Nicotine / THR - Guides for Healthcare and Social Services Professionals
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Reminder: Using NRT (Nicotine Replacement Therapy) is a form of Tobacco Harm Reduction (THR).
Healthcare Professionals
Doctors, Nurses, Clinics, Hospitals
ENDS (Electronic Nicotine Delivery Systems), E-Cigarettes, Vapes
- Click the link on the page for the latest "Briefing for healthcare professionals."
- This course educates physicians, nurses, dentists, pharmacists, and other healthcare workers about far less hazardous products that deliver nicotine/tobacco satisfaction together with a small fraction of the health risks of smoking. This course does not promote any medical intervention. Rather, it educates health professionals so that they are in a better position to offer lifestyle options, especially to smokers unable or unwilling to quit nicotine/tobacco entirely.
- This course contains the following tobacco harm reduction (THR) topics:
- Nicotine: Correcting Misperceptions
- Smoking and Vaping in the U.S.
- Risks of Smokeless Tobacco Use and Cigar Smoking Explained
- Risks of E-Cigarettes and Heat-Not-Burn Tobacco Explained
- Tobacco Harm Reduction Can Work: Evidence From Around the World
- The COSTED intervention has been developed through research to help deliver effective smoking cessation support to people who smoke attending the emergency department (ED).
- This toolkit has been designed by researchers at the University of East Anglia to help healthcare professionals implement the COSTED intervention.
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing.
- This briefing identifies principles and evidence-based actions to increase the impact of Local Stop Smoking Services (LSSS). Informed by a review of evidence and best practice, it aims to assist with planning and delivery processes to ensure decisions are based on evidence to further maximise the impact of services.
- Ensure tobacco dependence treatment and stop smoking support are embedded in key settings with direct contact with people who smoke, with a focus on priority groups. This includes community services, hospitals and other health and social care settings.
- Provide access to all first-choice stop smoking aids including combination Nicotine Replacement Therapy (NRT), nicotine vapes and nicotine analogues (varenicline and cytisine).
- E-cigarettes are non-combustible tobacco products that deliver nicotine through heated aerosols for inhalation. The use of e-cigarettes is often referred to as vaping.
- There is accumulating evidence from randomized clinical trials and systematic reviews that e-cigarettes are effective for smoking cessation.
- E-cigarettes are addictive and they contain and produce harmful chemicals.
- If a patient has already quit cigarette smoking through the use of vaping, providers should support continued smoking abstinence. As the patient becomes more confident about maintaining long-term smoking abstinence, the provider can encourage cessation of e-cigarettes, but not at the risk of relapse back to cigarette smoking.
- E-cigarettes are potentially valuable harm reduction tools for adults who smoke, especially those who are unable to use or quit with conventional evidence-based tobacco cessation treatments. Meta-analyses of randomized trials report strong evidence that e-cigarettes are effective to help people to quit smoking, with minimal harms when used short-term (6-12 months). Nicotine-containing e-cigarettes are effective for smoking cessation, and increase the odds of quitting by 2-3 times compared with placebo.
- They are effective for smoking cessation and adverse events are infrequent within 1-year follow-up. There are no e-cigarettes licensed or regulated as a medical product, but they are available as a consumer product. There is growing concern about the recreational use of e-cigarettes by nonsmokers, especially youth, who initiate nicotine use through e-cigarettes.
- (Click the link to download the main document.)
- "Building block 5: provide accurate and consistent information on Vaping
- Nicotine vapes deliver high dose fast-acting nicotine which can help to alleviate withdrawal and urges to smoke
- Vaping is an effective tool in the treatment for tobacco dependency and can be used to support patients during a hospital admission and to help achieve long term abstinence
- When using nicotine vapes as part of their tobacco dependency treatment plan, inpa�tients should be advised to switch entirely from smoking to vaping (and NRT) to maximise the harm reduction, both during the admission and after discharge
- If provided in the inpatient setting, nicotine vapes should be used alongside combination NRT as patients may not be able to use the vape at certain times or in certain environments (eg, the internal hospital building)
- Vaping is more likely to be effective when provided alongside behaviour change support from a TDA during the hospital admission and after discharge
- Vaping is not risk free. Patients that use vaping as part of their tobacco dependency treatment plan should be advised to reduce their vape usage at the appropriate time and ultimately to stop vaping, when there is minimal risk of a relapse to smoking
- People who do not smoke, should not vape. Vapes should not be used by any patients under 18 years of age or patients who do not smoke
- Inform patients who use nicotine vapes as part of their tobacco dependency treatment plan that vaping products are regulated under Tobacco and Related Product Regulations 2016 (TRPR). Adverse events related to vape products need to be reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and that vaping products should only be purchased from reputable sources. Additional information on reputable sources can be sought from local government stop smoking services
- From an environmental perspective, avoid single-use products
- Vapes should not be used when using home oxygen therapy"
- "There is guidance about working with children. Guidance for stop smoking services. Guidance for health and care professionals [includes sections on mental health and maternity] and for workplaces. The statement guides readers towards the evidence. It describes how to access training. It is referenced throughout and includes trusted sources for more information."
