In 1984, the US Food and Drug Administration (FDA) approved nicotine gum as the first pharmacotherapy for cigarette smoking cessation. Other types of nicotine replacement therapy have followed (nicotine lozenges, transdermal patches, inhaler, and a nasal spray), and in 1997, the first non-nicotine pharmacotherapy, bupriopion, was approved. The FDA has not approved a new drug with an indication for smoking cessation since varenicline was approved in 2006. For over a decade, more than 50% of US adults who smoke have attempted to quit at least once each year, with around 7% of those who smoke achieving abstinence each year for at least 6 months. Many have tried more than 1 FDA-approved pharmacotherapy unsuccessfully and have begun trying to switch to less harmful tobacco products, which are not approved as smoking cessation medications (eg, electronic cigarettes, smokeless tobacco, or nicotine pouches). In a recent international study of smoking cessation attempts in the US, Canada, Australia, and England in 2020, nicotine replacement therapy was the most commonly used quit aid at the last attempt (28.8%), closely followed by nicotine vaping products at 28% (ie, electronic cigarettes). Only 10.8% used a nonnicotine pharmacotherapy, while 38.6% used no aid at all on their last quit attempt (ie, no counseling, physician advice, website, brochure, nicotine replacement therapy, electronic cigarette, medication, etc). Of the 4 countries studied, US participants who smoked were the most likely to use no form of assistance on their last quit attempt (40.2%).
