India’s top drug advisory body recommends restricting over-the-counter access to most nicotine replacement therapies, sparking concerns that it will hinder smokers’ efforts to quit. While tobacco products remain widely available, this move could create more hurdles for those seeking quitting aids, potentially impacting public health initiatives.

NEW DELHI: Access to quitting aids like nicotine gums and lozenges may soon tighten, raising concerns among experts that it could make it harder for smokers to quit.The trigger is a recommendation by India’s top drug advisory body to restrict over-the-counter access to most nicotine replacement products. The proposal allows exemption only for unflavoured 2 mg nicotine gum, excludes nicotine lozenges (2 mg), and keeps all other nicotine replacement products outside the exemption.Currently, some of these products are available without a licence, making them easier to access. The proposed changes could mean fewer options and more hurdles for those trying to quit, even as tobacco products remain widely available.Experts say the concern stems from how addiction works. Nicotine—not the act of smoking—is the addictive substance, and withdrawal symptoms like low mood and poor concentration often push users back to cigarettes.Nicotine replacement therapies—gums, 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. “Many users continue smoking along with nicotine patches or gums, which defeats the purpose and may even increase overall nicotine intake,” said Prof (Dr) GC Khilnani, chairman PSRI institute of Pulmonary and former head of pulmonary, AIIMS, Delhi. While nicotine is less harmful than tobacco smoke, it is not risk-free and can have cardiovascular effects, making medical supervision advisable, he said. India, with over 1.35 million tobacco-related deaths annually, depends heavily on accessible quitting support. Experts warn that even small barriers—like prescription requirements or limited availability—can discourage quit attempts.There are also concerns about balance. While quitting aids face tighter scrutiny, tobacco products continue to be widely sold.The panel has proposed safeguards, including a ban on sale to minors, monitoring of online sales, post-marketing surveillance, and possible restrictions on tobacco industry involvement in marketing these products due to conflict of interest concerns.However, some experts argue the risk of misuse may be overstated. Dr Priyanka Chaudhary Bindroo, Consultant Pulmonologist at Maharaja Agrasen Hospital, said, “I have not encountered a single documented case of nicotine gum or lozenge misuse by a minor. These products have been available OTC in the US and UK for decades without a public health crisis. Restricting a WHO-approved cessation aid without contemporary evidence is a step backward.”The proposal is part of an ongoing policy debate on how to regulate nicotine products—whether to prioritise tighter control or easier access to support quitting. The final decision will be taken by the government, but for now, the key question remains: should quitting aids be made easier to access, or harder?