2024: AU: Guidance on the use of vapes for smoking cessation or the management of nicotine dependence
- This page contains practical guidance to assist medical and nurse practitioners with prescribing therapeutic vapes for smoking cessation or the management of nicotine dependence.
- "For persons who have unsuccessfully tried to stop smoking with approved pharmacotherapies, but continue to be motivated to stop smoking, therapeutic vapes may be a reasonable intervention."
2024: Canada (CAMH): E-CIGARETTE USE EVIDENCE-INFORMED GUIDANCE ON HARMS AND BENEFITS
- "There is interest among health care practitioners and Health Canada regarding the scientific evidence on the harms and benefits of using e-cigarette products at the individual and population level. The recommendations developed through this project examine existing evidence on the health impacts of e-cigarette use to conduct a nuanced harm-benefit analysis. The recommendations are intended as a decision-making and guidance resource for both healthcare practitioners and for people who either use, or are thinking of using e-cigarettes."
- Health Effects of E-Cigarette Use: Summary of Recommendations
- There is emerging, high-quality evidence that switching completely from conventional cigarettes to ecigarettes is an effective intervention for harm reduction and for smoking cessation, at least in the short term. Users of e-cigarettes are exposed to fewer (and lower levels of) toxic substances than users of conventional cigarettes, and while not without health risks, e-cigarette use is generally less harmful than smoking cigarettes.
2023: NCSCT (UK): Vaping: a guide for health and social care professionals
- This briefing is specifically written to summarise information and address issues relevant to health and social care professionals and to stop smoking practitioners in particular.
2023: Video by Dr. Oyston: A Physicians Guide to Safer Nicotine Products for People Who Smoke
- Covers smoking, stigma, facts about nicotine, and how to help people who smoke.
- Explains the various types of reduced-risk nicotine products and how they might help some people stop smoking.
- See Also: Harm Reduction
- This resource has been produced by the Mental Health and Smoking Partnership22 and is intended to provide mental health professionals with a summary of the evidence on e-cigarettes as well as suggested responses to questions service users may ask. It is primarily aimed at professionals working in England but can be used by anyone across the UK.
- "This updated guidance seeks to give clinicians the current understanding about where ECs may help with smoking cessation and the current understanding in regards to their safety."
- "Electronic cigarettes (ECs) may be an option for smokers who want to quit but who have failed using first-line therapies. GPs can have a role in providing patients with reliable information about ECs, supporting them in a quit attempt and prescribing nicotine solution."
Nicotine or Traditional NRT
- Covers how to talk with or about patients
- Covers misperceptions physicians have about nicotine.
2007: Advice on using over-the-counter nicotine replacement therapy-patch, gum, or lozenge-to quit smoking
- Explains how to use, clears up misperceptions, and discusses safety
Additional Considerations for Healthcare Providers
- This guide can support professionals working across behavioral health, public health, and tobacco control systems in addressing dual use among the patients and individuals they serve. Dual refers to the regular use of both combustible cigarettes and e-cigarettes. This resource provides practical guidance to help providers and program leaders better understand, assess, and treat dual use. Research on dual use remains in its early stages, and ongoing studies may lead to changes in some of the findings presented in this report.
- "A close study of the economics of tobacco cessation can support a reconceptualization of tobacco cessation as a profit center. Clinical guidelines describe an evidence-based intervention that can be provided to every tobacco user at every visit, regardless of their readiness to change."
- "Billing of cessation services is consistently below 2% across the medical centers studied suggesting substantial opportunities to improve quality and increase revenue."
- "In this study of adults who smoke and who were attending the ED, an intervention comprising brief advice, provision of an e-cigarette starter kit and referral to stop smoking services resulted in significantly increased sustained smoking abstinence 6 months later compared with those signposted to stop smoking services. Providing smoking cessation support in the ED should be considered to reach groups of the population that may not routinely engage with stop smoking services but have the most to gain from stopping smoking."
