Nicotine and tobacco cessation

Only if you want to. It is never a condition of your opioid treatment and we will not keep bringing it up.

The evidence does contradict the common assumption. People who address tobacco during substance use treatment tend to do slightly better with the substance they came in for. The idea that quitting smoking uses up willpower needed elsewhere is intuitive but not supported.

Go to any pharmacy in British Columbia with your BC Services Card and ask to register for the smoking cessation programme. No prescription and no appointment is needed for nicotine replacement therapy.

The benefit covers a continuous period of treatment each calendar year, so it is worth starting when you are reasonably ready rather than trying it for three days. We can also register you during a clinic appointment.

Generally yes. Varenicline is among the most effective cessation medications and does not interact with methadone or buprenorphine.

Older warnings about serious mood effects were reviewed in large trials and largely withdrawn. That said, if you have significant depression or a history of suicidal thoughts, tell us so we can follow up more closely. Nausea is the most common side effect and usually settles.

It can. Tobacco smoke induces liver enzymes that metabolise a number of medications, and some people find their methadone clears faster while they are smoking heavily.

The practical consequence is that quitting can occasionally make an existing dose feel stronger. It is not a reason to keep smoking. It is a reason to tell us when you quit, so we can watch for it and adjust if needed. This effect comes from the smoke rather than the nicotine, so patches and gum do not cause it.

It is considerably less harmful than smoking, and for some people it works when nothing else has. It is not harmless, and the long term effects are still being studied.

It is not covered by the provincial programme, so you pay for it yourself, which for many patients is the deciding factor. If vaping has got you off cigarettes, that is real progress. Talk to us about a plan to come off nicotine entirely when you are ready.

Yes, and the statistics are genuinely on your side. Most people who quit permanently did so after several earlier attempts. Each attempt teaches you something about which situations undo you.

What usually changes on a successful attempt is method rather than willpower: combination nicotine replacement instead of a patch alone, an adequate dose, a longer course, and coaching alongside it. If previous attempts were unaided, you have not really tested what the treatments can do.