This week the Canadian Task Force on Preventive Health Care presented its first set of advice for clinicians to help their patients quit cigarette smoking. These guidelines are published today in the Canadian Medical Association Journal in the article "Recommendations on interventions for tobacco smoking cessation in adults in Canada".
The task force has packaged its advice in a number of formats for different audiences. In addition to the CMAJ article and appendices, it has prepared infographics and discussion tools for physicians and smokers which are available on the Task Force's website.
These guidelines encourage clinicians to support quit attempts and the use of proven stop-smoking interventions and medications.
The task force strongly recommends the use of stop-smoking medications supported by clinical trials: NRT (patch, gum, lozenges, inhaler, spray used alone or together), Varenicline, Bupropion and Cytisine. (The use of nicotine pouches was not included in this review, but may be considered for future updates.) It strongly recommends combind behavioural and pharmacotherapy interventions.
Conditional recommendation is given to on-line support, provided it is accompanied by direct behavioural support.
The task force strongly recommends against the use of methods which have little to no proven effect, including acupuncture, hypnosis, laser therapy, electric current stimulation, ear acupressure and St. John's wort.
The task force conditionally recommends against the use of e-cigarettes, except for those smokers who have already unsuccessfully tried other interventions, are unwilling to try other interventions, or express a strong preference for e-cigarettes.
The authors of this review detail their many concerns with respect to e-cigarettes. They cite the potential for long-term harms, the evidence of lengthy continued use of e-cigarettes, the significant rate of dual use following an unsuccessful quit attempt using e-cigarettes and the greater risk of relapse among those who use this method. They also note the absence of an approved e-cigarette with a verified formulation, the wide variability in the design of products on the market, the involvement of tobacco companies in their manufacture and the greater risk than with other NRT of long term nicotine use.
Although their evidence review did not include population-level studies, the task force was concerned with the societal impact of e-cigarettes being promoted as cessation products. "There are uncertain public health and societal impacts of normalizing e-cigarettes as a population approach to cessation. The task force is concerned that this could, for instance, inadvertently increase uptake of vaping among youths and nicotine addiction in the general population. Given the large increases observed in youth vaping in recent years, the possible impact of recommending e-cigarettes for smoking cessation on this trend is a concern for the task force."
Their recommendations were tempered by the reality of the permissive legal framework for cigarettes and their widespread use. "Many people are already using e-cigarettes to attempt to quit smoking. For these individuals, the choice may be between attempting to quit using e-cigarettes with advice and support of a health care provider versus doing this alone without informed guidance."
About the work of the Canadian Task Force on Preventive Health Care
In developing these guidelines, the Task Force followed the process it had established for all clinical guideline reviews. Research reports on the results of experimental interventions for smoking cessation in clinical settings were collected, screened and reviewed following a research protocol developed more than 6 years ago. The guidelines were based on these research findings and informed by a subsequent review by interested stakeholders and some members of the public.
The Canadian Task Force on Preventive Health Care is a body of experts convened through the Public Health Agency of Canada (PHAC) and tasked with the development of clinical practice guidelines that support primary care providers in delivering preventive health care. Although it is managed through a government agency (and subject to some level of government control), it identifies itself as "an independent, objective, arms-length panel of experts without ties to industry or government."
Today's issue of the CMAJ also includes an editorial calling for greater institutional and clinical support for smoking cessation and a commentary on ways to modernize the work of the Task Force.
