Frequently Asked Questions
This page provides answers to some frequently asked questions about smoking and becoming smokefree.
General Questions
- Where do I go to get more training in how to help people to quit?
- Can I still advise people about becoming smokefree if I smoke?
- Where can I read about what has helped other people become smokefree?
- Do mental health and addictions services have to be smokefree by law?
- Where can I get 'no smoking' signs to put around our organisation's premises?
- Where can my I get information/pamphlets to give clients and staff about quitting?
- Which medications are effected by smoking and which might be effected when someone gives up?
NRT (Nicotine Replacement Therapy) Questions
- Is NRT safe?
- How much does it cost and where can one get it?
- Is it possible to overdose on NRT or nicotine?
- Is NRT addictive?
- What happens if someone smokes while using NRT?
- I've heard NRT can give you weird dreams. Is this true?
- Does NRT interact with medications?
- Why use both patch AND gum?
- What if someone has tried NRT before and it didn't work?
General Questions
Can I still advise people about becoming smokefree if I smoke?
Absolutely! In some ways you may feel slightly uncomfortable, but when you are working with a client your role is to look after their wellbeing.
There are no drug interactions with NRT. However smoking effects the way some medications are metabolised. For this reason, when someone stops smoking the dosage of some medications may need to be adjusted. As a general rule therapeutic drug monitoring should be carried out following smoking cessation and dosage adjustments should be made accordingly. See the NZ Smoking Cessation Guidelines for more information on medications which may be effected by stopping smoking.
Do mental health and addictions services have to be smokefree by law?
The Smoke-free Environments Act (as amended by the Smoke-free Environments Amendment Act 2003) requires employees to take all reasonably practicable steps to ensure that no person smokes at any time in the internal areas of the workplace. The definition of “workplace” includes mental health and addictions facilities, hospital care institutions; residential disability care institutions; and rest homes. However clients and residents may smoke in these workplaces if:
- The smoking only takes place in one or more dedicated smoking rooms
- Each dedicated room has ventilation system that takes air from the room to a place outside the workplace.
- All reasonably practicable steps are taken to minimise the escape of smoke from the smoking rooms into any part of the workplace that is not a smoking room
- For each smoking room there is an equivalent smokefree room
International studies on smokefree mental health facilities have found no significant increases in disruptive behaviour; ‘against medical advice’ discharges; additional seclusion or restraints; or the use of emergency or ‘as needed’ medication in smokefree environments.
(Source: Factsheet: ASH Smoking and Mental Health)
Which medications are effected by smoking and which might be effected when someone gives up?
Smoking tobacco can alter the metabolism of a number of medicines. This is primarily due to substances in tobacco smoke, such as hydrocarbons or tar-like products that cause induction (speeding up) of some liver enzymes (CYP 1A2 in particular). Therefore, medicines metabolised by these enzymes are broken down faster and can result in reduced concentrations in the blood (see table below). When a person stops smoking, the enzyme activity returns to ‘normal’ (slows down), which may result in increased levels of these medicines in the blood. Monitoring and dosage reduction may often be required.
Medication Effect of smoking
| Caffeine | Increased clearance (by 56%) |
| Chlorpromazine |
Decreased serum concentrations (by 24%) |
| Clozapine | Decreased plasma concentrations (by 28%) |
| Estradiol | Possibly anti-estrogenic effects |
| Flecainide |
Increased clearance (by 61%) |
| Fluvoxamine |
Decreased plasma concentrations (by 47%) |
| Haloperidol |
Decreased serum concentrations (by 70%) |
| Heparin | Increased clearance |
| Imipramine | Decreased serum concentrations |
| Insulin |
Decreased absorption due to poor peripheral blood flow |
| Lidocaine | Decreased oral bioavailability |
| Olanzapine |
Increased clearance (by 98%) |
| Propranolol |
Increased oral clearance (by 77%) |
| Tacrine |
Decreased mean plasma concentrations (3-fold) |
| Theophylline | Increased metabolic clearance (by 58 to 100%) |
| Warfarin |
Decreased plasma concentrations (by 13%) |
Stopping smoking can result in the opposite of the effects noted above.
Health care workers should be aware of the potential for increased blood levels of some of these medicines when smoking is stopped. Blood levels of some (for example, clozapine, theophyline) may need to be monitored.
NRT (Nicotine Replacement Therapy) Questions
Is NRT safe?
Yes. NRT only contains nicotine to replace the nicotine found in tobacco which is the addictive chemical in tobacco that keeps people smoking cigarettes. Tobacco smoke however has approximately 4,000 chemicals- 43 of which are cancer causing in addition to the nicointe. Therefore, it is safe to use nicotine replacement therapy.
How much does it cost and where can one get it?
You can buy NRT at supermarkets and pharmacys but the cheapest way is when you have a quit card or prescription. This way NRT will be subsidised and cost only $3 for an 8 week supply of any one product (patches, gum or lozenge). Quit cards and prescriptions are redeemable at any pharmacy.
Is it possible to overdose on NRT or nicotine?
Nicotine overdose associated with NRT use in smokers is uncommon. Smokers are generally used to very large doses of nicotine which they receive from smoking tobacco. The most common adverse effect of too much nicotine is nausea and this is easily managed by reducing the dose.
NRT can be dangerous if consumed by children, so if this happens, contact your emergency health facility.
Is NRT addictive?
Although NRT contains nicotine it is very unlikely that someone will become addicted. This is because there is less nicotine than in cigarettes and the nicotine is released slowly from the NRT. A few people continue using the gum and lozenge long term, and there is not problem with this.
What happens if someone smokes while wearing a patch?
They may feel nauseous, however it is important that they continue to war the patch. The overall aim is for someone to become smokefree, but it is not a contraindication to smoke while using NRT. If someone is still craving while wearing the patch they may need more NRT to reduce their craving.
Why use both patch AND gum?
Studies have shown that the chance of a successful quit attempt is higher when people use a combination of NRT products eg. patch and gum or patch and lozenge. Because the nicotine in patches can take up to 2-3 hours to take effect, it can be beneficial to use lozenges or gum in combination with patches as these take effect faster (within approx. 15-20mins).
I've heard NRT can give you weird dreams. Is this true?
Some people (but not all) do experience vivid dreams or disrupted sleep while using NRT overnight. If this is disturbing you, you can try taking the patch off overnight. If you are feeling cravings during the night or first thing in the morning, a lozenge or gum first thing when you wake will help before a new patch will take effect.
Does NRT interact with medications?
NRT itself does not interact with medications, but smoking can effect the way some medications (especially some medications commonly prescribed for mental illness) are processed by the body. For this reason, when someone stops smoking the way their medications effect them. It may be that when someone stops smoking (and starts using NRT), they may need to reduce their dose of medication. It is important that when someone stops smoking, the clinical team involved with their care are informed.
What if someone tried NRT before and it didn't work?
There maybe several reasons that someone may feel that NRT didn't 'work' for them. If someone expects NRT to put them off smoking altogether, they may feel that it hasn't 'worked'. NRT should ease withdrawals and reduce cravings but it is important that they are using it correctly. Previously they may not have been using enough NRT to help with them, they may have been using it incorrectly (eg. putting a patch on a hairy arm), or not using it for long enough. Addressing these issues will hopefully help people get the best benefit from NRT.