a pharmacist. 2024.
https://www.tga.gov.au/news/media-releases/therapeutic-vapes-available-without-prescription-following-consultation-pharmacist
Therapeutic Goods Administration. Vapes: Advertising and promotion.
https://www.tga.gov.au/products/unapproved-therapeutic-goods/therapeutic-vaping-goods/vaping-hub/vapes-advertising-and-promotion
Therapeutic Goods Administration. Advertising a health service.
https://www.tga.gov.au/resources/guidance/advertising-health-service
Australian Health Practitioner Regulation Agency. Guidelines for advertising regulated health services.
https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance.aspx
