Why This Matters

Tobacco smoking remains the number one cause of preventable disease and death in Canada. It increases the risk of lung, mouth, throat, and bladder cancers, as well as cardiovascular and respiratory diseases. Despite decades of awareness campaigns, 11% of Canadians aged 15+ still smoked in 2022, with most smoking daily.

Quitting smoking is not easy. Nicotine is highly addictive, and many people need multiple attempts and different methods before they succeed. Recognizing this, the Canadian Task Force on Preventive Health Care has released a new guideline in CMAJ offering practical, evidence-based ways to help patients quit.

What Clinicians Should Do

The guideline encourages clinicians to:

• Ask every patient about their smoking status.
• Encourage quitting using one or more recommended methods.
• Engage in shared decision-making, tailoring the approach to each patient’s preferences.

Recommended Interventions

Behavioral Options

• Advice from primary care providers
• Individual or group counselling (in person or by telephone)
• Text messaging interventions
• Self-help materials

Pharmacotherapy

• Nicotine replacement therapy (patch, gum, lozenges, inhaler, or spray—alone or in combination)
• Varenicline
• Bupropion
• Cytisine (a natural health product)

Combined Approach

• Using both behavioral support and medication gives patients the best chance of quitting successfully.

Not Recommended
The guideline advises against acupuncture, hypnosis, laser therapy, ear acupressure, electric current stimulation, St. John’s Wort, or SAMe, as evidence does not support their effectiveness.

What About E-Cigarettes?

The guideline recommends against the routine use of e-cigarettes for smoking cessation. They may be considered only for people who:

• Strongly prefer them, or
• Have failed to quit with other proven methods.

Uncertainties about safety, inconsistent product quality, and limited long-term data mean e-cigarettes should not be the first choice.

Focus on Equity

The guideline highlights that certain groups are at higher risk of smoking, including Indigenous peoples, individuals with mental health issues, those with substance use disorders, and people working in lower-skilled jobs. Tailored interventions and culturally sensitive approaches are essential to support these populations.

The Bigger Picture for Doctors

• Quitting smoking is often a journey, not a single event. Patients may relapse and try again, and clinicians should encourage persistence.
• Shared decision-making, practical tools, and offering multiple options empower patients to choose what works best for them.
• Preventive medicine is most powerful when doctors and patients work together to tackle addiction with compassion and science.

Final Word

Canada has made progress in reducing smoking rates, but this new guideline provides a fresh opportunity for clinicians to help patients finally break free from tobacco addiction. As the task force members put it:

“Quitting smoking may be just an intervention away.”

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