Twenty years ago there were only a few dozen of services dedicated to the care of smokers in France. In 1999, the Minister of Health (Bernard Kouchner) created the smoking cessation services (consultation de tabacologie) in France with the obligation to have a tobacco cessation service in all hospitals with more than 500 beds and at least one tobacco cessation service and in each of the 99 French departments. Training of doctors and nurses was organized through 5 university diplomas for tobacco control and smoking cessation. Some of the trained students used this training for their general daily practice; others become doctor in smoking cessation services. Adequate funding has been implemented. Gradually more than 650 tobacco cessation services were set up, including one-third of private (unfunded) smoking cessation services and 2/3 of public smoking cessation services (hospitals, city clinics, Non-Governmental Organization). Over time private services have almost all disappeared because the price paid by smoker (23€) was not suitable for long consultation.
Today there is no formal network of tobacco cessation service, but the Respadd regarding the health facility side and the French-speaking tobacco society play this role.
These smoking cessation services are all equipped with expiratory CO analyser. A common paper file for smoking cessation services has been set up with validation of the French speaking society of tobacco science. A few years later, an online computer file has been set up for all centres with an immediate anonymization system. Statistics comprising more than 250,000 patients are accessible online (everyone may consult http://www.cdtnet.fr).
The varenicline is totally free of charge for patients. In the same time the acceptance of this drug by health professional and smokers improved dramatically.
Since some weeks a generic nicotine gum 2mg and 4mg and nicotine patches 16 h are free of charge for smoker as all effective usual medication. All nicotine replacement therapies will be reimbursed by the end of 2018 and the non-effective a posteriori partial reimbursement will be cancelled.
The efforts of some to integrate the treatment of smokers within addiction general services don’t succeeded so smoking cessation service still remains largely independent.
The tobacco cessation service network remains weak and if the political willing declines, and the-funded system remain not enough efficient a risk exist to decrease the efficacy of tobacco cessation services.