Last November, the NHS announced a miracle cure for smokers: a demographic I've identified with from age 14. Better than a nicotine patch and much better than a vape, GPs are now able to prescribe a pill called Varenicline for a duration of 12 weeks (24 in severe cases). Varenicline is a nicotinic acetylcholine receptor and has some of the highest success rates among smoking cessation techniques. It also costs next to nothing: £9.90 for 28 film-coated tablets in local pharmacies, amounting to two weeks' worth of treatment.
Varenicline is the upgraded version of an old pill by Pfizer sold under the brand name Champix, which was shelved in 2021 because it contained too many nitrosamines: naturally occurring compounds and the result of a reaction between nitrates and amines. They typically appear during food processing and – ironic for something found in an anti-smoking medicine – can be carcinogenic.
Obtaining a prescription to nitrosamine-lite Varenicline is laborious, so be ready to jump through some hoops. My GP, for one, had no idea the pill had become available again, leading to a Sisyphean battle between him, my local pharmacy, and Camden and Islington's Stop Smoking Service (the patronisingly named Breathe). It got to a point where I began exploring alternatives (having tried neither vaping nor nicotine patches before). But I was right to persist: eventually, I was walking home from the pharmacy clutching a quaint little packet with detailed instructions on how to take Varenicline, each pill numbered according to the day on which it should be taken.
Varenicline works very differently to Nicotine Replacement Therapy, for a long time the de facto solution for serious smokers who model their lives off Carrie Bradshaw. The tablet is essentially Ozempic for smokers, designed to make you feel ill when you succumb to the seduction of a fag.
I find the real challenge is to resist smoking when people in front of me are doing it: pub gardens, house parties, Europe
I didn’t smoke for the first five days on Varenicline, too petrified to see what the unholy cocktail would do. The drug alone was making me feel iffy (common side effects include nausea and constipation). It is so potent that every health practitioner I spoke to insisted I “build up” to the full dose – two pills a day – over the course of a week. On day six, I was still taking only one pill per day, split in two halves which I’d have with lunch and dinner.
It was then I realised that if I didn’t smoke at least once during treatment, my lasting memory of cigarettes would be paired with a negroni on a beach in the Med. The point of Varenicline is to snap you out of such associations, and for smoking to connote pain, illness and disgust.
My first cigarette on the pill was daunting – I felt woozy by the end of it. Telling myself it could be the placebo effect, I experimented by having another. That one went down a treat, and I began to wonder whether Varenicline was all that. I hadn’t vomited. In fact, I felt good. Light, even. Which is what people who’ve never smoked before feel like when they do. Hours later, though, I still felt weirdly high – simultaneously frenetic and exhausted, as if I’d micro-dosed magic mushrooms or had a couple bottles of wine.
Experiences differ. Some people report particularly harsh side-effects from Varenicline (body rash, difficulty sleeping) and say that smoking during the treatment "feels funny", but not unpleasant. Others find Varenicline painless but report feeling "disgusted" by cigarettes once on the pill. My own account falls somewhere between the two, and I found it was enough for me to quit.
The consultant at Breathe, however, told me that for most people Varenicline only kicks in after a few weeks. Don’t be discouraged if, by day eight, you’re still smoking a little too happily.
The GP, meanwhile, reminded me the key to quitting is personal resolve. Varenicline is what you make of it; and it falls to you to imagine its effect on your body as part of a wider attempt to wean you off. Feel good on the pill? Great: that's how you feel when you don't smoke. Feel wretched? Smoking now would undo all your hard work. Feel slightly worse for wear but still fine enough to smoke? Go ahead: see how that works out. I doubt it will.
I find the real challenge is to resist smoking when people in front of me are doing it: pub gardens, house parties, Europe. The supposedly exceptional 24-week prescription can be a saviour here. Old habits die hard, and being allowed more time to achieve lasting abstinence is a wise move from the NHS. As someone firmly opposed to the smoking ban in outdoor public spaces which Labour briefly advertised last year, I appreciate I have a choice between being led back into temptation, as I did aged 14, and recognising this was a habit I once had which I've been strong enough to kick.
With Varenicline, I was able to choose the latter – and to quit within a week.
