New Delhi [India], May 8 : Leading public health experts commended the Government of India's ongoing efforts in tobacco control and urged the Drug Technical Advisory Board (DTAB) for strengthening cessation pathways by ensuring 2 mg and 4 mg nicotine replacement therapies (NRTs) remain easily accessible as over-the-counter (OTC) products.
Speaking at Respire-2026, an event organized by Asian Coalition for Health Empowerment (ACHE); experts emphasised that improving access to evidence-based cessation tools is critical to addressing India's persistent challenge of low quit success rates, currently below 5%.
The discussion comes at a time when recent policy discourse has been informed by insights from a report by the Economic Advisory Council to the Prime Minister (EAC-PM) titled "Rise in Tobacco Consumption and Policy Implication: An Analysis of Household Consumption Expenditure Survey."
The report highlights the significant economic burden of tobacco use, particularly among low-income households, and underscores how reducing consumption can lead to measurable improvements in household welfare and economic mobility.Experts noted that these findings reinforce a key public health principle: cessation tools must be accessible at the moment individuals decide to quit, without avoidable barriers that may delay or discourage quit attempts.
Experts at the forum highlighted that ensuring OTC access to 2 mg and 4 mg NRTs- such as gums and lozenges- can significantly expand reach beyond the limited clinical infrastructure currently available under the National Tobacco Control Programme.
Dr. R.K. Sinha, President, IMA South Delhi Chapter, said, "The government's NRT framework has made an important contribution to public health. Strengthening access by keeping 2 mg and 4 mg therapies over-the-counter (OTC) ensures that support is available at the exact moment a person decides to quit. That is how policy translates into real-world impact."
Evidence Supports Access-Driven CessationGlobal evidence continues to support the effectiveness of NRTs in improving quit outcomes. Large-scale systematic reviews indicate that 2 mg and 4 mg NRTs can increase quit success rates by 50-70% compared to unassisted attempts.However, experts cautioned that limited access remains a key bottleneck in India, where cessation infrastructure is still developing and behavioural support alone may not be sufficient for many users.
Dr. Karl Fagerstrom, PhD, Professor Emeritus and Deputy Editor of Nicotine & Tobacco Research, said, "India's policy framework already recognizes that nicotine replacement is key to cessation. Decades of science show disease comes from combustion and toxicants, not nicotine itself. To be effective as a smoking cessation aid, nicotine needs to be delivered in sufficient dose to a smoker trying to quit. That is why the 2 mg and 4 mg doses of NRT are on the WHO list of essential medicines and the majority of OECD countries make the 2 and 4 mg dose available as OTC."
Aligning Policy with Public Health OutcomesExperts also emphasised that regulatory consistency and ease of access are essential for maximizing public health benefits. Restricting access to cessation tools, they noted, could unintentionally slow progress in reducing tobacco use.
Dr. Nimesh G. Desai, Former Director, IHBAS, said, "Public health policy must be aligned with clinical realities. Individuals attempting to quit require timely and practical support. Expanding access to proven therapies strengthens, rather than weakens, the overall cessation framework."
Salim Veljee, Former Director, FDA Goa, added, "Balanced regulation ensures both safety and accessibility. Making 2 mg and 4 mg NRTs widely available through OTC channels supports public health goals while maintaining regulatory oversight."
Respire-2026 Recommendations:To support national tobacco control objectives, experts recommended:
Retain 2 mg and 4 mg NRTs as OTC products to maximize accessibility
Expand reach of cessation tools alongside existing public health programs
Ensure policy decisions are grounded in robust evidence, reflect real world usage patterns, and follow international best practices for nicotine replacement therapies and alternative products to effectively reduce tobacco consumption.
With India facing a substantial tobacco burden and low quit success rates, experts concluded that improving access to evidence-based cessation tools is one of the most immediate and scalable interventions available.
As recent (EAC-PM) economic analysis highlights the broader societal impact of tobacco consumption, the need for accessible, effective, and evidence-led cessation pathways becomes even more pertinent.
The Asian Coalition for Health Empowerment (ACHE), champions SDG-3 through Doctor Against Addiction (DAAD). Addressing tobacco, alcohol, drugs, and smartphone dependence, ACHE leads science-based de-addiction programmes with a strong focus on smoking cessation. Guided by an expert Advisory Board, it advances prevention, treatment, rehabilitation, and policy advocacy, envisioning a healthier, resilient, and addiction-free society.
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