Experts say restrictions on nicotine gum, lozenges may make quitting smoking more difficult

NEW DELHI: Access to smoking cessation aids such as nicotine gum and lozenges may soon be tightened, raising concerns among experts who fear it could make it harder for smokers to quit.The trigger was a recommendation by India’s top drug advisory body to restrict over-the-counter sales of most nicotine replacement products. The proposal only allows for an exemption for plain 2 mg nicotine gum, excluding nicotine lozenges (2 mg), and excludes all other nicotine replacement products from the exemption.Currently, some of these products are available without a license, making them more accessible. While tobacco products remain widely available, the proposed changes could mean people trying to quit smoking will face fewer options and more barriers.Experts say this concern stems from the way addiction works. Nicotine (not the act of smoking) is the addictive substance, and withdrawal symptoms such as low mood and difficulty concentrating often prompt users to return to cigarettes.Nicotine replacement therapies—gum, lozenges, and patches—help manage these symptoms by delivering nicotine without the thousands of harmful chemicals in tobacco smoke that cause cancer, COPD, and heart disease. But they are not a guaranteed solution. Professor (Dr) GC Khilnani, Chairman, PSRI Pulmonary Research Institute and former Director, Pulmonary Department, AIIMS, Delhi, said, “Many users continue to smoke using nicotine patches or gums, which defeats the purpose and may even increase their overall nicotine intake.” He said that while nicotine was less harmful than tobacco smoke, it was not without risks and could have cardiovascular effects, so medical supervision was recommended. With more than 1.35 million tobacco-related deaths every year, India relies heavily on available cessation support. Experts warn that even small barriers — such as prescription requirements or limited supplies — can hinder attempts to quit smoking.There are also concerns about balance. Although smoking cessation aids face greater scrutiny, tobacco products remain widely sold.The panel proposed safeguards including prohibiting sales to minors, monitoring online sales, post-market surveillance and possible restrictions on the tobacco industry’s involvement in marketing these products due to conflict of interest concerns.However, some experts believe the risk of abuse may be overstated. Dr Priyanka Chaudhary Bindroo, consultant pulmonologist at Maharaja Agrasen Hospital, said: “I have not come across a single case of underage misuse of nicotine gum or nicotine lozenges. These products have been available over-the-counter in the US and UK for decades without a public health crisis. Restricting WHO-approved smoking cessation aid without contemporary evidence is a step backwards.”“The proposal is part of an ongoing policy debate over how nicotine products should be regulated – whether to prioritize tighter controls or easier access to cessation support. The final decision will be made by the government, but for now the key question remains: should smoking cessation assistance become easier or harder to access?