What is nicotine dependence?

Nicotine is the addictive chemical found in tobacco and most vapes. If you find it difficult to cut down or stop using products containing tobacco, such as cigarettes, or vapes, you may have nicotine dependence (also known as addiction).

Here are some signs that you may be nicotine dependent:

• You smoke or vape within 30 minutes of waking up.
• You smoke 10 or more cigarettes each day.
• You find it hard to concentrate if you have not vaped recently.
• You vape when you are stressed.
• You have cravings and withdrawal symptoms if you try to cut down or quit.

Understanding how dependent you are on nicotine can help you choose the most effective strategy to quit.

How does nicotine replacement therapy (NRT) work?

Nicotine replacement therapy (NRT) works by releasing nicotine into your bloodstream to minimise or avoid cigarette and nicotine vaping cravings.

NRT is considered a ‘first-line’ medicine for treating nicotine dependence. This means that it’s a good first option if you want medicine to help you quit smoking or vaping. If used correctly, NRT can increase your chance of successfully quitting smoking and vaping.

NRT comes in many forms, including:

• patches (to stick on your skin)
• chewing gum
• lozenges
• mouth sprays
• inhalers

Many people use different types of NRT. For example, you might use a daily nicotine patch with a nicotine inhaler or gum. Using different types of NRT is often more effective than using one.

Using NRT to quit smoking or vaping is less harmful than smoking and vaping, so it’s worth considering if you are trying to quit. Most people can safely use NRT, but check with your doctor or pharmacist before you start.

NRT is available over the counter at pharmacies. You do not need a prescription. Nicotine patches are also available on the Pharmaceutical Benefits Scheme (PBS) with a doctor’s prescription.

What types of prescription medicines treat nicotine dependence?

In Australia, there are 2 types of prescription medicines to treat nicotine dependence, which are only for people aged 18 years or over:

• varenicline
• bupropion

Both medicines are taken as oral tablets. You can only buy them from a pharmacy with a doctor’s prescription. They are not usually taken at the same time.

Varenicline is considered a ‘first-line’ medicine for treating nicotine dependence from smoking cigarettes. Bupropion is also effective at helping people quit smoking but is considered less effective than varenicline and just as effective as NRT.

The effectiveness of using varenicline and bupropion to quit vaping is currently uncertain.

Your doctor is the best person to help decide which medicine is most suitable for you.

How does varenicline help with nicotine dependence?

Varenicline helps by making smoking less enjoyable. It works by attaching to certain pleasure receptors in your brain. If those receptors are occupied, nicotine can’t bind to those same receptors when you smoke, so it doesn’t feel as good. This can lead to you feeling fewer withdrawal symptoms and cravings.

Varenicline is generally recommended for people who smoke at least 10 cigarettes each day. Your doctor can give you more advice about whether varenicline is right for you.

How does bupropion help with nicotine dependence?

Bupropion is an antidepressant medicine that can help people quit smoking. It is not clear how bupropion helps with nicotine dependence. It is thought to act on certain chemicals in the brain to reduce cravings.

How do I take varenicline and bupropion?

Your doctor will advise which medicine is most suitable for you. They are not usually taken at the same time.

It can take a few days for the medicine to start working so it’s usually recommended to start taking it 1 or 2 weeks before you stop smoking. However, your doctor or pharmacist should advise you on when to start taking it.

Varenicline is taken daily for about 12 weeks. Bupropion is usually taken for at least 7 weeks. Your doctor will regularly review and monitor your progress.

Most people tolerate both medicines well, but some people have side effects. If you have side effects after starting a new medicine, discuss this with your doctor or pharmacist.

Neither medicine will make you quit smoking alone, but along with a quit plan, support from your doctor and quit-smoking services, they can increase your chance of successfully quitting smoking. Depending on your situation, your doctor may recommend that you take a medicine with NRT to increase your chance of quitting smoking.

What are the risks associated with these medicines?

All medicines have side effects, and they are not suitable for everyone. You should read the Consumer Medicine Information (CMI) that comes with the medicine and talk to your doctor or pharmacist if you are concerned about its risk.

Can vapes help with nicotine dependence?

There is limited evidence that vapes are effective in helping you to give up smoking in the short- or long-term.

In Australia, the safety of vapes for anyone’s use has not been assessed by the Therapeutic Goods Administration (TGA, the Australian Government medicine regulator). Because of this, vapes are not first-line treatments to help you to quit smoking.

There are medicines to treat nicotine dependence (nicotine replacement therapy) that have been assessed and approved by the TGA, which are proven to help you quit and are safer than vapes.

To give up smoking or vaping, you should speak with your doctor first. They can advise on how to quit according to your circumstances.

Learn more about what is involved with quitting smoking or vaping.

When should I see my doctor?

If you want to quit smoking, speak to your doctor or pharmacist first — especially if you are pregnant of have a chronic health condition. They can assess your situation and help you make a plan to maximise your chances of succeeding.

You should also speak to a doctor or pharmacist if you are concerned about the side effects of the medicines that treat nicotine dependence.

Resources and support

Quitting support helplines and tools:

• Quitline or Aboriginal Quitline (staffed by Aboriginal and Torres Strait Islander counsellors) on 13 7848 (13 QUIT)
• Download the MyQuitBuddy app
• QuitCoach, online tool

State and territory-based resources:

• Help to quit (ACT)
• iCanQuit (NSW)
• Smoking (NT)
• Quit HQ (QLD)
• Be smoke free (SA)
• Quit Tasmania (TAS)
• Quit Victoria (VIC)
• Make smoking history (WA)

For more information and support:

• Beyond Blue for mental health support on 1800 512 348.
• Kids Helpline for mental health support for people aged 5-25 years on 1800 551 800.
• Lung Foundation Australia on quitting smoking.
• Department of Health and Aged Cared on helping someone to quit.

Other languages:

• Health Translations
• Multicultural Health Communication Service