Vapes Outperform NRT for Smokers Who Have Tried Past Quitting Aids

August 26, 2021

For people who want to stop or reduce their smoking and have previously been unable to do so using conventional treatments, e-cigarettes are much more effective than nicotine-replacement therapy (NRT), according to new research.

A study published in Addiction assessed the efficacy of e-cigs compared to NRT among smokers who had tried previous treatments, including NRT. It was conducted as a follow-up to an earlier study by many of the same researchers, which found vapes to be more effective than NRT for smoking cessation among people who hadn’t previously tried any treatments.

These findings add to the growing evidence of vaping’s efficacy for reducing or quitting smoking—but show that it can be especially useful for people who haven’t gotten the results they wanted from NRT.

After six months, only 3 percent of the NRT participants had maintained abstinence from smoking, compared with 19.1 percent of the vaping group.

Participants in the study had previously and unsuccessfully, tried NRT, varenicline (a drug commonly sold under the brand-name Chantix) or both to quit or reduce smoking. They were divided into an NRT group and a vaping group. Those in the NRT group were offered a choice of nicotine patches, chewing gum, nasal spray, microtabs, inhalators and mouth spray; those in the vaping group were offered e-cigs in the flavor and nicotine strength of their choice. 

While the previous study found that e-cigs were more effective for smoking cessation than NRT when both products were accompanied by substantial behavioral support, the followup found this to be true for both cessation and reduction—and even when behavioral support was limited. 

After six months, only 3 percent of the NRT participants had maintained abstinence from smoking, compared with 19.1 percent of the vaping group. And while only 6 percent of people using NRT had reduced their smoking by at least 50 percent, that figure was 26.5 percent for the participants using e-cigs.

“Many dependent smokers have tried and tested many products and been unable to stop. E-cigarette use should be encouraged by health care professionals and stop-smoking advisers,” lead author Dr. Katie Myers Smith told Filter. “Harm to the user, even if they continue to use in the longer term, will be drastically reduced compared to continuing to smoke.”

Allowing the e-cig participants to choose their own preferred strength and flavor is likely to have been crucial to their success rate. Patient choice and autonomy is a backbone of harm reduction—it’s an evidence-based pathway toward finding the treatment option most likely to benefit someone trying to stop or reduce their substance use. Harm reduction practices don’t force people into certain treatment paths, not least because we know that coerced treatment has a greatly reduced chance of success.

“Anyone wanting to stop should consider using an e-cigarette.”

The habitual and ritual aspect of drug use must be considered when presenting options intended to reduce harm. E-cigs, involving inhalation and hand-to-mouth movement, are a much closer approximation than NRT of combustible cigarettes, helping people maintain the social functions of their nicotine use.

“E-cigarettes provide smokers with a device that can be tailored to be a close match to the nicotine levels they got from smoking but without the toxins,” Myers Smith said. “NRT is often underused due to the limited delivery of nicotine and satisfaction [and] enjoyment they get from the products.”

Some people who use e-cigs to quit combustibles are using them as a short-term aid, with the intent of subsequently quitting e-cigs, too. Others are using them as a sustained replacement. Long-term e-cig use needs to be seen in the context of hard-to-reach cigarette smokers who would have otherwise been subjected to higher health risks from continued smoking.

According to the study, about 80 percent of smokers previously treated in clinical trials and provided with intensive treatment in routine care had continued to smoke one year later. If smokers are unable to quit with the best treatments currently available, and providers want the best outcomes, why not offer approaches that are shown to still reduce the harms from smoking without quitting nicotine?

“Vaping poses only a small fraction of the risks of continuing smoking,” Myers Smith said. “Anyone wanting to stop should consider using an e-cigarette.”



Photograph via United States Food and Drug Administration

Kevin Garcia

Kevin is a tobacco harm reduction fellow for Filter. He began working in harm reduction as a health educator, providing street-based syringe access services for people who inject drugs. He was later a bilingual medical case manager, providing case management for people living with HIV/AIDS. He has also been a chapter leader and member of the board of directors at Students for Sensible Drug Policy. Kevin's fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to support Filter.

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