Methods and medications

General information

Varenicline (Champix®) is only available by prescription to your doctor. It blocks the effects of nicotine and reduces cravings and withdrawal symptoms. If you start smoking again while taking the medicine, you won't feel as satisfied. This improves your chances of quitting.

Varenicline (Champix®) is one of two prescription medications covered under the PharmaCare BC Smoking Cessation program.

Learn more about your coverage.

Effectiveness

Evidence suggests that varenicline is the most effective medication for helping people quit. When used as directed, there is evidence that varenicline can increase your chances of quitting successfully.

Advantages

Varenicline works by changing the way the brain reacts to nicotine. It makes it harder to get pleasure to nicotine and also helps to reduce cravings by blocking the receptor in the brain that responds to nicotine. Other advantages include:

• It's easy to use
• It does not contain nicotine

Common side effects

• Nausea and vomiting
• Gas and constipation
• Insomnia and abnormal dreams
• Headache
• Mood & behavioural change

How to use

Varenicline is available as a pill that you take by mouth. 

• Start taking varenicline one week before you quit smoking. This builds up the level of medicine in your body.
• Continue to smoke as usual while taking varenicline until your quit date.
• The recommended dose of varenicline to help you quit smoking is:
  • Days 1-3: take one 0.5mg tablet once a day.
  • Days 4-7: take one 0.5mg tablet twice a day, once in the morning and once at night.
  • Day 8 to the end of treatment: take one 1mg tablet twice a day, once in the morning and once at night.
• Take varenicline after eating and with a full glass of water to decrease the nausea and vomiting side effect.
   

Warnings & precautions

As with any prescription medication, there are benefits and risks to taking varenicline. Health Canada has determined that for varenicline, the benefits outweigh the risks.

Heart or stroke events

Talk to your doctor if you have any changes in cardiovascular symptoms, including:

• Chest discomfort for more than a few minutes or that goes away and comes back. 
• Pain or discomfort in one or both arms, back, neck, jaw or stomach. 
• Shortness of breath, sweating, nausea, vomiting, or feeling lightheaded associated with chest discomfort.

Get emergency medical help right away if you have symptoms of a stroke, including: 

• Weakness or sudden numbness in the face, arm or leg even if temporary. 
• Trouble speaking, even if temporary. 
• Vision problems, even if temporary.

Do not use if

Do not use varenicline if one of the following applies to you:

• Have an allergy to varenicline.
• Currently using nicotine replacement therapy (like gum or patch). The combination of taking both does not increase your chance of quitting and increases the likelihood of experiencing side effects.
• Less than 18 years old.
• You are pregnant.

Speak to a doctor or pharmacist

About whether varenicline is right for you if one of the following applies to you:

• Depression or other mental health problems
• Breast-feeding
• Kidney problems
• Currently taking medications such as insulin, theophylline, or warfarin

Stop taking if

Stop taking varenicline and speak to your doctor immediately if you experience any of the following symptoms:

• Depressed mood
• Agitation
• Changes in behaviour that are not typical
• Suicidal thoughts or behaviour
• Thoughts of harming yourself or others

Bupropion (Zyban®) is one of two prescription medications covered under The PharmaCare BC Smoking Cessation program.

Learn more about your coverage.

Effectiveness

When used as directed, there is evidence that buproprion can increase your chances of quitting successfully.

Advantages

Buproprion is a prescription-only drug treatment that works by changing the brain's response to nicotine. It makes smoking less pleasurable and reduces cravings while you work on your smoking habits. Other advantages include:

• It doesn't contain nicotine.
• It can delay weight gain after quitting for some people.

Common side effects

• Dry mouth
• Insomnia
• Headache
• Shakiness or nervousness
• Weight loss

How to use

Bupropion is available as a pill that you take by mouth. 

• Start taking bupropion about two weeks before you quit smoking. This builds up the level of medicine in your body.
• Continue to smoke as usual while taking bupropion until your quit date.
• You can take bupropion with or without food.
• The recommended dose of bupropion to help you quit smoking is:
  • Days 1-3: Take one 150mg tablet once a day in the morning.
  • Day 4 to the end of treatment: Take one 150 mg tablet twice a day, once in the morning and once in the early evening  (at least 8 hours between doses).
  • The recommended length of bupropion therapy is seven to twelve weeks.
     

Warnings & precautions

As with any prescription medication, there are benefits and risks to taking bupropion. Health Canada has determined that for bupropion, the benefits outweigh the risks.

