Smoking cessation
Screening
- INESSS Institut national d'excellence en santé et services sociaux
- CTFPHC Canadian Task Force on Preventive Health Care
| Decision | Guideline |
|---|---|
| Who, when | Determine and update tobacco status at every opportunity, from age 12 (tobacco or nicotine vaping). |
| Anyone who uses | At least a brief intervention:Discuss quitting and its benefits. Offer follow-up, accompaniment or referral to J'ARRÊTE opens in a new tab. If needed, consider reducing risk or use. |
| Adults who smoke | Encourage everyone who smokes to quit and offer one or more recommended interventions (strong, high certainty). |
| Exclusion | Sacred or ceremonial tobacco use INESSS tool opens in a new tabCTFPHC 2025 opens in a new tab |
Diagnose
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Clinical evaluation | Ask about:Quit attempts: number, methods, length of abstinence, causes of relapse. Health: chronic or mental health conditions, prescription drugs. |
| Motivation | Importance and confidence, each rated 0 to 10. Motivation is not an absolute condition to start treatment, with or without drugs. |
| Dependence | Heaviness Smoking Index (HSI) for conventional cigarettes, from two answers: time from waking to the first cigarette, and cigarettes per day.Low 0–1, moderate 2–3, high 4 or more. |
Treat
- INESSS Institut national d'excellence en santé et services sociaux
- CTFPHC Canadian Task Force on Preventive Health Care
| Decision | Guideline |
|---|---|
| Daily or regular use | Offer accompaniment plus pharmacotherapy whatever the person's goal for their use.The combination may triple the chance of abstinence. |
| Adults who smoke | Behavioural, drug or combined options (strong recommendation), chosen by shared decision. |
| Accompaniment | 4 or more encounters per quit attempt, in person (individual or group) or remote (phone or text).Start as soon as possible, at the latest within the week after the quit or reduction date. Services: J'ARRÊTE opens in a new tab. |
| More intensive help | Consider more intensive accompaniment or referral to specialized services, for example:Pregnancy; High dependence (HSI > 4); A mental health disorder. |
| Low motivation | Risk or use reduction may be considered when motivation to quit is low.Offer short- or long-acting NRT dosed on the cigarettes cut per day, or varenicline at the standard dose. |
| Cytisine | Alternative option, notably when first-line options are contraindicated.Not sold in Quebec pharmacies or stores;
the person orders it online from the manufacturer. Listed among recommended drugs with bupropion, NRT and varenicline (strong recommendation, low to moderate certainty). |
| E-cigarettes | Not approved by Health Canada for cessation.
May be considered, notably after several failed attempts with usual methods, after weighing risks and benefits. Suggests against e-cigarettes for cessation except in certain cases (conditional, low certainty). |
| Alternative methods | Insufficient evidence to recommend hypnosis, acupuncture or mindfulness.Advise against aversion therapy. Recommends against acupuncture, continuous auricular stimulation, hypnotherapy, laser therapy, electrostimulation, SAMe and St. John's wort (strong, very low to low certainty). |
| Drug | Dose | How long | Notes |
|---|---|---|---|
| First-line | |||
| Varenicline | Days 1–3: 0.5 mg DIE titration: see INESSS tool opens in a new tab | 12–24 weeks | Among the most effective |
| Combined NRT | Patch DIE + short-acting PRN Patch start: about 1 mg per cigarette a day Vaping: device mg ÷ days of use; start the patch below that Short-acting: 4 mg if first cigarette 6–30 min after waking 2 mg if 31–60 min titration: see INESSS tool opens in a new tab | 12–24 weeks | Among the most effective |
| Bupropion | Days 1–3: 150 mg DIE titration: see INESSS tool opens in a new tab | 7–12 weeks, up to 52 | Notably with depressive symptoms or fatigue |
| Alternatives | |||
| Cytisine | 25-day taper: see the INESSS tool | 25 days, up to 12 weeks | Notably if first-line options are contraindicated |
| Varenicline + NRT | Standard dose of each Short- or long-acting NRT | Not stated | Notably for high dependence (HSI > 4) or relapse |
| NRT alone | Per product: see the INESSS tool | 12–24 weeks | Occasional use, or little or no dependence |
| In some cases | |||
| Bupropion + NRT | Standard dose of each titration: see INESSS tool opens in a new tab | Not stated | Especially after a partial response to bupropion |
| Bupropion + varenicline | Standard dose of each | Not stated | Complementary mechanisms of action |
Maximum doses, the cytisine schedule, and renal or hepatic limits: open the INESSS tool opens in a new tab.
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| Visits | Follow up at least at these times:On the quit date or in the first week of pharmacotherapy: check effect, tolerance and confidence in the goal. At the planned end of treatment: assess relapse risk and whether to extend or intensify. After treatment: prevent relapse. |
| Low confidence | Revise the goal with the person. |
| Relapse risk | Extend treatment if needed when at least one relapse risk factor is present at the end of treatment.Relapses are part of the process: revise the treatment plan. More than one attempt with the same treatment may be needed. |
| Bupropion | Consider switching if the person has not quit by week 7.Hypertension: monitor when combined with NRT. |
| Side effects | Some can mimic withdrawal. Tell the person serious effects are rare; consult for persistent or significant effects. |
| Drugs affected by quitting | Do not adjust doses systematically before or after quitting;base changes on effect and side effects.
Interaction risk with drugs metabolized by CYP450, mainly CYP1A2. Watch
|
Pregnancy, breastfeeding, under 18
- INESSS Institut national d'excellence en santé et services sociaux
| Decision | Guideline |
|---|---|
| First step | Accompaniment without pharmacotherapy |
| If not enough | NRT, preferably short-acting |
| Not recommended | Varenicline and bupropion |
| E-cigarettes | Advise against in pregnancy and under 18. |
| Under 18 | Avoid the NRT inhaler, mouth spray and pouches (misuse risk). |
Reviewed 17 October 2026 against the official sources below.
Sources
Blue square: Québec · red round: Canada. The code names the body; each section's key gives its full name.