How Malaysia’s Smoking Cessation Efforts Can Improve

Studies show that making nicotine replacement therapy products like the patch or gum available over-the-counter boosts their usage, smoking abstinence, and quit attempts.

KUALA LUMPUR, Feb 25 – Malaysia still maintains prescription for nicotine replacement therapy (NRT) products like the patch or gum, even though multiple countries enable easier over-the-counter (OTC) access to these smoking cessation aids.

According to a search on the Association of the European Self-Care Industry, a non-profit that represents manufacturers of non-prescription medicines and other consumer health care products in Europe, the nicotine patch and gum are available OTC in the United States, Canada, the United Kingdom, Australia, New Zealand, Finland, China, Japan, and South Korea, as well as European countries like France, Germany, Italy, and Spain, among others.

Dr Amer Siddiq Amer Nordin, the chief coordinator of University Malaya Centre of Addiction Sciences (UMCAS) and director of UMCares (The Community and Sustainability Centre), called for NRT products to be “available as widely and as freely” as possible.

“This will allow the public who smoke to have no qualms to quit when they want to. Also, the availability will allow smokers to quit as easily as when they initially started,” Dr Amer Siddiq told CodeBlue recently.

Research shows that using NRT products increases quit-smoking rates by up to 60 per cent, while making NRT available OTC boosts their usage, smoking abstinence, and quit attempts.

A literature review published 2008 in the Health Policy journal found that OTC availability of NRT increased access to and utilisation of treatment, while initial fears of an OTC switch causing safety issues or addiction did not materialise. 

“Studies show that OTC NRT has been used safely and effectively, without substantial misuse or abuse, and with continued physician engagement and wide access to proven behavioural treatment,” said researchers. 

A 2005 study published in the Cancer Epidemiology, Biomarkers & Prevention journal by the American Association for Cancer Research found a significant increase in the number of smokers who used the nicotine patch or gum in the months following OTC availability in California, based on data from the 1996 California Tobacco Survey.

“These findings complement and extend the results from the sales data studies and suggest that the regulatory status of these products served as a barrier to their use. When NRT products became available without having to see a physician for a prescription, their use by smokers increased almost immediately,” researchers said.

Crucially, their study also showed a significantly higher proportion of smokers reporting smoking abstinence with the gum or patch immediately after these NRT products were made available without a prescription.

The research found no similar increases in abstinence rates among those who tried to quit smoking without NRT, suggesting a causal relationship between OTC availability and increased abstinence.

“The results of this study suggest that removing the prescription status of NRT products resulted in an immediate increase in quit attempts and smoking abstinence with the use of nicotine gum or patches,” concluded researchers.

A review published 2019 in the Cochrane Database of Systematic Reviews of 136 NRT studies, with 64,640 participants in the main analysis, found that all forms of NRT (the gum, patch, nasal spray, inhalator and sublingual tablets or lozenges) could help smokers successfully quit. NRTs increased the rate of stopping smoking by 50 per cent to 60 per cent. 

“NRT works with or without additional counselling, and does not need to be prescribed by a doctor,” researchers said.

Finland is one of the most inclusive nations when it comes to the accessibility of NRT products. Besides pharmacies where NRT products can be obtained OTC, these smoking cessation nicotine products can also be sold by shops licensed to sell tobacco products. 

According to a University of Helsinki research study in 2015, NRT sales in Finland almost doubled when NRT was deregulated with the change in the distribution channel of NRT products from pharmacy-only to general sales in 2006. 

New Zealand provides five different NRT products: the patch, gum, lozenges, inhalators, and mouth spray. The patch, gum, and lozenges are subsidised — available cheaply or free — if supplied on prescription or via the Quit Card programme. 

The mouth spray and inhalator can be purchased OTC without a prescription from supermarkets or pharmacies for the normal retail price.

Daily smoking rates in New Zealand among adults aged 15 and older nearly halved from 18 per cent in 2006/07 to 9.4 per cent in 2020/21. Just 10.9 per cent of adults currently smoke.

In Canada, NRT products like the patch, gum, inhaler, and lozenges can be bought in pharmacies without a prescription. 

Canada’s smoking cessation efforts seem to pay off as it was reported that 63.1 per cent of Canadians who have ever been smokers have now quit, according to a 2019 report on tobacco use in Canada by the Propel Centre for Population Health Impact at the University of Waterloo. 

Two-thirds of smokers who attempted to quit in the past two years used some form of cessation assistance, including 30.8 per cent who used NRT. The nicotine patch has been the most popular smoking cessation aid in Canada since 2003.

Apart from products, Dr Amer Siddiq also believes that many other aspects of smoking cessation aids should be strengthened and diversified in an aim to reach more people.

“These smoking cessation aids made available need to be also in tandem with the availability of support to quit like our own website. The wide introduction of a national quitline will further strengthen support for those who want to quit.” is a government website with information on quit-smoking efforts and access to quit-smoking programmes with professional help.

“All efforts to reduce new smokers like the mentioned smoke-free generation and also preventive methods like point-of-sale bans should also be made available apart from further enforcement,” Dr Amer told CodeBlue.

Earlier this year, Health Minister Khairy Jamaludin announced that the government plans to prohibit the sale of cigarettes, tobacco products, and vape or e-cigarettes to people born after 2005.

“Together, we will be able to achieve our smoke-free 2040 target,” Dr Amer concluded.

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