Everyone’s aware of the dangers of cigarette smoking and the health benefits that can be gained by quitting. Varenicline (sold as Chantix and Champix) is the drug of choice for cigarette smoking cessation because it’s been shown to effectively prevent both short- and long-term relapse. But what if you want to quit e-cigarettes?
E-cigarette use, or vaping, has risen dramatically, especially among younger adults, as more and more research emerges about its effects on health. However, there’s a concern among those wanting to quit vaping, or the medical professionals encouraging it, that traditionally used treatments like varenicline might not work. Now, the results of the first US trial using varenicline to aid in quitting e-cigarette use have shown that it can be effective.
“People can get to very high levels of nicotine exposure with these e-cigarette products, and they can use them near constantly throughout the day,” said Lisa Fucito, director of the Tobacco Treatment Service at the Yale Cancer Center and Smilow Cancer Hospital and the study’s lead and corresponding author. “So, the question we all have is, ‘Can any pharmacotherapy stand up to this challenge?’”
Researchers from the Yale Cancer Center and the Medical University of South Carolina (MUSC) Hollings Cancer Center conducted the trial. Forty participants with an average age of 28 years who’d vaped exclusively every day for six months or more were randomly assigned to receive either eight weeks of varenicline or a placebo.
Fifty percent of participants used disposable vape devices; 90% used nicotine-salt-based vapes. Just over half (52.5%) of the participants reported a history of smoking combustible cigarettes, and the average e-cigarette use was 4.9 years. Some had pre-existing psychiatric conditions, such as depression (22.5%) and anxiety (25%).
“We had a 15% difference in quit rates, with those in the medication group having a quit rate of 45%,” Fucito said.
These results were seen at eight weeks and are comparable to results seen in varenicline trials for cigarette smoking. The difference was sustained at week 12: 40% for the medication group versus 30% for the placebo. Adults with smoking histories were more likely to quit vaping than those who hadn’t smoked (47.6% vs 26.3%). Importantly, participants did not revert to smoking combustible cigarettes after quitting e-cigarettes.
“If you have a former smoking history, one of the worries in the field is that you’re going to go back to smoking when you quit vaping,” said Benjamin Toll from the Department of Psychiatry and Behavioral Sciences at MUSC and a senior author on the study. “And we did not find that.”
There were no serious adverse effects. The most frequent side effects seen in the varenicline group included nausea, insomnia, and vivid dreams or nightmares.
What’s interesting about this study is that the participants were provided with very little support other than a self-guided cessation booklet that contained practical tips for quitting and meeting with a licensed healthcare provider who informed them about medication use and setting a quit date.
“We took a much lighter touch to reflect the behavioral support that you’d likely experience if you went to your doctor and asked for help with quitting e-cigarettes,” said Fucito.
Arguably, quit rates could be higher if more intensive counseling support was provided.
The researchers say that doctors have backed off from prescribing varenicline due to its history of causing psychiatric side effects, including anxiety, depression, psychosis and mood swings. As a result, the medication carried a ‘black box warning’ for a while that was removed in 2016 after a large study found the drug to be safe. That’s why the researchers considered it important to include participants with pre-existing psychiatric conditions in their study.
“There’s still some hesitancy to prescribe this very safe – now generic – drug, and it really shouldn’t be that way,” said Toll.
The promising results of the current trial should pave the way for larger ones. In the meantime, the researchers say that medical professionals should feel confident prescribing varenicline to those who want to quit vaping.
“We want people to come back to this medication,” Fucito said. “There are people who need help now and are likely to struggle to quit e-cigarettes on their own because the technology facilitates nicotine use on a level that we’ve never seen before.”
The study was published in the American Journal of Preventive Medicine.
Source: MUSC Hollings Cancer Center