Do not use bupropion if one of the following applies to you:

• Currently using bupropion for another reason (such as Wellbutrin for depression)
• Have an allergy to bupropion
• Have a seizure disorder
• Have an eating disorder, such as anorexia or bulimia
• Heavy alcohol drinker who plans to quit drinking abruptly
• Currently use or recently (in the last two weeks) have used a class of medications called Monoamine Oxidase Inhibitors (MAO-I)
• Currently using a drug called thioridazine

Speak to a doctor or pharmacist about whether bupropion is right for you if one of the following applies to you:

• Liver or kidney problems
• Pregnant or breast-feeding
• High blood pressure
• Less than 18 years old
• Currently taking medications that can increase your risk of seizures

Stop bupropion and speak to your doctor or healthcare provider immediately if you experience:

• Agitation
• Depressed mood
• Suicidal thoughts or behaviour

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

• The nicotine gum is good for occasional smokers to reduce withdrawal symptoms, cravings and manage stress.
• You can use the gum to help you reduce the number of cigarettes you smoke daily.

Common side effects

Nicotine gum is not like regular gum. If used incorrectly, you are more likely to experience side effects, including:

• Nausea
• Stomach upset
• Mouth, throat or gum irritation
• Jaw ache
• Hiccups
• Headaches
• Trouble sleeping

How to use

Note: The taste of nicotine gum can be unpleasant at first but most people get used to it with regular use.

• Nicotine gum shouldn’t be chewed like regular chewing gum. Use bite-park technique. 'Bite' the gum once or twice, then “park” the gum in the corner of your mouth (between your cheek and gums).
• Wait one minute, bite the gum a few more times, and then “park” the gum again.
• Repeat the 'bite' and “park” process for 30 minutes.
• It takes 15 to 30 minutes for the gum to start working so use the gum prior to when you think you will need it. For instance, if you used to smoke on your coffee break, take the gum 30 minutes prior to your regular break.
• Avoid acidic food or beverages like coffee, tea, juice, and soda 15 minutes before using the gum. The acid in these products can prevent your mouth to absorbing the nicotine to the gum.
   

Warnings & precautions

If you have an active jaw disease or jaw/dental pain you should use a different form of nicotine replacement therapy, as these conditions will make it difficult to use the gum.

Consult your doctor or pharmacist prior to starting the gum if the following apply to you:

• Pregnant or breastfeeding.
• Have heart arrhythmias, have had a heart attack or have angina pectoris.
• Heart attack or stroke within last two weeks.
• Require kidney dialysis.
• Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquilizers or sleeping pills.

Stop using the nicotine gum immediately and see your doctor if you experience the following:

• chest pain
• irregular heartbeat
• palpitations
• leg pain
• persistent stomach pain

Fully covered supply of Nicotine Gum for BC Residents 

Each calendar year, eligible BC residents can receive up to a three month supply of  Nicorette® gum (2 mg, 4 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

• Easy to use.
• Small lozenge that dissolves in the mouth.
• Helps to manage the symptoms of nicotine withdrawal such as breakthrough cravings.
• You can choose the strength of lozenge to use. This is dependent on the number of cigarettes you smoke per day.

Common side effects

• Mouth, throat or tongue irritation
• Headaches
• Nausea
• Hiccups
• Upset stomach
• Dizziness

How to use

• Place one lozenge in your mouth and allow it to dissolve slowly.
• Occasionally move the lozenge to one side of your mouth to the other.
• Do not bite, chew, or swallow the lozenge whole.
• Do not eat or drink while the lozenge is in your mouth.
• Do not use more than 15 lozenges per day.
• The lozenge should take about 20 to 30 minutes to dissolve.

Note: There are two strengths of lozenges so talk to your doctor or pharmacist about which strength is right for you.

For more information on appropriate dosage, read the package insert or consult your physician or pharmacist.
 

Warnings & precautions

Do not use the nicotine lozenge if you are:

• Under the age of 18 years of age.
• Allergic to nicotine or any of the non-medicinal ingredients in the product.

Consult your pharmacist or physician prior to using the nicotine lozenge if the following apply to you:

• Pregnant or breastfeeding.
• Heart problems.
• Thyroid problems.
• Circulation problems.
• Stomach problems.
• High blood pressure.
• Taking insulin.
• Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquilizers or sleeping pills.

