picNew Delhi: Prescription proposal looms large over Nicotine Replacement therapy (NRT), most effective intervention in Tobacco Cessation campaign. In the prescription versus OTC debate, the latter clearly wins approval of experts.

Experts have rubbished the idea of making nicotine replacement therapy (NTR) a prescription intervention in fighting the menace of tobacco consumption wreaking havoc on Indian population. They have said without mincing words that the proposal in the pipeline might bring tobacco cessation efforts to a grinding halt. It will severely restrict people’s access to nicotine items available on the counter. Health Experts Advocate for Widespread Access to Nicotine Replacement Therapy (NRT).

In a press conference yesterday, experts appealed to government to shelve this idea forthwith as it will adversely impact government’s own efforts against this menace. They said Health Ministry of India will be well advised to drop the proposal popping up in 89th Drugs Technical Advisory Board (DTAB). The proposal entails that nicotine replacement therapy be placed under schedule K  so that in future they would be available  only on the prescription of authorized medical practitioners and not as over – the –counter preparations. Nicotine polacrilex gums, lozenges and transdermal patches are used as NTR.

Padma Shri Dr. Chandrakant S Pandav, former Head of the Department of Community Medicine at AIIMS, New Delhi, and Dr Sajeela Maini, Head, Tobacco Cessation, De-addiction, Mental Health Expert, Sir Gangaram Hospital  batted for NTR stuffs to be available on OTC citing the urgent need to make this therapy easily available to all and sundry as tobacco consumption is wreaking havoc on Indians.

Dr. Chandrakant S Pandav, while emphasizing the pressing need for improved access to tobacco cessation methods in India, said, “Tobacco use afflicts 28.6% of adults in the country, with a particularly significant impact on 42% of men and 14.2% of women. Challenges continue to exist in challenging geographic locations and rural areas, highlighting the importance of making NRT accessible over the counter (OTC). I believe that easier access to NRT without prescriptions empowers individuals to quit smoking.”

Renowned tobacco cessation expert and the writer of a best seller book ‘The Last Puff’,  Dr Sajeela Maini, said “In my years of practice in smoking cessation, I have found that Nicotine Replacement Therapy is the mainstay of Smoking Cessation Therapy. Substituting cigarettes with a nicotine product works the best. It is most effective in reducing the urges, and withdrawals of quitting the stick.

Dr Maini further said, ‘Tobacco dependence is a mind-body addiction. We need to address both the physiology and psychology of addiction in proper perspective, to be effective. Pharmacotherapy, per se, has a supportive role in reducing the urges and withdrawals of quitting and making the process less discomforting. To ensure the success of our smoking cessation endeavours, we should concentrate on enhanced access to NRT. Tobacco addiction is one of the most widespread addictions in the world. In fact, we need a multi-pronged approach to arrest this menace. Tobacco cessation is still in its infancy in India. We need to educate the public pro-actively about scientifically-backed options like NRT to assist them in quitting smoking and thus prevent them from developing tobaccosis – spectrum of diseases caused by smoking, and chewing of tobacco”.

Nicotine, the primary addictive component in cigarettes, delivers rapid pleasurable effects through smoking. NRT, on the other hand, serves as a temporary replacement for a small quantity of nicotine, controlling cravings, alleviating withdrawal symptoms and facilitating the transition to tobacco abstinence. Unlike cigarettes, NRT provides a gradual and very small increase in blood nicotine levels, which discourages misuse. The aim of NRT is to enable people to quit smoking with the help of nicotine delivery systems with reduced addictiveness.

Dr. Pandav also points to Indian trials conducted in 2023, such as the one in Odisha, which demonstrated the efficacy of NRT in halting smokeless tobacco use—a specific issue in India. Another study in Bengaluru in the same year highlighted the effectiveness of combining NRT with behavioural counselling in reducing cigarette smoking.