New anti-smoking pill set for NHS postcode lottery

A new pill which has been shown to help smokers quit may only be available in some parts of the UK after it becomes available on the NHS this month, a leading campaigner has said.

Cytisine pills recently gained regulatory approval in the UK and will be available via prescription from 22 January. The pills – a non-nicotine aid – have been safely used as a tool to help people quit smoking in central and eastern Europe for decades.

A study this week concluded that smokers were twice as likely to quit by using cytisine, a natural ingredient in laburnum seeds, compared to a placebo. Doctors said it dampens nicotine cravings and that the medicine could play a major role in helping people kick the habit.

However, Deborah Arnott, chief executive of Action on Smoking and Health (ASH), said that the cost of the pills – £115 for a 25-day course of 100 pills – may put some areas off from providing the medicine as part of their health services thus creating a postcode lottery.

She told i: “Cytisine is an effective quitting aid for smokers and it’s good news that it will be available on prescription from the end of January. However, the decision about whether stop smoking services or doctors provide it to their patients will be made locally.

“While it is obviously cost effective given the impact on public services of people continuing to smoke, it is currently more expensive than providing nicotine replacement therapy or vapes and some areas may decide not to offer it to smokers.

“Smokers who aren’t able to access this medication straightaway should be reassured that using e-cigarettes is just as effective as cytisine at helping smokers quit, and is much less harmful than smoking.”

A recent Cochrane review concluded with “high certainty” that the most effective smoking cessation interventions for adults were nicotine e‐cigarettes, cytisine, and another smoking cessation drug called varenicline.

More than 6 million people in the UK smoke, according to latest ONS figures, while smoking remains the leading cause of cancer causing around 150 new cases a day. The Government wants to make the UK “smoke-free”, defined as 5 per cent smoking prevalence or less, by 2030.

Robert West, Professor Emeritus of Health Psychology at UCL, told i: “Cytisine looks potentially to be as effective as e-cigarettes in helping people stop smoking and has the benefit of addressing the smoker’s dependence on nicotine. Having this medicine available through the stop-smoking services will be a great incentive for smokers to attend the services and get evidence-based help with quitting. It could be just what we need to get the UK on track to reach the national target of less than 5 per cent smoking prevalence by 2030.”

Peter Hajek, Professor of Clinical Psychology at Queen Mary University of London, said: “Compared to medications for stopping smoking, low-risk nicotine delivery devices such as vapes are helping a much larger proportion of smokers, but medical treatments are still needed for those who do not find vapes helpful or do not want to continue nicotine use.”

The National Institute for Health and Care Excellence (NICE) has yet to publish any guidance on who would be eligible for cytisine pills – topics are referred to the drugs watchdog by the Department of Health and Social Care and NHS England. NICE is carrying out a review to consider the potential impact of recently published evidence on the pills and whether an update to its tobacco prevention guidance is required.

Ms Arnott said: “The more choice smokers have the better, we know that unfortunately misperceptions about the risks of e-cigarettes may put some smokers off switching to vaping, who might be happy to use non-nicotine aids like varenicline.

“They need to be reassured that vaping is much less harmful than smoking. Four in ten smokers incorrectly believe vaping is as or more harmful than smoking up from a third last year and one in five in 2019.”