General Practice

Tobacco smoking remains the leading preventable cause of death in Australia. Advice from a trusted health professional is known to be a positive trigger for prompting a person who smokes to make a quit attempt, and all health professionals working in general practice play a key role in supporting people who smoke to stop. As tobacco dependence is typically a chronic relapsing condition, people may require multiple episodes of cessation treatment and ongoing care.  

Evidence-based smoking cessation treatment is a combination of brief advice with multi-session behavioural intervention (such as Quitline), and pharmacotherapy as clinically appropriate.  

Brief advice is a way of structuring a conversation about smoking that is fast and simple, and connects people to evidence-based cessation care.

Quit’s 3-step Brief Advice model, Ask, Advise, Help (AAH) allows health professionals to identify patients who smoke and connect them to evidence-based treatment. AAH can be used at every clinically appropriate opportunity, using the following steps:

  • Ask all patients about smoking status and document this in their medical record.

  • Advise all patients who smoke to quit in a clear, non-confrontational and personalised way, and advise of the best way to quit.

  • Help by offering all patients who smoke an opt-out referral to behavioural intervention through Quitline (13 7848), and by prescribing (or helping patients to access) pharmacotherapy.

Learn more about using the AAH model and pharmacotherapies for your patients using this practical guide for GPs (PDF).

Most people who smoke make attempts to quit. Multi-session behavioural support, such as that offered at Quitline, supports people to plan, make and sustain a quit attempt.

Quitline is a welcoming, confidential and evidence-based telephone counselling service based on established approaches such as cognitive behavioural therapy and motivational interviewing.

Quitline counsellors:

  • assess a person’s smoking history and work with them to enhance motivation and develop and sustain a plan to stop smoking. 

  • assess the person’s behaviours associated with smoking and provide tailored psychoeducation to support them in understanding and managing their withdrawal experiences, including mood monitoring and the use of pharmacotherapy.  

  • support people in developing confidence to set and achieve goals, and building skills to manage triggers and cravings, and adopt a new self-image, as a person who doesn’t smoke.

Quitline counsellors are counselling professionals who use core counselling skills to engage the patient, and guide them through each call, working collaboratively toward treatment goals. GPs can partner with Quitline in providing best practice care.  Making a referral to Quitline, rather than simply recommending your patient to call, increases the likelihood of that patients will access behavioural support in a quit attempt.  
 

Make a referral to Quitline

Quitline is tailored to meet the needs of priority populations including patients living with a mental illness, pregnant people and young people. Quitline also provides counsellors who are Aboriginal or Torres Straight Islanders, and is able to assist people with hearing or speech impairment, or people needing an interpreter.

Smoking cessation pharmacotherapy can reduce the severity of cravings and withdrawal symptoms.   

People who are nicotine dependent can experience withdrawal symptoms on stopping, usually commencing within 24 hours of the last cigarette, and peaking over the first week, before steadily declining and disappearing over approximately 2–4 weeks. Indicators of nicotine dependence include smoking within 30 minutes of waking, smoking more than 10 cigarettes per day, and a history of withdrawal symptoms in previous attempts to quit.  

Smoking cessation pharmacotherapies currently listed on the ARTG include nicotine replacement therapy (formulations include nicotine patch, gum, lozenge, inhalator, mouth spray), varenicline and bupropion. These medications have been approved by the Therapeutic Goods Administration (TGA) for efficacy, safety and quality. 

Learn more about the best smoking cessation pharmacotherapy for your patient, based on clinical suitability and reasons to prefer, using the flowchart in the practical guide for GPs (PDF).

Nicotine Replacement Therapy (NRT)

NRT is effective and can increase 6–12 month abstinence rates by 6% compared to placebo.

There are different formulations of NRT:

  • Transdermal – nicotine patch

  • Faster-acting – nicotine gum, lozenge, inhalator and mouth spray

Combination therapy is using a nicotine patch together with a faster-acting formulation. Combination NRT can increase 6–12 month abstinence rates by 5% compared to using a single formulation of NRT.

Practical tool to guide initial dosing of NRT

Some formulations are currently subsidised by the Pharmaceutical Benefits Scheme (PBS). All formulations of NRT can be accessed over the counter through pharmacies and supermarkets.

Learn more about using NRT in pregnancy and breastfeeding using this guideline (PDF), developed by Quit in collaboration with The Royal Women’s Hospital Pharmacy Department.

Videos outlining how to use each formulation of NRT

Varenicline1

Varenicline at standard doses can more than double the likelihood of long-term quitting compared to using no pharmacotherapy. It is more effective than NRT monotherapy, has similar efficacy to combination NRT and is more effective than Bupropion. Varenicline can be combined with NRT, and a second course of Varenicline can be considered to prevent relapse.

Varenicline is not recommended for pregnant and breastfeeding women, nor for adolescents. Varenicline can be used in people who smoke and have mental health problems, but these must be monitored during quit attempts. The EAGLES study did not find a significant increase in the rates of moderate-to-severe neuropsychiatric adverse events in those with or without stable mental illness taking varenicline, compared with those using placebo, bupropion, or a nicotine patch.

Bupropion1

Bupropion, originally developed and approved for use as an antidepressant, reduces the urge to smoke and reduces symptoms from nicotine withdrawal. Bupropion significantly increases quit rates compared with placebo. It has been shown to be effective in a range of patient populations, including those with depression, cardiac disease and respiratory diseases.

While is not as effective as varenicline for smoking cessation, bupropion may be an option when varenicline is not appropriate (e.g. patient choice, side effects). Bupropion is not recommended in pregnancy or breastfeeding. 

Nicotine vaping products (NVPs)

Nicotine vaping products contain liquid nicotine designed to be inhaled using a vaping device. From 1 October 2021, patients require a prescription for NVPs (this includes products purchased both in Australia and imported from overseas). From 1 January 2024, reforms to the regulation of vapes are being implemented in Australia. There are currently no TGA-approved NVPs registered in the Australian Register of Therapeutic Goods (ARTG). This means that NVPs have not been assessed by the TGA for safety, quality and efficacy, and their long-term health impacts remain unknown. 

The RACGP recommendations include that, for people who have tried to achieve smoking cessation with first-line therapy (combination of behavioural support and TGA-approved pharmacotherapy) but failed and are still motivated to quit smoking, NVPs may be a reasonable intervention to recommend along with behavioural support. However, this needs to be preceded by an evidence-informed shared-decision making process.

1The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. East Melbourne, Vic: RACGP, 2021

Clinical Tools & Guidelines
Smoking cessation practical guide for GPs
RACGP Clinical Guidelines
NRT initiation tool
Talking to your patients with cardiovascular disease about smoking (video)
Talking to your patients with cancer about smoking (video)
Drug interactions with smoking table (PDF) lists medications and drugs that require dosage adjustments when smoking is stopped. Patients should be regularly monitored with regard to their smoking status and doses of relevant drugs adjusted accordingly.
See the Clinical Tools & Guidelines page for more.

Education & Events
NPS Medicine Wise Podcast Episode 51: Quit smoking. What makes a difference?
See the Education & Events page for a list of the latest webinars, podcasts and other educational events.

Online Training
Quit online training modules
See the Online Training page for more.

Facts & Issues
Tobacco in Australia A comprehensive review of the major issues on smoking and health in Australia, compiled by Cancer Council Victoria.

Last updated: 6 June 2024