'Make anti-tobacco therapy acessible'

NEW DELHI: Nicotine replacement therapies (NRT), including gums, lozenges and patches, seem to have become quite popular, and to prevent their misuse, the government is considering making a prescription compulsory for selling all formulations containing over 2mg of nicotine. However, health experts in the city are in favour of making NRT more accessible and even distributing them for free to reduce tobacco usage.

One out of every three people in the age group of 15-50 years in Delhi-NCR is addicted to smoking and around half of them are aged between 20 and 30, claimed Understanding Smoking Attitudes in Youth, a survey conducted in 2019 by Aviss Health Foundation. According to World Health Organization (WHO), India is home to 12% of the world's tobacco smokers.

NRT is a critical tool in the fight against tobacco addiction and its commercially available forms include gums, transdermal patches, mouth sprays, inhalers and lozenges - all endorsed by leading world health bodies like WHO and regulatory bodies like US Food & Drug Administration.

In India, NRT received a formal recognition with its inclusion in National List of Essential Medicines in 2022. In the city, the most commonly available NRTs are gums and patches. While the nicotine gums come in two strengths of 2 and 4mg, the patches are available in 7, 14 and 21mg. According to the current law, only 2mg nicotine gums are allowed for over-the-counter (OTC) sales.

In May this year, Drugs Technical Advisory Board (DTAB), the advisory body of the country's drug approval authority, proposed to reclassify NRT products from the OTC category to that of prescription-based. The DTAB minutes cited concerns about NRTs being used as nicotine substitution during abstinence rather than for quitting tobacco altogether.

The proposal has since triggered a debate. During a recent discussion over NRT prescription vs OTC availability, health experts urged the government to make these products more accessible to the public to make Delhi free from tobacco.

Stating that smoking is a mind and body addiction, Dr Sajeela Maini, head of tobacco cessation and deaddiction at Sir Ganga Ram Hospital, said people smoke as they are addicted to nicotine. NRT provides someone with a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke, she said.

"Though overdose of NRT can have some side-effects, they will be multiple-fold less than that of smoking cigarettes," Dr Maini pointed out, adding that in a country like India, very few percentages of people actually take professional help for deaddiction and making NRT prescription-based will do more harm than good.

Heath experts claim that nicotine gums can help in quitting tobacco. "One who wants to quit smoking should start the therapy by taking 2mg gums. The number can be increased gradually," Dr Maini said. She suggested that instead of the curb, the government should raise awareness on how to start NRT. "Unlike a regular gum, a nicotine gum has to be chewed differently, which is mentioned on the packet." It should be chewed a few times and then "parked" between the cheek and the space below the teeth, the doctor explained.

Dr Chandrakant S Pandav, former head of the community medicine department at AIIMS, said, "Fewer people will go for these therapies if even 2mg nicotine gums need a prescription." He also urged the government to make more people aware about NRT. In a city, more people consume betel leaves and gutka than smoking cigarettes, Dr Pandav said. He suggested that the government should make NRT more accessible by subsidising them for people belonging to economically weaker sections.

Tushar Kaushik, a 33-year-old smoker, called the move "a step in the wrong direction". He said a curb would be counter-productive as it would take away one avenue that smokers had for quitting. Another smoker said that if a person could more easily buy a tobacco product, it would be like encouraging more people to consume tobacco.