(May 2011) by Dr Bruce Sutherland

Smoking is the commonest cause of preventable death in this country. About 20% of New Zealanders still smoke and 40% of Maori smoke.

One in two smokers will die of smoking related disorders. This amounts to about 4,500 NZ deaths per year.

The Ministry of Health’s aim is to halve the number of smokers in NZ by 2015 and to make Aotearoa smoke free by 2025.

The main way of doing this is by increasing tobacco taxes, recently introduced in April 2010, and then again to be increased this year.

This has worked well so far, with more people presenting to Quit Line and to GPs for smoking cessation advice.

Government initiatives have also focused on smoking cessation medications. These mediations have been expensive but now different levels of Government subsidies apply.

1. Nicotine replacement therapy (NRT)

This comes as patches, gums or lozenges. NRT doubles the chance of quitting. It is safe and does not increase the risk of cancer. Side effects are minor and it can be used by most people safely. One should not use NRT and smoke at the same time. NRT is fully subsidised if accessed through Quit Line or your doctor and a course will cost approx $3.

2. Zyban (Bupropione)

This more than doubles the chance of quitting. It works by reducing the desire to smoke. It should be started whilst still smoking, approximately 2 weeks before quit date, and is continued for a 12 week course. In some countries, Zyban is used as an antidepressant and as such it has more side effects and drug interactions than NRT, and some people cannot take it. It is prescribed by your doctor. It now has government funding without restriction.

3. Champix (Varenicline)

Studies have shown Champix to be the most effective smoking cessation medication. Like Zyban it reduces the desire to smoke, in addition, it also gives smokers some of the satisfied feeling that smoking imparts. It is taken in the same way as Zyban. Champix can accentuate some of the side effects of smoking cessation: headache, nausea, abnormal dreams and poor sleep. There have been some reports of depression and even possibly an increase in suicidality. There are no known drug interactions. Champix is expensive, approximately $200 per month, and should be taken for 3 months.

In some cases, if other forms of medication have been trialed and failed, and if the patient is partaking in a smoking cessation program, a government subsidy can be accessed by your doctor.

Psychological support from a trained health profession is effective. Most GP surgeries offer smoking cessation programmes at affordable prices.