Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial

The recent study by Ferguson (BMJ online) (1) on the effect of free nicotine replacement therapy (NRT) for English quitline callers should be interpreted with caution. The study found that callers offered free NRT had similar quit rates to those who were not given NRT at 6 months follow up. Media reports have suggested that this is evidence that NRT is not effective and this could undermine practitioner and user confidence.

However, there were a number of factors which undermine the effect of NRT in this trial and which invalidate the effectiveness outcomes.

Most importantly, up to 45.8% of those not offered NRT used other pharmacotherapies for quitting such as NRT or varenicline sourced outside the trial. According to the authors, ‘this may have offset any difference that might have arisen owing to the provision of free nicotine replacement therapy to the other group”.

Furthermore, only 42.9% of those offered NRT actually received the medication and many did not use it daily. There was also a low follow up rate of 58% which the authors admit could have biased the results. As well, smokers were also offered only 6 weeks therapy which is half the usual recommended course.

The findings from this study are in contrast to other studies which have shown that free NRT greatly increases quitline utilisation rates and enhances quit rates. (2,3)

The main message for practitioners is that there is an overwhelming body of evidence from clinical trials (4) and community studies (5) that NRT is effective. Clinicians should feel confident to continue to recommend NRT to their smoking patients.

References

1. Ferguson J et al. Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial. BMJ 2012;344:e1696 doi: 10.1136/bmj.e1696 (Published 23 March 2012)
2. An LC et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tob Control 2006;15:286–93.
3. Tinkelman D et al. Offering free NRT through a tobacco quitline: impact on utilisation and quit rates. Tob Control 2007;16(suppl l):i42–i46.
4. Stead LF et al. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub3.
5. Hughes JR et al. Effectiveness of Over-the-Counter Nicotine Replacement Therapy: A Qualitative Review of Nonrandomized Trials. Nic Tob Res 2011 doi: 10.1093/ntr/ntr055