- More information: 2023: Cessation of smoking trial in the emergency department (CoSTED): protocol for a multicentre randomised controlled trial
Supporting People Before, During, and After Pregnancy
ENDS (Electronic Nicotine Delivery Systems), E-Cigarettes, Vapes
- Provides links to guides and infographics for maternity and healthcare professionals. Also, it provides information for pregnant people and their families.
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing
- "There is guidance about working with children. Guidance for stop smoking services. Guidance for health and care professionals [includes sections on mental health and maternity] and for workplaces. The statement guides readers towards the evidence. It describes how to access training. It is referenced throughout and includes trusted sources for more information."
2023: NCSCT (UK): Vaping: a guide for health and social care professionals
- This briefing is specifically written to summarise information and address issues relevant to health and social care professionals and to stop smoking practitioners in particular. Includes a section on pregnancy.
Supporting People Living With Mental Health Conditions
- This ASH webinar focussed on preparing mental health trusts for the upcoming single-use (disposable) vapes ban, bringing together case studies from trusts and the prison estate.
- “The aim of this treatment manual is to provide a format to address tobacco for those with mental health conditions, defined as those with a mental health or substance use disorder.” “This 2024 Version of LAHL includes many updates including two new sessions on topics of harm reduction, e-cigarettes and vaping.”
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing
- "There is guidance about working with children. Guidance for stop smoking services. Guidance for health and care professionals [includes sections on mental health and maternity] and for workplaces. The statement guides readers towards the evidence. It describes how to access training. It is referenced throughout and includes trusted sources for more information."
- "Recommendations for care
- Provide clear information to both staff and patients about the difference between vaping and smoking and the associated risks of both.
- Encourage patients to stop smoking or to abstain temporarily and offer behavioural support and prescribed smoking medications in support of any quit attempt.
- Ensure patients have access to vaping products and consider whether to provide them proactively to patients who smoke.
- Do not discourage patients using their own e-cigarettes in a quit attempt or when trying to abstain from smoking temporarily (unless an individual risk assessment suggests it is unsafe to do so).
- Nicotine replacement supports temporary abstinence and quitting smoking, so do not rush patients to stop vaping as this may increase the risk of relapse to smoking.
- Where patients are admitted who already vape, allow them to continue to use e-cigarettes. They do not need a stop smoking intervention unless they are also smoking cigarettes.
- NHS trusts that provide stop smoking support should consider offering a wider package of support to the family at home, such as information on referral to local stop smoking services.
- It is an offence to sell a nicotine inhaling product to anyone under the age of 18 [in the UK - check local laws outside of the UK] or to buy one on their behalf. Public Health England (PHE) does not recommend the use of e-cigarettes by anyone under 18."
Supporting People Living With Substance or Alcohol Use Disorders
Training
- “The aim of this treatment manual is to provide a format to address tobacco for those with mental health conditions, defined as those with a mental health or substance use disorder.” “This 2024 Version of LAHL includes many updates including two new sessions on topics of harm reduction, e-cigarettes and vaping.”
Tobacco Harm Reduction
2024: Webinar from the Safer From Harm Coalition: New Approaches to Tobacco Smoking Cessation Among People Who Use Drugs
- "Some clinicians and practitioners who work with people who use drugs are integrating patient-centered tobacco harm reduction into their approaches. This panel will showcase two such people, who will discuss the current evidence about reduced-risk nicotine products, how they decide whether or when to explore tobacco harm reduction with patients and clients, and how people who use drugs respond to these concepts."
- “If smokers want to try ENDS, they should be encouraged to switch completely as the dual use of ENDS and combustible cigarettes may undermine efforts at cessation. For patients that exclusively use ENDS, motivational interviewing should still be used to promote cessation and to prevent the patient from relapsing to combustible cigarettes.”
Supporting Veterans
- The section on ENDS (vaping) is not very good. It makes them sound more harmful than vaping is known to be, and it doesn't provide any comparison to smoking tobacco. Due to a lack of finding veteran-specific guides, this one is included. Providers are encouraged to look at some of the other resources available on this page.
Cessation Services - Public Health
Training Programs
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing
- "There is guidance about working with children. Guidance for stop smoking services. Guidance for health and care professionals [includes sections on mental health and maternity] and for workplaces. The statement guides readers towards the evidence. It describes how to access training. It is referenced throughout and includes trusted sources for more information."
