We had this issue come up in clinic. "What interventions can help patients stop using chewing tobacco?"
Nicotine replacement therapy (NRT), including gum and patches, decreases cravings and short-term abstinence rates, but does not improve long-term abstinence (strength of recommendation [SOR]: B, meta-analysis of small randomized controlled studies [RCT]).
It is unclear if bupropion has an effect on cessation rates (SOR: B, small RCTs with conflicting results). Behavioral interventions increase abstinence rates for smokeless tobacco users (SOR: B, meta-analysis of small RCTs).
All of the included intervention studies have been conducted in the United States where smokeless tobacco (ST) includes ground tobacco (snuff) and chewing tobacco. Nicotine replacement therapy (patches or gum), and bupropion have not been shown to help people to stop using ST. Dentists and hygienists may help their patients to stop, especially when they show them the damage that ST causes in their mouths. Telephone counselling may assist ST users in quitting. More and larger studies are needed.