Canada releases updated smoking cessation recommendations

On August 25, 2025, the Canadian Task Force on Preventive Health Care (CTFPHC) published in the Canadian Medical Association Journal (CMAJ)[1] an update of its clinical recommendations for the management of smoking cessation in adults. The text proposes a range of validated options – behavioral interventions, drug treatments (nicotine substitutes, varenicline, bupropion) and cytisine – to be combined according to the patients and their history, while reserving a cautious and conditional place for electronic cigarettes. This approach is part of a perspective of shared decision-making and health equity, with tools dedicated to caregivers and patients.

The recommendations were developed based on a systematic review of the scientific evidence on smoking cessation interventions for adults. The quality of the evidence was assessed using standardized methods, and priorities were established in consultation with experts, partner organizations, and current and former smokers. The working group emphasized consideration of criteria deemed essential by patients, such as efficacy, adverse effects, and impact on quality of life. Practical tools, designed to support shared decision-making between healthcare professionals and patients, accompany these new recommendations.

A range of validated interventions

Canadian guidelines emphasize the need to offer smokers a wide range of proven solutions to maximize their chances of success. The approach relies on a combination of behavioral and pharmacological strategies, which can be used separately but are more effective when combined.

Behavioral interventions are the foundation stone of smoking cessation. They include brief counseling, delivered directly in primary care, which remains a simple and effective measure when systematically offered. In addition, there are structured individual or group support programs led by trained professionals, as well as telephone support lines and digital text message programs. These accessible and inexpensive programs provide regular monitoring and ongoing motivation for patients. Self-help materials, such as brochures or scientifically validated online platforms, complete this range.

In terms of pharmacotherapy, nicotine replacement therapies (patches, gum, lozenges, sprays, or inhalers) are confirmed as first-line options. They can be used alone or in combination, for example, by combining a continuous-release patch with a fast-acting oral form, to better control withdrawal symptoms. Varenicline and bupropion, two prescription treatments, also benefit from solid efficacy data and are among the main recommendations for pharmacological management.

Added to these options is cytisine, presented in Canada as a natural health product. This drug, used for several decades in Eastern and Central Europe, now has a growing body of studies demonstrating its effectiveness and good tolerance. Although it is not yet marketed in France, its inclusion in Canadian recommendations reflects the desire to broaden the spectrum of available solutions.

All of these interventions are designed to be offered through a shared decision-making process. The healthcare professional must support the patient in choosing the strategy best suited to their profile, preferences, and previous cessation experience. The recommendations emphasize that the combination of behavioral monitoring and pharmacological treatment remains the most effective combination for supporting sustainable cessation.

Limited space for electronic cigarettes

The working group takes a measured stance on e-cigarettes. While available data suggest these devices can help some people quit smoking, many uncertainties remain regarding their long-term safety and effectiveness. Unlike nicotine replacement products and authorized drug treatments, e-cigarettes present a wide variety of products, formulations, and modes of use, making it difficult to assess their actual health effects.

The CTFPHC therefore recommends prioritizing interventions that have been the subject of robust behavioral and pharmacological evidence as a first-line treatment. Electronic cigarettes should only be considered as a second-line treatment in specific situations: when the smoker has not been able to quit using validated methods or when they express a clear and informed preference for this option. In this case, healthcare professionals are encouraged to engage in an in-depth dialogue with the patient, transparently presenting the potential benefits and the uncertainties and risks associated with vaping.

This approach reflects a desire to meet the needs of some smokers who are resistant to conventional methods, without legitimizing the e-cigarette as the go-to cessation tool. It is also part of a public health framework aimed at limiting the risks of maintaining nicotine dependence, or even dual use, when the e-cigarette is used alongside combustible cigarettes.

Finally, experts stress the need for regular monitoring of people using vaping as part of the withdrawal process, in order to gradually support the reduction and then complete cessation of nicotine use, a central objective of any smoking cessation strategy.

Taking health inequalities into account

The CTFPHC's new recommendations highlight that tobacco use remains marked by significant social, economic, and cultural disparities. Some populations have smoking rates significantly higher than the national average, with direct consequences for their health and life expectancy. This is particularly the case for First Nations, Inuit, and Métis peoples, who face particularly high smoking rates, often linked to adverse social determinants, limited access to health services, and persistent structural inequalities.

Beyond indigenous communities, tobacco more severely affects people living alone, separated or widowed, or from disadvantaged socioeconomic backgrounds. Workers in low-skilled jobs are also at increased risk, with greater exposure to tobacco and a reduced likelihood of accessing appropriate prevention and support services. Similarly, people suffering from mental health disorders or substance dependence constitute a high-risk group, experiencing difficulties quitting and higher morbidity.

The CTFPHC therefore recommends increased vigilance from healthcare professionals with regard to these populations. Proactively identifying smoking status and systematically offering effective options appear to be essential levers for reducing disparities. The report also emphasizes the importance of adapting support methods: using digital tools or accessible telephone lines, taking into account cultural contexts, strengthening local services, and integrating specific support strategies for people living with psychiatric or addictive comorbidities.

This approach aims to strengthen public health equity by ensuring that the benefits of smoking cessation interventions are not reserved for the most advantaged populations but can be extended to all smokers. By addressing these disparities, the new recommendations aim to help reduce the burden of smoking as a factor in social inequalities in health, which remains one of the most significant factors in Canada and internationally.

©Generation Without Tobacco

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[1] Brett D. Thombs, Gregory Traversy, Donna L. Reynolds, Eddy Lang, Stéphane Groulx and Brenda J. Wilson; for the Canadian Task Force on Preventive Health Care, CMAJ August 25, 2025 197 (28) E846-E861; DOI: https://doi.org/10.1503/cmaj.241584