Tobacco treatment specialists (TTS) are essential to developing an adequate system of treatment for smoking. Tobacco cessation treatment should be seen, not solely as a public health or prevention activity, but rather as a clinical activity. TTS should increase their professionalism by embracing evidence-based medicine. TTS should form professional organizations and credentialing bodies to insure a high quality professional identity.

Varenicline tartrate (Champix) is the first in a new class of therapy for smoking cessation and has been available on NHS prescription since December 2006. It has received approval from The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium and NICE final guidance was issued in July 2007. Varenicline is a partial agonist of the nicotinic receptor (·4, 2 subtype) and also prevents nicotine from binding to it. Studies comparing safety and efficacy with bupropion (Zyban) have been favourable and efficacy with varenicline has been shown to be greater than that with bupropion. A study comparing the nicotine patch is due for publication this year. Varenicline has a good safety profile with nausea being the most common side effect in about a third of those who take it. Despite the treatment's advantages there have been numerous issues which have affected its use. These include funding and administrative issues and this paper looks at ways of overcoming those barriers to prescribing what is a valuable addition to the range of treatments on offer to smokes who want to stop.