Intended for healthcare professionals


Drug treatment for users of smokeless tobacco

BMJ 2010; 341 doi: (Published 06 December 2010) Cite this as: BMJ 2010;341:c6598
  1. Tim Lancaster, reader in primary healthcare,
  2. Lindsay Stead, university research lecturer
  1. 1Cochrane Tobacco Addition Review Group, NIHR National School for Primary Care Research, Department of Primary Health Care, Oxford University, Oxford OX3 7LF, UK

Varenicline has the strongest evidence base but is not yet licensed for this indication

The linked randomised controlled trial of varenicline reported by Fagerström and colleagues (doi:10.1136/bmj.c6549) is the first to show that a drug can help patients who do not smoke but are dependent on smokeless tobacco to give up their habit.1 The participants were dependent on snus, moist smokeless tobacco that is placed under the upper lip and sucked. The trial found that varenicline significantly increased abstinence at the end of treatment compared with placebo (weeks 9-12: 59% v 39%; relative risk 1.60, 95% confidence interval 1.32 to 1.87; number needed to treat 5). The benefit was still significant at follow-up 14 weeks after the end of treatment. Adverse events resulting in treatment discontinuation were of similar frequency (varenicline 12%, placebo 8%).

Although banned in the European Union, snus is widely used in Sweden and Norway. Other forms of smokeless tobacco are chewed or inhaled. Although the popularity of smokeless tobacco varies by region, it is used worldwide—a prevalence of 20% is reported in India and, in 2005, 7.7 million Americans were users. …

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