Fully covered supply of Nicotine Lozenge for BC Residents 

Each calendar year, eligible BC residents can receive up to a three month supply of  Nicorette® lozenges (2 mg, 4 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

• Easy to use - just put it on once per day and forget about it.
• Useful for heavier smokers who need steady release of nicotine.
• Designed to temporarily replace some of the nicotine that cigarettes would normally supply and thus reduce the symptoms of nicotine withdrawal such as cravings, irritability and anxiety.
• You can choose the strength of the dosage. This is dependent on the number of cigarettes you smoke per day. See below for suggested dosages or talk to your doctor or pharmacist.

Common side effects

• Headaches
• Cold or flu-like symptoms
• Dizziness
• Anxiety
• Sleep problems
• Vivid dreams
• Stomach upset
• Mild itching, burning and tingling are normal in the first hour of wearing the patch
• Redness of the skin when the patch is removed

Note: Remove the patch and consult your doctor if you experience chest pain, irregular heartbeat, palpitations, leg pain or persistent stomach upset while using the patch.

How to use the patch

• Dosing should be individualized based on how much you smoke.
• The patch should be applied and left on the skin for 24 hours per day. Other patch products may be different.
• The patch comes in three patch sizes, which give doses of 21 mg/day (Step 1), 14 mg/day (Step 2) and 7 mg/day (Step 3).
• Typically a pack-a-day smoker would wear each size for 3 to 4 weeks, gradually reducing nicotine delivery by going to Step 1 to Step 2 to Step 3.

Note: For more info on getting the proper dosage, read the package insert, consult with your physician, pharmacist or contact our QuitLine at 1.877.455.2233 and speak with a Quit Coach.

Things to remember

• Mild itching, burning and tingling are normal in the first hour of wearing the patch.
• Do not use more than one nicotine patch at a time. Using more than one would increase your risk of experiencing side effects.
• Do not cut or trim the patch. This will interfere with how the nicotine is released to the patch. Only use the nicotine patch as directed.
• Remove the patch two hours before prolonged strenuous activity or going scuba diving. These activities may increase your risk of experiencing side effects.
• If you find yourself still craving cigarettes while using the patch, speak with your doctor or pharmacist to see what options (such as using nicotine gum and the patch together) are available for you. But remember that PharmaCare will only cover one smoking cessation aid per calendar year: January 1st through December 31st.
   

Warnings & precautions

Do not use the patch if you have severe eczema, psoriasis or other generalized skin disorders.

Consult your pharmacist or physician prior to using the patch if the following apply to you:

• Pregnant or breastfeeding.
• Being treated for any serious heart condition.
• Heart attack or stroke within the last 2 weeks.
• Require kidney dialysis.
• Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquilizers or sleeping pills.

Stop using the patch immediately and see your doctor if you have:

• Chest pain
• Irregular heartbeat
• Palpitations
• Leg pain
• Persistent stomach pain
• Rash or hives

Coverage of Nicotine Patches for BC Residents 

Each calendar year, eligible BC residents can receive up to a three month supply of Nicoderm® patch (7 mg, 14 mg, 21 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

• It mimics the hand-to-mouth action of smoking.
• The user decides how often to use the inhaler.
• Reduces the symptoms of nicotine withdrawal cravings and irritability.

Common side effects

• Nausea
• Headaches
• Mouth or throat irritation
• Stomach upset

How to use

• Take the mouthpiece out of its plastic wrapper.
• Line-up the markings on the mouthpiece and separate the two pieces.
• Remove one cartridge to the foil wrapped tray.
• Press the cartridge firmly down into the bottom of the mouthpiece until the seal breaks.
• Replace the top of the mouthpiece. Line up the markings.
• Press the cartridge firmly down to break the upper seal of the cartridge.
• Twist the mouthpiece to mis-align the markings.
• With the tapered end of the mouthpiece in your mouth, either take in deep or short puff into the back of the throat.
• Each cartridge will last for about 20 minutes of continuous frequent puffing.
• When the cartridge is empty, remove the cartridge to the mouthpiece and dispose of the cartridge out of reach to children and pets.
• Clean the mouthpiece regularly with soap and water.
• Don't have any acidic beverages like coffee, tea, juice, and soda while using the inhaler. The acid in these drinks can prevent your mouth to absorbing the nicotine to the inhaler.

Recommended schedule

• Use at least six to twelve cartridges per day initially.
• Do not use more than twelve cartridges a day.
• As your body adjusts to not smoking, you can choose to stop using the inhaler or slowly reduce the number of cartridges you use a day.
• Do not use the inhaler for more than six months.
   

