WHO Guidelines for Adult Smoking Cessation: Medication, NRT, and Counseling

On July 2nd, the World Health Organization (WHO) released its first-ever clinical treatment guidelines for adult smoking cessation, recommending the use of medication therapy, nicotine replacement therapy (NRT), and prescription drugs such as bupropion and varenicline. The guidelines aim to support the over 750 million tobacco users worldwide who are looking to quit all forms of tobacco. It provides a comprehensive approach, including behavioral support provided by healthcare providers, digital smoking cessation interventions, and medication therapy. These recommendations apply to all adults looking to quit various tobacco products, including cigarettes, hookah, smokeless tobacco products, cigars, roll-your-own tobacco, and heated tobacco products (HTP).

For smokers who are interested in quitting, there are several pharmaceutical treatment options available, including varenicline, nicotine replacement therapy (NRT), bupropion, and cytisine. Varenicline, NRT, or bupropion are typically the first-line treatments recommended. For those choosing NRT, combination therapy (such as patches along with short-acting forms like gum or lozenges) may be considered.

For non-smokers who are interested in quitting smoking, they can choose varenicline or nicotine replacement therapy (NRT) as medication intervention options, and are offered enhanced behavioral support interventions (including individual face-to-face counseling, group face-to-face counseling, or telephone counseling).

Director-General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, stated that

This guide provides countries with essential tools to effectively support individuals in quitting smoking and reducing the global burden of tobacco-related diseases.

Despite the widespread desire to quit smoking (with over 60% of the world's 1.25 billion tobacco users expressing a desire to quit), 70% of people are unable to access effective smoking cessation services due to challenges such as limited healthcare resources. In order to improve accessibility, especially in low- and middle-income countries, the World Health Organization (WHO) encourages the provision of these therapies for free or at a low cost. In 2023, in an effort to increase access to recommended smoking cessation medications, the WHO initiated a prequalification process for drugs targeting tobacco use disorders. Significant progress was made in April 2024, with Kenvue's nicotine gum and patches becoming the first NRT products to receive WHO prequalification. The guidelines also recommend various behavioral interventions, including brief counseling by healthcare workers routinely provided in healthcare settings (lasting 30 seconds to 3 minutes). For those seeking further assistance, more intensive behavioral support is advised, such as individual, group, or telephone counseling. Additionally, digital interventions, such as text messages, smartphone applications, and internet programs, are also recommended as useful tools for self-management or supplemental support.