Study Shows How Much Vapes Can Help Smokers With Schizophrenia

March 22, 2021

A groundbreaking study from Italy with adults who have schizophrenia spectrum disorders found that using JUUL vapes helped some 40 percent of participants to stop smoking traditional cigarettes by the end of 12 weeks. This finding is of enormous importance because smoking prevalence among people with this diagnosis is a staggering 60 to 90 percent, and there are no signs of the numbers decreasing.

“Smoking is the primary cause of the 15-25 years mortality gap between users of mental health services and the general population,” said Riccardo Polosa, one of the lead researchers. “This study demonstrates that switching to high-strength nicotine e-cigarettes is a feasible, highly effective smoking cessation method for smokers who have schizophrenia. And it improves their quality of life too!”

The study—conducted in collaboration with the University of Stirling, City University of New York and Weill Medical College of Cornell University, and published in the journal Nicotine & Tobacco Research—enrolled 40 adult smokers with schizophrenia spectrum disorders.

Aged between 22 and 65, the participants all said at the outset that they did not intend to quit or reduce their smoking. They were each given a free starter kit—containing one JUUL device with a 5 percent nicotine pod flavored with Virginia tobacco and a charger—and taught how to use it. In addition, participants were asked to maintain a daily study diary to record product use, number of tobacco cigarettes smoked and any adverse side effects.

Among the study’s key findings:

*Researchers observed [either] an overall, sustained 50 percent reduction in smoking or complete smoking abstinence in 92.5 percent of participants at the end of 12 weeks.

*Researchers observed an overall 75 percent reduction in median daily cigarette consumption, from 25 to six, by the end of the 12 weeks.

*After six months, 35 percent of participants had completely stopped smoking conventional tobacco cigarettes, while continuing to use e-cigarettes.

*After six months, 57.5 percent of participants reduced their cigarette usage by over 50 percent.

*Participants’ mean blood pressure, heart rate and weight measurably decreased between the start of the study and the 12-week follow up.

*Positive and negative symptoms of schizophrenia were not significantly different after using e-cigarettes throughout the duration of the study.

*At the end of the study 61.9 percent of participants reported feeling more awake, less irritable, and experiencing greater concentration and reduced hunger.


These findings are remarkable and should give hope to the international mental health community that has essentially given up on helping smokers with schizophrenia.

For people with this diagnosis, the reality is it’s particularly difficult to go without the positive effects that nicotine provides: Increased energy and concentration, relaxation, reduced anxiety, minimization of the side effects of medication and the normalizing of sensory gating. Nicotine also provides pleasure because it releases lots of dopamine—the “feel good” neurotransmitter. Other challenges to quitting include lack of motivation and not fully understanding the long-term, negative consequences of smoking on health.

For decades, the only options beyond “quit or die” were nicotine replacement therapy (NRT) in the form of patches, gums and inhalers, and the prescription medications bupropion and varenicline. These smoking cessation treatments have only short-term success and for a combination of reasons they are unappealing.

The power of vaping is that the enjoyable and comforting rituals remain, while the dangers of combustion are eliminated.

Many smokers with schizophrenia are dependent on very high doses of nicotine and often chain-smoke throughout the day or night. NRT simply doesn’t deliver sufficient nicotine, or fast enough. With a patch or gum, it can take up to 20 minutes for nicotine to reach the brain; with inhalation, it takes about 8 seconds.

Traditional NRT also eliminates rituals of smoking which are critically important to many people—in particular, hand-to-mouth movement and the process of inhalation and exhalation. And for some people with schizophrenia, a cigarette gives them something to do with their hands that helps to relieve loneliness and boredom. The power of vaping is that the enjoyable and comforting rituals remain, while the dangers of combustion are eliminated.

The researchers acknowledged the small number enrolled in the study, the lack of a control group, and the need for randomized control studies. However, they rightly concluded, “This study showed that use of a new-generation e-cigarette, with a high nicotine content, in participants not motivated to quit, substantially decreased cigarette consumption without causing significant side effects.”

The study is a call to action for those who work with smokers with schizophrenia. Now is the time to offer a range of vaping products to this vulnerable group and support the switch.

This research is also a call-out to the tobacco control organizations, frequently funded by billionaire Michael Bloomberg, that deny vaping’s efficacy in helping people to quit smoking; spread the misconception that vapes are not safer than cigarettes; and support bans.

If their worldwide war on vaping isn’t stopped, people with schizophrenia spectrum disorders, among many other vulnerable populations, will continue to pay with their lives for a lack of access to safer nicotine products.


Photograph by Helen Redmond

*CoEHAR, which Riccardo Polosa founded, has received grants from the Foundation for a Smoke-Free World (FSFW). The Influence Foundation, which operates Filter, has received both restricted and unrestricted grants from FSFW. The Influence Foundation has also received an unrestricted grant from Juul Labs, Inc. Filter’s Editorial Independence Policy applies.

Helen Redmond

Helen is Filter's senior editor and a multimedia journalist. She is on the methadone, vaping and nicotine train. Helen is also a filmmaker. Her two documentaries about methadone are Liquid Handcuffs and Swallow THIS. As an LCSW, she has worked with people who use drugs for over two decades. Helen is an adjunct assistant professor and teaches a course about the War on Drugs at NYU. She lives in Harlem.

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