Primary health care nurses are highly respected sources of health information. Advice from a trusted health professional is known to be a major trigger for prompting a person who smokes to make a quit attempt, and a brief advice conversation with a patient about their smoking can be fast, simple and effective.
Changes to vaping in Australia came into effect on 1 July 2024, with subsequent changes on 1 October 2024.
From 1 July all vapes can only be sold in a pharmacy for the purpose of helping people to quit smoking or manage nicotine dependence. Retailers such as tobacconists, vape shops and convenience stores cannot sell any type of vape.
From 1 October people 18 years and older can buy vapes with a nicotine concentration of 20 mg/mL, or less from certain pharmacies without a prescription where state and territory laws allow.
Quit’s 3-step brief advice model, Ask, Advise, Help (AAH) focuses on identifying patients who smoke and connecting them to evidence-based tobacco dependence treatment: multi-session behavioural intervention through Quitline and approved pharmacotherapy.
If clinically appropriate:
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) approved pharmacotherapy, such as nicotine replacement therapy (NRT).
Assessment of a patient's motivation to quit smoking is not required and brief advice should be offered at every clinically appropriate opportunity.
Learn more about using the AAH model with your patients using this practical guide for primary care nurses (PDF).
The best way to quit is to combine brief advice from a primary care nurse with behavioural intervention (such as Quitline), and pharmacotherapy as clinically appropriate. Behavioural intervention helps people to identify their triggers for smoking and/or vaping, develop practical strategies and shift their self-identify from someone who smokes or vapes to someone who doesn’t. Pharmacotherapy helps to reduce cravings and withdrawal symptoms.
Primary care nurses can partner with Quitline in providing best practice care.
Quitline is a confidential, evidence-based telephone counselling service. Quitline is tailored to meet the needs of priority populations including patients living with a mental illness, pregnant people and young people. The Aboriginal Quitline is provided by counsellors who are Aboriginal and/or Torres Strait Islander. Quitline has provision to assist individuals with hearing or speech impairment or for people needing an interpreter.
Quitline counsellors are counselling professionals who use behaviour change techniques and motivational interviewing. Over multiple calls, Quitline counsellors use core counselling skills to help people plan, make and sustain a quit attempt.
There is evidence that making a proactive referral to Quitline, rather than simply recommending your patient to call will result in a 13-fold increase in the proportion of patients using behavioural intervention in a quit attempt.
Make a referral to QuitlineSmoking cessation pharmacotherapies 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.
Patients are more likely to stop smoking when pharmacotherapy is combined with behavioural intervention (Quitline).
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 primary care nurses.
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.
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 Supporting smoking cessation in pregnancy (PDF), developed by Quit in collaboration with the Royal Women’s Hospital Pharmacy Department.
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.
1The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. East Melbourne, Vic: RACGP, 2021
Vapes
From 1 January 2024, reforms to the regulation of vapes are being implemented in Australia. There are currently no TGA-approved vapes registered in the Australian Register of Therapeutic Goods (ARTG). This means that vapes 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, vapes 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.
Vapes are not first-line treatments for smoking cessation. There is limited evidence for the effectiveness of vapes for smoking cessation and their long-term health impacts remain unknown. If vapes are considered clinically appropriate for a quit attempt, multi-session behavioural intervention (Quitline) is recommended.
There is limited evidence for the most effective way to cease using vapes.
Clinically significant drug interactions occur with tobacco smoke.
This Drug interactions with smoking table (PDF) table 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.
Last updated: 9 October 2024