Warnings & precautions

Consult your pharmacist or physician prior to using the inhaler if the following apply to you:

• Pregnant or breastfeeding.
• Being treated for any serious heart condition.
• Heart attack or stroke within the last two weeks.
• Require kidney dialysis.
• Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquilizers or sleeping pills.

Stop using the inhaler immediately and see your doctor if you have:

• Chest pain
• Irregular heartbeat
• Palpitations
• Leg pain
• Persistent stomach pain
• Rash or hives

Coverage of Nicotine Inhaler for BC Residents 

Each calendar year, eligible BC residents can receive up to a three month supply of Nicorette® inhaler and cartridges (10 mg) through the PharmaCare BC Smoking Cessation Program. You can find more information about how to access this program here.

The spray is NOT covered under the PharmaCare BC Smoking Cessation Program.

Effectiveness

When used as directed, there is evidence it can increase your chances of successfully quitting.

Advantages

• Controls cravings fast.
• User decides how often to use the mouth spray (i.e. use it only if you need it).
• Reduces the symptoms of nicotine withdrawal cravings and irritability.

Common side effects

• Tingling lips
• Hiccups
• Strong taste – to nicotine
• Throat irritation
• Nausea
• Heartburn

How to use

• Prime the dispenser - point the nozzle away and press the dispenser several times until a fine mist appears. If the spray is not used for 2 or more days, this may be repeated.
• Hold dispenser as close to the open mouth as possible – avoid the lips.
• Press the top of the dispenser to release one spray into the mouth.
• Do not inhale while spraying – spray into the mouth not the throat.
• For best results, do not swallow for a few seconds after spraying.
• If after a few minutes cravings are still present, spray once more.

Recommended schedule:

• Use a maximum of 2 sprays at a time, maximum 4 sprays per hour.
• Do not use more than 64 sprays per day.
• As your body adjusts to not smoking, you can choose to stop using the mouth spray or slowly reduce the number of sprays you use a day.
• Do not use the mouth spray for more than six months, unless directed to do so by your healthcare provider.
• Do not have any acidic beverages like coffee, tea, juice, and soda while using the mouth spray. The acid in these drinks can prevent your mouth to absorbing the nicotine to the mouth spray.
• It is important to carry the mouth spray with you at all times so that you can respond to your cravings when they occur.
   

Warnings & precautions

Consult your pharmacist or physician prior to using the nicotine mouth spray if the following apply to you:

• Pregnant or breastfeeding.
• Being treated for any serious heart condition.
• Heart attack or stroke within the last two weeks.
• Require kidney dialysis.
• Use any prescribed medication regularly. Smoking alters the effects of some medications, and when you quit smoking it may be necessary for your doctor to adjust the doses, especially if you are diabetic, taking medications for high blood pressure or heart disease, or taking antidepressants, tranquilizers or sleeping pills.

Stop using the nicotine mouth spray immediately and see your doctor if you have:

• Chest pain
• Irregular heartbeat
• Palpitations
• Leg pain
• Persistent stomach pain
• Rash or hives

PharmaCare BC Smoking Cessation Program

Currently, Nicotine Mouth Spray is not covered under the PharmaCare BC Smoking Cessation Program. Availability and price varies by pharmacy.

Cytisine is a compound found in some plants. It works by blocking the effects of nicotine to reduce cravings and withdrawal symptoms. If you start smoking again while taking cytisine, you won't feel as satisfied. This improves your chances of quitting.

In Canada, one product containing cytisine (brandname Cravv®) has been licensed for sale as a natural health product. This term includes products such as vitamins and minerals, herbal medicines and other alternative and traditional medicines.

Effectiveness

When combined with brief behavioral support, cytisine was found to be superior to nicotine replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events (nausea, vomiting and sleep disorders). 

Advantages

Cytisine works by changing the way the body reacts to nicotine. It makes it harder to get pleasure to nicotine and also helps to reduce cravings by blocking the receptor in the body that responds to nicotine. Other advantages include:

• It is easy to use
• It does not contain nicotine, which is important to some people
• Short duration of therapy (25 days)

Common side effects

• Nausea and vomiting
• Insomnia and abnormal dreams

How to use

Cytisine is available as a pill that you take by mouth and is available as a natural health product. The manufacturer recommends users to:

