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 pharmacists can play a key role in supporting people who smoke to stop. As tobacco dependence is typically a chronic relapsing condition, people may require ongoing advice and 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.
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.
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 helping patients to access approved pharmacotherapy.
Learn more about using the AAH model and pharmacotherapies for your patients using this practical guide for community pharmacists (PDF).
Most people who smoke and/or vape 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 and/or vaping history and work with them to enhance motivation and develop and sustain a plan to stop smoking and/or vaping.
assess the person’s behaviours associated with smoking and/or vaping 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 or vape.
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. Pharmacists 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 that patients will access behavioural support in a quit attempt.
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.
Make a referral to QuitlineSmoking 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.
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 NRTSome 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 and breastfeeding using this guideline (PDF) developed by Quit in collaboration with the Royal Women’s Hospital Pharmacy Department.
Pharmacists supporting Aboriginal and Torres Strait Islander people who smoke (PDF). A resource for pharmacists which includes suggested ways of yarning about nicotine replacement therapy (NRT). Developed in collaboration with the PSA.
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.
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.
Clinically significant drug interactions occur with tobacco smoke.
This 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.
Clinical Tools & Guidelines
Professional practice guidelines for pharmacists: nicotine dependence support (PSA)
Helping patients to stop smoking - a practical guide for community pharmacists
Nicotine replacement therapy (NRT) initiation tool
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.
Pharmacists supporting Aboriginal and Torres Strait Islander people who smoke. A resource for pharmacists (PDF) which includes suggested ways of yarning about nicotine replacement therapy (NRT). Developed in collaboration with the PSA.
See the Clinical Tools & Guidelines page for more.
Events
NPS Medicine Wise Podcast Episode 51: Quit smoking. What makes a difference?
See the 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: Facts & Issues is a regularly updated comprehensive online resource of the major issues in smoking and health in Australia, compiled by Cancer Council Victoria.
A complete EndNote library of all citations for all chapters and sections is available.
Last updated: 9 October 2024