Tobacco smoking is a leading cause of poor health outcomes and inequalities amongst people experiencing extensive health and social needs (e.g., homelessness, substance dependencies). A long-lived perception exists that individuals living with such needs do not engage in health services and as such, are described as ‘hard to reach’, ‘disengaged’ or ‘unimotivated’. This talk highlights why these descriptors are not grounded in evidence. It will also highlight how we can maximise existing opportunities to offer cessation support, including how tobacco harm reduction approaches are central to reducing smoking and will help to reduce inequalities.