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[49] The 2008 US Guideline specifies that three combinations of medications are effective: [46] : 118120 Long-term nicotine patch and ad libitum NRT gum or spray Nicotine patch and nicotine inhaler Nicotine patch and bupropion (the only combination that the US FDA has approved for smoking cessation) A meta-analysis from 2018, conducted on 61 RCTs, showed that during their first year of trying to quit, approximately 80% of the participants in the studies who got drug assistance (bupropion, NRT, or varenicline) returned to smoking, while 20% continued to not smoke for the entire year (i.e.: remained sustained abstinent)

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But in the past, when the United States tried to ban Native American culture and force their assimilation, Native Americans did not have access to traditional tobacco