• Reduce the number of cigarettes you smoke each day after you start using cytisine until you no longer smoke at day 5 – your quit date.
• The recommended use of cytisine is:
  • 1 capsule 6 times daily every 2 hrs, with a corresponding reduction of the number of cigarettes smoked, for the first 3 days.
  • 4th to 12th day: 1 capsule every 2.5hrs ( 5 capsules daily )
  • 13th to 16th day: 1 capsule every 3hrs ( 4 capsules daily )
  • 17th to 20th day: 1 capsule every 5hrs ( 3 capsules daily )
  • 21st to 25th day: 1 to 2 capsules daily

Warnings & precautions

Do not use cytisine if one of the following applies to you:

• Have an allergy to cytisine.
• Currently using nicotine replacement therapy (like gum or patch). The combination of taking both does not increase your chance of quitting and increases the likelihood of experiencing side effects.
• Less than 18 years old.

Speak to a doctor or pharmacist about whether cytisine is right for you if one of the following applies to you:

• exacerbated peptic ulcer
• ischemic heart disease
• cardiac impairment
• cerebrovascular diseases
• obliterating arterial diseases
• hyperthyroidism
• diabetes mellitus 
• renal or hepatic insufficiency
• pregnant or breastfeeding

Stop taking cytisine and speak to your doctor immediately if you experience any of the following symptoms:

• dizziness
• mental confusion
• rapid heartbeat
• difficulty breathing
• marked weakness

If you are a smoker, quitting smoking is the best thing you can do to improve your health. There is free support to help you quit, including QuitNow’s counselling services and medications covered by PharmaCare BC Smoking Cessation Program.

Completely replacing cigarette smoking with a vaping product like E-Cigarettes will reduce your exposure to harmful chemicals. If you are not a current smoker, vaping can increase your exposure to some harmful substances that could negatively affect your health.

Effectiveness

Vaping is less harmful than smoking, and switching to tobacco cigarettes to vaping products will reduce a person's exposure to many toxic and cancer-causing chemicals.

Health Canada states that as a step towards quitting cigarettes, many smokers may go through a transition period when they use both cigarettes and vaping products. Studies have shown short-term general health improvements in those who have completely switched to smoking cigarettes to vaping products.

What are e-cigarettes?

E-cigarettes are available in many shapes and sizes. Some are small and look like USB drives or pens, while others are much larger. Most vaping devices consist of a:

• battery
• mouthpiece
• heating element
• chamber (a tank or reservoir to contain a liquid solution)

Most devices use electrical power to a battery to heat a liquid solution, which becomes vaporized. The vapour then condenses into an aerosol, which is inhaled by the user through the mouthpiece.

Are e-cigarettes legal for use in Canada?

Yes, effective May 2018, adults can now legally get vaping products with nicotine. However, vaping products that are produced, advertised, imported or sold in Canada are subject to a number of laws. The goals of these laws are:

• to protect youth to nicotine addiction and incentive to use tobacco and vaping products
• to allow adults (mainly adults who smoke) to access vaping products as a less harmful option than smoking

For more information on these laws, see the Health Canada website.

In British Columbia, the rules for both smoking and vaping are similar. The law bans smoking and vaping in all indoor public/work spaces and within 6 metres of most public/workplace doors, open windows and air intakes and schools. Some communities may have rules that make buffer zones larger than 6 metres. For more information, see the Ministry of Health webpage on tobacco and vapour free places.

Can e-cigarettes help me quit smoking?

Quitting smoking can be difficult, and there are other proven, safe, and effective methods for quitting smoking (see medications section above). However, vaping products and e-cigarettes deliver nicotine in a less harmful way than smoking, and may reduce health risks for smokers who are unwilling or unable to:

• quit on their own 
• quit using approved nicotine replacement therapies (such as gums, lozenges and patches) or medication
• quit using counselling

While evidence is still emerging, there is limited evidence that e-cigarette use is linked to improved rates of success when quitting.

Are e-cigarettes safe?

If you are not a smoker, vaping can increase your exposure to some harmful chemicals that could negatively affect your health. Vaping could also expose you to nicotine, which is addictive.

There are also concerns about the appeal of vaping products among youth and their potential to encourage tobacco use. There is clear evidence that nicotine exposure during adolescence adversely affects cognitive function and development and using vaping products that contain nicotine could potentially lead to addiction.

If you are a smoker however, vaping is a less harmful option than smoking.

Health risks of vaping

There are a number of health concerns relating to vaping, including the presence of nicotine, other harmful chemicals, exposure to second-hand vape, and device malfunctions.

