WHO endorses NRT and prescription meds in first ever tobacco cessation guidelines  

The World Health Organization (WHO) has released its first clinical treatment guideline for tobacco cessation in adults, recommending pharmacological treatments Nicotine Replacement Therapy (NRT) and prescription medications like bupropion and cytisine.
 
The guideline aims to support more than 750 million tobacco users worldwide who wish to quit all forms of tobacco. It offers a comprehensive approach, combining behavioural support from healthcare providers with digital cessation interventions and pharmacological treatments.
 
These recommendations apply to all adults looking to quit various tobacco products, including cigarettes, waterpipes, smokeless tobacco products, cigars, roll-your-own tobacco, and heated tobacco products (HTPs). “The guideline empowers countries with the essential tools to effectively support individuals in quitting tobacco and alleviate the global burden of tobacco-related diseases,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
 
Despite the widespread desire to quit – over 60% of the world’s 1.25 billion tobacco users – 70% lack access to effective cessation services due to challenges such as resource limitations within health systems.
 
To improve accessibility, especially in low- and middle-income countries, WHO has encouraged making these treatments available at zero or reduced cost. In 2023, to enhance access to recommended tobacco cessation medications, WHO initiated a prequalification procedure for medicinal products against tobacco use disorders. This effort saw a major development in April 2024, with Kenvue’s nicotine gum and patch becoming the first WHO-prequalified NRT products.
 
The guideline also recommends various behavioural interventions, including brief health worker counselling (lasting 30 seconds to 3 minutes) routinely provided in healthcare settings. For those seeking further assistance, more intensive behavioural support, such as individual, group, or phone counselling, is advised. Additionally, digital interventions, including text messaging, smartphone apps, and internet programmes, are recommended as useful tools for self-management or supplementary support.
 
WHO has called on healthcare providers, policymakers, and stakeholders to adopt and implement this guideline to promote tobacco cessation and improve global health outcomes.

The development holds significance for India. Data from GATS-2 (2016-17) shows that 55.4% of current smokers and 49.6% of current smokeless tobacco (SLT) users planned to or were considering quitting. However, only a few smokers (4.1%) and smokeless tobacco users (3.2%) utilised pharmacotherapy, and a small percentage sought counselling support (8.6% of smokers and 7.3% of SLT users).
 
According to Dr Monika Arora, Vice-President (Research and Health Promotion) at the Public Health Foundation of India (PHFI), a public-private partnership organisation, these guidelines are comprehensive, timely, and much needed, especially in low- and middle-income countries like India.
 
“This low utilisation highlights the need to innovate solutions and strengthen existing services to address tobacco as a significant risk factor contributing to the global DALYs burden,” she said. DALYs or Disability-Adjusted Life Years, measure the total burden of disease by combining years of life lost due to premature death and years lived with disability. One DALY equals one lost year of healthy life. 
 
The global push for tobacco cessation is supported by initiatives like the Framework Convention on Tobacco Control and MPOWER. In India, efforts began with the establishment of 19 Tobacco Cessation Centres (TCCs) in tertiary care, expanding to over 500 TCCs nationwide under the National Tobacco Control Programme. These efforts were further extended by the establishment of the National Tobacco Quitline Services (NTQLS), Regional Satellite Centres, mCessation, de-addiction services, and TCCs in dental institutes under the National Oral Health Programme.