India’s top drug advisory body has recommended restricting over-the-counter access to most nicotine replacement therapies, raising concerns that it will hinder smokers’ efforts to quit. While tobacco products are widely available, this move could create more barriers for people who seek help to quit smoking, potentially impacting public health initiatives.

New Delhi: Access to quit smoking aids like nicotine gum and lozenges may soon become tighter, raising concerns among experts that it could make it harder for smokers to quit.The trigger is a recommendation from India’s top drug advisory body to restrict over-the-counter access to most nicotine replacement products. The proposal allows exemptions only for unflavored 2 mg nicotine gum, excludes nicotine lozenges (2 mg), and excludes all other nicotine replacement products from exemptions.Currently, some of these products are available unlicensed, making them easier to access. The proposed changes could mean there will be fewer choices and more barriers for those trying to quit tobacco, even if tobacco products remain widely available.Experts say the concern stems from how addiction works. Nicotine—not the act of smoking—is an addictive substance, and withdrawal symptoms such as low mood and poor concentration often push users toward cigarettes.Nicotine replacement therapies – gums, lozenges and patches – help manage these symptoms by providing 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 with nicotine patches or gum, which does not serve the purpose and may also increase overall nicotine intake,” said Professor (Dr) GC Khilnani, Chairman, PSRI Institute of Pulmonary and former Head of Pulmonary, AIIMS, Delhi. He said, although nicotine is less harmful than tobacco smoke, it is not risk-free and can have cardiovascular effects, so medical supervision is advised. India, where more than 1.35 million tobacco-related deaths occur annually, is largely dependent on accessible tobacco quitting support. Experts warn that even small barriers — such as prescription requirements or limited availability — can discourage attempts to quit.There are also concerns about balance. Although the means to quit smoking are under strict scrutiny, tobacco products continue to be widely sold.The Panel has proposed safeguards, including a ban on sales to minors, monitoring of online sales, post-marketing surveillance, and possible restrictions on tobacco industry involvement in the marketing of these products due to conflict of interest concerns.However, some experts argue that the risk of abuse may be higher. Dr Priyanka Chaudhary Bindru, consultant pulmonologist at Maharaja Agrasen Hospital, said, “I have not found a single documented case of nicotine gum or lozenge abuse by a minor. These products have been available OTC in the US and UK for decades without causing a public health crisis. Banning a WHO-approved cessation aid without contemporary evidence is a step backward.“The proposal is part of an ongoing policy debate over how to regulate nicotine products – whether to prioritize strict control or easy access to support quitting. The final decision will be taken by the government, but for now, the main question is: should help to leave be made easier, or harder?