Vaping with nicotine: Nicotine is not known to cause cancer. It is approved for use in nicotine replacement therapies, such as the patch or nicotine gum. However, there are risks linked to nicotine. Nicotine is a highly addictive substance. Vaping could result in symptoms of nicotine dependence.

Children and youth are especially susceptible to the negative effects of nicotine, including addiction. Nicotine is known to alter brain development and can affect memory and concentration. It may also predispose youth to addiction to nicotine and possibly other drugs.

In some cases, vaping liquid containers have enough nicotine to be poisonous to young children. Children must be prevented to getting vaping liquid.

Health risks of other chemicals in vaping: There are health risks linked to other chemicals found in vaping products. While the main liquids in vaping products are considered safe for use in many consumer products, the long-term safety of inhaling them is unknown and continues to be assessed.

The heating of the liquid during vaping can cause new chemicals to be created. Some contaminants might also get into the vaping products and then into the vapour.

Second-hand vapour: Bystanders can also be exposed to vapour that is exhaled by users. The health effects to non-users to exposure to second-hand vapour are still unknown. While the risks to vapour are expected to be much lower than tobacco smoke, Health Canada recommends that users be cautious around non-users and youth.

Device malfunctions: Injuries to vaping product malfunctions, including explosions and fires, have occurred. For more information on product safety requirements, and how to protect yourself, read about vaping product, safety and regulation. 

More information
In British Columbia, the sale, display, promotion and use of e-cigarettes are regulated under the Tobacco and Vapour Products Control Act and Regulations.

Effectiveness

The reduce to quit method has proven to increase your chances of quit success in the long-term.

What does “reduce to quit” mean?

The reduce to quit method involves gradually reducing tobacco intake while using NRT products like nicotine gum or lozenges, to help manage nicotine cravings and withdrawal symptoms. This approach is often done over a six-month period, or until the person reaches the point where stopping completely can be achieved. 

• Slowly reduce the number of cigarettes you smoke each day.
• Choose a quit date - usually over a six-month period (although you can choose any quit date and work out your own cut down schedule).
• Manage the withdrawal symptoms by using nicotine replacement therapy and behavioural techniques like the 4 D’s (Drink Water, Deep Breathe, Distract, Do Something Else).

Advantages of using the reduce to quit method

• Keep you engaged in a positive behavior change
• Make it easier to stick with your plan to eventually quit
• Provide you with a more realistic goal 
• Respect your decision to manage your smoking the way you want to
• Help you achieve small health benefits by reducing the amount you smoke overall
• Nicotine is what your body craves as you reduce to quit, so it’s better to get clean nicotine found in the gum, inhaler or lozenge as it does not have the tar and other chemicals that can harm your body.

Suggested plan to reduce to quit: (6 month period)

Weeks 1-6

• Identify which cigarettes in your days you smoke because they are part of your routine rather than a real need
• Replace these cigarettes with a short-acting nicotine replacement product like the gum, lozenge or inhaler
• Reduce by one cigarette each week to ease into it

Weeks 7-16

• Your goal is to get down to 50% of your original number of cigarettes by week 16
• You will need to work on eliminating some of those more difficult cigarettes, like the first one in the morning or the one after work
• Continue to use nicotine gum, lozenge or inhaler to help manage the withdrawal symptoms

Week 17-24

• Your body has gotten used to having less nicotine so it will be less dependent on it
• Continue to eliminate cigarettes to your day by replacing them with the gum, lozenge or inhaler
• You are so close to quitting for good
• you should be close to quitting for good at this stage, but can continue to use the gum, lozenge or inhaler whenever you get an urge to smoke.

Acupuncture, hypnosis, relaxation, and meditation are alternative approaches and treatments to quitting smoking that some people use. 

While there are stories of quit success using these methods, there is no consistent, bias-free scientific evidence to show that these approaches help people quit for six months or more. However, quitting smoking is a personal journey, and if you find something that is safe and works for you, then stick with it. What's important is that you find an approach that you are comfortable with and have confidence in.

Remember, that if one approach doesn’t work, you can always try another that’s proven to increase your chances of quit success. 

Quitting cold turkey means quitting abruptly without using any quit smoking aids or support. While it might work for some, unfortunately there are fewer than 5% who are able to successfully quit using this method. This is because many just aren't prepared for the intensity of withdrawal and urges to smoke around every corner. Going cold turkey to quit can be difficult, and most people relapse without support.

Consider combining your willpower efforts with other evidence-based quit methods that are proven to increase your chances of quit success.