Smoking is the greatest single cause of preventable illness and premature death in Ireland, killing almost 6,000 people a year.
The primary objectives set out in the Tobacco Free Ireland (2013) policy document are to denormalise smoking and to protect children from the dangers of tobacco consumption. Tobacco Free Ireland sets a target for Ireland to be tobacco free (i.e. with a prevalence rate of less than 5%) by 2025.
Tobacco Free Ireland contains a number of recommendations to assist smokers in quitting tobacco use. One of those recommendations is to examine the evidence regarding the outcomes of the use of Nicotine Replacement Therapy ('NRT') and other approaches.
My Department requested HIQA to undertake a Health Technology Assessment ('HTA') of the clinical and cost effectiveness of pharmaceutical and non-pharmaceutical smoking cessation products and services. The HTA was published in 2017 and found that all the pharmacological interventions were effective compared to no treatment and that a prescription only drug called varenicline was the most effective drug on its own. However, the HTA also found that using a combination of varenicline and NRT was the most effective pharmacological intervention and that people using this combination were over three and a half times more likely to quit than those who were in a control group and did not receive this treatment.
Group behavioural therapy, individual counselling, intensive advice and telephone support were all found to be effective behavioural interventions with group therapy found to be the most effective of these interventions. The addition of a behavioural intervention to a pharmacological intervention improved the effectiveness of the intervention.
The HTA recommended that smoking cessation services should seek to increase the uptake of varenicline, either alone or in combination with NRT, for smokers who want to use a pharmacological support.
In relation to e-cigarettes and vaping, although the HTA found that results for e-cigarettes are promising, there is currently a lack of evidence to recommend their use as a smoking cessation aid and at present no e-cigarette product is licensed as a medicinal product in Ireland. The safety of e-cigarettes is an evolving area of research; while potentially safer than smoking, evidence on its long-term safety has yet to be established. In the absence of additional evidence confirming the effectiveness of e-cigarettes, the HTA recommended that the HSE smoking cessation services should seek to increase the uptake of combination NRT treatment among those for whom varenicline is contraindicated, not tolerated or not preferred.
The results of the HTA are informing the development by the HSE, in conjunction with the National Clinical Effectiveness Committee, of national clinical guidelines.
Current evidence-based means of quitting include behavioural support and pharmacotherapies. The HSE provides and promotes these safe and evidence-based services, supports and aids to help people to quit. The HSE recommends that those wishing to give up smoking uses its cessation services as the first port of call.
My Department will continue to monitor the emerging research on all products, so as to inform decisions around any future additional regulation in this area.