A patient can access opioid substitution therapy for as little as $7.70 per month, while equivalent nicotine dependence treatment can exceed $200 monthly without subsidy.
Australia’s tobacco control success story is masking a growing policy failure: the system is underspending on helping people quit, particularly those who need support most.
A new Perspective, published in Public Health Research and Practice, argues the country is “failing those who most need support to quit smoking”, with government investment in cessation treatment lagging both international benchmarks and spending on other forms of addiction.
While smoking prevalence has fallen to around 10.5% of the population, rates remain disproportionately high among disadvantaged groups – up to 30% among people with mental illness and as high as 77% among those experiencing homelessness.
This creates what the authors described as a structural paradox:
“Those most likely to experience nicotine addiction and smoking-related harms … are least able to afford cessation treatment.”
Despite longstanding national and international commitments to equitable access, current funding levels fall well short of recommended benchmarks. The World Health Organization has called for annual per capita investment in pharmacological cessation support of around $2.39, but Australian spending equates to roughly one-third of that level.
The gap is not just about amounts, but also about design, the authors wrote.
Under the Pharmaceutical Benefits Scheme, subsidised nicotine replacement therapy is limited to two 12-week courses per year, and largely restricted to patch-based monotherapy – despite evidence that combination therapy is more effective.
“Best-practice interventions are not affordable for many patients,” the authors wrote, noting that out-of-pocket costs for optimal treatment can run into the hundreds of dollars.
The result is a system in which clinical guidelines and funding settings are misaligned – particularly for populations with higher levels of dependence who require longer or more intensive support.
The Perspective drew a sharp comparison with other areas of addiction treatment, arguing the imbalance was difficult to justify on epidemiological or economic grounds.
“It is in stark contrast to far less prevalent addictions … for which people can receive heavily subsidised treatment for many years,” the authors noted.
The case study in the article underscored the disparity: a patient could access opioid substitution therapy for as little as $7.70 per month, while equivalent nicotine dependence treatment could exceed $200 monthly without subsidy.
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This mismatch comes as tobacco continues to impose a far greater burden, responsible for more than 24,000 deaths annually – more than three times those attributed to alcohol and more than 20 times opioid-related deaths.
System incentives may be further undermined by market dynamics, the authors wrote. The rise of illicit tobacco – sold at less than half the price of regulated products – has created a perverse situation where “it can be cheaper to remain smoking than to seek cessation support”.
For policymakers, the authors argued the issue was not a lack of evidence but a failure to act on it.
They pointed to strong data showing cessation interventions delivered both health and economic returns, particularly for low-income populations, and called for expanded PBS coverage, including subsidised combination NRT and longer treatment durations.
Ultimately, the paper framed the issue as one of system priorities.
“The ongoing enormity of harm caused by smoking … highlights the imperative for much greater government investment,” the authors concluded, warning that without reform, current settings would continue to entrench health inequities rather than reduce them.
Read the full article here.