2019: NCSCT (UK) STANDARD TREATMENT PROGRAMME A guide to providing behavioural support for smoking cessation
- Includes THR as one of many options to help people stop smoking
- Links to complementary materials to their guide
Information Guides
2023: NCSCT (UK): Vaping: a guide for health and social care professionals
- This briefing is specifically written to summarise information and address issues relevant to health and social care professionals and to stop smoking practitioners in particular.
- “As e-cigarette starter packs are an effective and cost effective treatment, SSS should include them among their treatment options.”
Cessation Services - Nontraditional such as Vape Shops
Exploring the Possibility
- "There was consensus that the service should comprise both product (98%) and behavioural support (97%)...Delivering vape-shop based smoking cessation interventions could help to maximise the effectiveness of e-cigarettes for quitting smoking."
- The results suggest that the intervention should be delivered by vape shop workers with mandatory training with the support of stop smoking service providers...The intervention should comprise both technical guidance on using a vape and behavioural support to prevent a return to smoking.
Stop Smoking Service and Vape Shops - A Team Effort
- Most staff in these shops are vapers, having stopped smoking themselves, and they are generally keen to help others become ex-smokers.
- Alternative link
Social Services and Social Care
General
- "Like doctors, community nurses, midwives, psychologists, and psychotherapists, social workers can have a significant influence, both over people’s decisions and their overall wellbeing. Serving as the initial – and in some cases only – point of contact with marginalised communities, social workers could therefore play an important role in reducing the prevalence of smoking."
- "There is guidance about working with children. Guidance for stop smoking services. Guidance for health and care professionals [includes sections on mental health and maternity] and for workplaces. The statement guides readers towards the evidence. It describes how to access training. It is referenced throughout and includes trusted sources for more information."
2023: NCSCT (UK): Vaping: a guide for health and social care professionals
- This briefing is specifically written to summarise information and address issues relevant to health and social care professionals and to stop smoking practitioners in particular.
Supporting People Experiencing Unstable Housing
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing.
Adoption and Foster Care - “Substitute Carers”
- The training programme is founded upon evidence-based behaviour change techniques and includes practical interventions that will make a significant difference to the chances of your clients becoming permanent ex-smokers.
- The four Very Brief Advice (VBA) training modules are essential training for anyone who comes in to contact with smokers in primary care (VBA+), pregnant women (VBA for pregnant women), parents and carers of children (VBA on Secondhand Smoke), and those working with people experiencing homelessness (VBA+ for Homelessness Services).
- The training programme includes all of the information that you need to pass the online assessment. Upon successful completion of the assessment, you will become an NCSCT Certified Stop Smoking Practitioner.
- Includes specialty modules on pregnancy, mental health, and supporting people experiencing unstable housing.
2020: Together4Children: Smoking (including use of e-cigarettes) (Fostering, Adoption Special Guardians) Policy and Procedure
- “Due to the recognised differences on health impacts, Together4Children treat tobacco smoking and the use of electronic cigarettes differently as reflected in the following policy…Together4Children recognises the low risk to children and does not view the use of ecigarettes as a reason to exclude prospective foster carers/adopters, purely on this basis. However, prospective carer/adopter’s use of e-cigarettes will be discussed at the initial visit, during the full assessment and monitored via the review process. “
2019: Worcestershire Children First Fostering (WCFF): Smoking and E-Cigarettes (Vaping) Policy for Staff and Foster Carers
- “Social Workers should support foster carers to give up smoking by signposting them to organisations which can help them…E-cigarettes, also known as vaporisers, are not tobacco cigarettes. The use of them has become more wide spread in recent years and can provide a route for smokers to help them reduce or give up smoking.”
2018: CoramBAAF: PRACTICE NOTE 68 Reducing the risks of environmental tobacco smoke for looked after children and their carers
- “We would strongly recommend that all substitute carers should be proactively encouraged to stop smoking…The issue is therefore not one of banning prospective adopters and new carers, but of engaging with them, providing information and advice, and facilitating access to smoking cessation programmes…"
- Note: Covers us of vapor products
- “Agencies should therefore recognise the low risk to children and not see the use of e-cigarettes as a reason to preclude foster carers or adopters purely on this basis. Each circumstance should be risk assessed on an individual basis.”
- Note: This non-profit closed in 2015 - A new charity called CoramBAAF took its place.
Educators
- "(1/Thread): Hey health policy/econ professors, ever considered adding an #ecig section to your health course? Here is a slide deck for you: http://bit.ly/3pCsIGV. Feel free to use any part of this in your own courses to spread knowledge about this important/interesting topic. #econtwitter" (Note: This doc always links to a clickable link for an updated version)