Experts push easier access to nicotine gums to boost smoking cessation in India

Amid growing public debate around nicotine products and tobacco control policies, doctors and public health experts are urging policymakers to consider improving access to nicotine gums—particularly the 4 mg strength—as an effective tool to help smokers quit.

Nicotine gums, available globally in 2 mg and 4 mg strengths, are part of nicotine replacement therapy (NRT), a medically approved approach that helps people manage withdrawal symptoms while gradually reducing dependence on cigarettes.

Respiratory specialists say these therapies are backed by decades of scientific evidence and play an important role in smoking cessation programmes worldwide.

“Nicotine replacement therapy has been used for several decades as a scientifically validated aid for smoking cessation,” said Dr Ravi Shekhar Jha, director and unit head of pulmonology at Fortis Escorts Hospital, Faridabad.

“Clinical evidence consistently shows that nicotine gums improve quit rates compared to unaided attempts. Smokers who try to quit without medical or behavioural support often relapse within weeks because nicotine dependence has both pharmacological and behavioural components.”

How nicotine gums support quitting

Doctors explain that nicotine gums work by delivering controlled doses of nicotine without the harmful toxins produced when tobacco burns.

Withdrawal symptoms such as irritability, cravings, restlessness and difficulty concentrating often cause smokers to relapse during quit attempts. Nicotine gums help reduce these symptoms while eliminating exposure to smoke.

“The 2 mg gum is generally recommended for light to moderate smokers, while the 4 mg gum is more effective for heavy smokers or those who smoke soon after waking, as it better suppresses strong cravings,” Dr Jha said.

International cessation guidelines suggest that nicotine replacement therapy can increase the likelihood of successful quitting by nearly 50 to 70 per cent compared with quitting without medical assistance.

Dr Akshay Budhraja, senior consultant and head of respiratory and sleep medicine at Aakash Healthcare, said nicotine gums help make quitting more manageable by gradually reducing dependence.

“These products provide a controlled amount of nicotine to help lessen withdrawal symptoms and cravings when a person quits smoking,” he said. “They allow smokers to reduce nicotine dependence gradually without exposure to harmful smoke.”

Nicotine often misunderstood

Health experts say there is widespread confusion about nicotine itself. While nicotine is addictive, it is not the primary cause of most smoking-related diseases.

“People often equate nicotine as the main cause of smoking-related disease when the real cause of health damage from cigarettes is the toxic substances released during tobacco burning,” Dr Budhraja said.

Cigarette smoke contains more than 7,000 chemicals, including tar, carbon monoxide and numerous carcinogens that can lead to cancers, cardiovascular disease and lung damage.

Nicotine replacement products, by contrast, deliver nicotine in measured doses without these toxic combustion products.

“It is critical to separate fear from facts. Nicotine gums are not initiation products; they are therapeutic tools,” said Dr Owais Nazir, a physician working in Srinagar, Kashmir.

“Extensive global evidence shows that regulated NRT delivers controlled nicotine without exposure to tar, carbon monoxide or the thousands of toxic chemicals present in cigarettes.”

Debate over over-the-counter access

Experts say wider access to higher-strength nicotine gums could help more smokers attempt quitting, particularly in settings where specialised cessation clinics are limited.

“Making 4 mg nicotine gum available over the counter has the potential to improve cessation rates, particularly in a country like India where access to structured tobacco cessation clinics is limited,” Dr Jha said.

Smokers with stronger nicotine dependence often require higher nicotine doses to manage cravings effectively, he added.

“If stronger formulations are difficult to access, patients may relapse early. Easier availability allows motivated individuals to attempt quitting without procedural barriers,” he said, adding that pharmacist guidance and clear labelling remain important.

Dr Sheikh Hilal, senior consultant in the Jammu and Kashmir health department, said restricting access to medically approved cessation aids could undermine tobacco control efforts.

“Nicotine itself is not risk-free, but the harm profile of medicinal nicotine is dramatically lower than smoking,” he said. “The real danger lies in denying dependent smokers access to effective cessation tools, especially in low-resource settings.”

Globally, more than 100 countries—including the United States, the United Kingdom, Canada, Australia and most European Union nations—allow both 2 mg and 4 mg nicotine gums to be sold over the counter.

Concerns over misuse

Some policymakers have raised concerns that easier access could lead to misuse or youth uptake. However, doctors say evidence from countries where nicotine gums are widely available suggests the risk is low.

“The misuse or youth access issue is often raised, but global evidence shows nicotine gums have relatively low abuse potential,” Dr Budhraja said.

Because nicotine from gums is absorbed slowly through the oral lining rather than rapidly through inhalation, it does not produce the immediate reinforcing effects associated with cigarettes.

Surveillance data from countries with over-the-counter availability have not shown significant addiction among non-smokers or adolescents, experts say.

A major public health opportunity

India carries one of the world’s largest burdens of tobacco-related disease, with millions of smokers and a rising number of deaths linked to lung disease, heart disease and cancer.

Public health specialists say improving access to proven cessation tools could significantly reduce this burden.

“Nicotine replacement therapy can play a very important role in helping smokers quit and reducing tobacco-related illness in the long term,” Dr Budhraja said.

Combining NRT with counselling, awareness campaigns and stronger tobacco control policies could substantially improve quit rates, experts added.

Correct use remains important

Doctors emphasise that nicotine gums must be used correctly to maximise their effectiveness.

Users are advised to follow the “chew and park” technique—chewing the gum slowly until a tingling sensation appears and then placing it between the cheek and gum to allow gradual nicotine absorption.

“Chewing it continuously like normal gum can cause throat irritation or nausea,” Dr Budhraja said.

Acidic beverages such as coffee, soft drinks and citrus juices should be avoided shortly before using the gum, as they can interfere with nicotine absorption.

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Health experts also advise smokers with certain medical conditions or those who are pregnant to consult a doctor before starting nicotine replacement therapy.

Despite these precautions, doctors agree that nicotine gums remain among the safest and most accessible tools available to help smokers break their addiction.

“Expanding awareness and access to these therapies can meaningfully reduce tobacco-related harm,” Dr Jha said. “Even small improvements in quit rates can translate into large public health gains in a country like India.”