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Smokeless tobacco users should be offered behavioural support. There is limited evidence for pharmacotherapy.

Behavioural interventions incorporating telephone support, with and withoutoral examination and feedback about the specific risks of oral tobacco use, have been shown to assist quitting smokeless tobacco; however oral examination and feedback alone have not been found to be associated with a benefit. Trials of bupropion have not found significant long-term effects on quitting smokeless tobacco, whereas trials of NRT have demonstrated heterogeneous effects. Two trials of varenicline showed a significant long term effect.

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008

West R, McNeill A, Raw M. Smokeless tobacco cessation guidelines for health professionals in England. Br Dent J. 2004; 196: 611-618.

Ebbert J, Montori VM, Erwin PJ, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD004306. DOI: 10.1002/14651858.CD004306.pub4.

Fagerström K, Gilljam H, Metcalfe M, Tonstad S, Messig M. Stopping smokeless tobacco with varenicline: randomised double blind placebo controlled trial. BMJ. 2010; 341: c6549. logo
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