Testing the feasibility of nicotine assisted reduction to stop in pharmacies. The RedPharm Study

Nicotine assisted reduction to stop means treating smokers who do not want to stop smoking but are prepared to reduce smoking with nicotine replacement therapy. Trials in highly controlled circumstances showed this increased smoking cessation, but there are doubts about whether this can be implemented in health systems. We propose a trial to examine whether pharmacists who provide stop smoking services can integrate a reduction service into their practice and develop methods for use in a subsequent trial. This subsequent trial will investigate whether behavioural support is more effective than no support and whether shorter reduction programmes are more effective.

Harm reduction in nicotine addiction means providing treatments such as nicotine replacement therapy to smokers who cannot or do not want to quit with the aim of reducing the harm they suffer from continued smoking. The least controversial step would be to provide NRT to smokers who are prepared to reduce smoking and provide advice on how to reduce with a view to one day quitting. A systematic review and meta-analysis and cost-effectiveness analysis shows that such a strategy is effective and cost-effective but it is not currently recommended in either British or US smoking cessation guidelines because of uncertainty as to how this fits with current practice. We propose a pilot randomised trial to examine whether pharmacists can be trained to implement NARS, how well they do so, and how this is received by smokers and by pharmacists. These pharmacists will be selected from those providing NHS stop smoking support. We will use this to prepare for a future definitive factorial trial of short versus standard reduction and behavioural support versus no support. About 160 participants will be randomised to test the acceptability, take up, adherence, and feasibility of trial follow up procedures. We propose using minimal contact procedures initially by email to monitor process and outcome of the trial and qualitative interviews with trial therapists and participants to examine how they integrated reduction programmes into their brief interventions and cessation work and how this is understood by participants. This would assess some of the barriers precluding use of reduction programmes and prepare for a further trial to assess the effectiveness of behavioural support and length of programme.