Don’t rely solely on willpower to quit smoking — get medication first: success rates more than double

3. Don’t rely solely on willpower to quit smoking — get medication first: success rates more than double

Cost: Nicotine patches and gum are over-the-counter products available at any pharmacy. A full course lasts 8–12 weeks and costs anywhere from a few hundred to over a thousand yuan. Varenicline and bupropion, on the other hand, are prescription-only drugs; you’ll need a prescription from a smoking cessation clinic or a pulmonology department. These costs are roughly offset by the money saved from buying fewer cigarettes during the same period.

In plain terms: Relying on sheer willpower alone rarely works for most smokers. People taking varenicline are more than twice as likely to succeed compared to those taking a placebo. Those using nicotine replacement products also have a 50% higher success rate than non-medication users. Combining patches with gum or lozenges further boosts success rates by roughly 20%.

Benefit: A pooled analysis of 41 randomized trials involving 17,395 participants shows that varenicline increases smoking cessation rates by 2.32 times compared to placebo (RR 2.32, 95% CI 2.15–2.51; high-certainty evidence). Varenicline also outperforms bupropion (RR 1.36, a 36% relative increase) and single-form nicotine replacement therapy (RR 1.25, a 25% relative increase). Across 133 trials with 64,640 participants, nicotine replacement products raise success rates by about 55% versus no medication at all (RR 1.55, 95% CI 1.49–1.61). Using both a patch and a fast-acting form such as gum or lozenges yields a 27% relative improvement over patch-only use (RR 1.27, 95% CI 1.17–1.37; high-certainty evidence from 16 trials with 12,169 participants).

Evidence grade: A

Sources: Livingstone-Banks J, Fanshawe TR, Thomas KH, et al. (2023). Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD006103. <https://doi.org/10.1002/14651858.CD006103.pub8>; Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 5, CD000146. <https://doi.org/10.1002/14651858.CD000146.pub5>; Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308. <https://doi.org/10.1002/14651858.CD013308.pub2>; Shanghai Municipal Health Commission (2021). Choose the right medicine to make quitting smoking easier: "There are three main types of smoking cessation drugs available on the market, namely nicotine replacement therapy drugs., Bupropion, varenicline","Nicotine replacement therapy medicines are over-the-counter medicines (OTC) , available over the counter at pharmacies; Bupropion, Varenicline is a prescription drug. You must go to the hospital's smoking cessation clinic or respiratory medicine department. It can only be obtained after a doctor's prescription and a pharmacist's preparation.". <https://wsjkw.sh.gov.cn/jtyx/20211119/df50681e01ba49f896d54f771d8176ae.html>

Notes: In China, these three types of medications are currently available for smoking cessation; only nicotine replacement products are sold over the counter. Common side effects of varenicline include nausea, vivid dreams, and sleep disturbances; anyone with a psychiatric history should discuss this with their doctor. A typical course of nicotine replacement therapy lasts 8–12 weeks — do not abruptly stop use but taper off gradually under medical guidance. While these medications ease withdrawal symptoms during the first few weeks, they do not eliminate cravings triggered by specific situations, so they should be used alongside the other strategies outlined in this chapter: setting a quit date (Section 4) and seeking professional help at a smoking cessation clinic (Section 5).