ENDS Cessation

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Can we help e-cigarette users intending but unable to quit vaping? Yes.

This is little studied, and the product was developed by ex-smokers as a commercial alternative to cigarettes, from almost the very start (2010 for sure) consumers insisted on an off ramp. From the early days the nicotine refills where available in a range of strengths, from 48mg/ml at the high end, to 0.3mg/ml as well as zero nicotine at the low. The general advice has always been, select a product that works to prevent relapse to smoking, and once dissociated from smoking taper the nicotine level down at a rate that works to prevent return to smoking, eventually, however long it takes for the individual reach zero nicotine, then stop using the product entirely. Some find they are unable to stop vaping entirely, even without nicotine at all, and if you would return to smoking in that case, it is better to vape when needed than to light a cigarette and start the journey again.

Should it be the users choice to stop vaping, at their preferred pace?

Short answer: Yes!

However if you wish to stop and have trouble doing so, help and advice should be available. What we should not do is browbeat, or pressure vapers to quit. Especially if it might mean a return to smoking. Roughly 30% of smokers who switch to vaping in the UK use the taper down method and stop vaping after a time, the pace varies from one person to another.

Sudies, Papers, Randomised Controlled Trials etc...

2023: Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

  • Jed E. Rose, Suzanne Frisbee, David Campbell, Alfred Salley, Susan Claerhout & James M. Davis Psychopharmacology (2023)
  • Included here as it may have found ENDS use reduced or accidental quitters from NRT use. See section 1 here Myth: Alternative nicotine products don't help people stop smoking.
  • Electronic nicotine delivery systems (ENDS) are used by smokers seeking to reduce combustible cigarette (CC) use, but the role of nicotine replacement vs. behavioral and sensory factors is still poorly understood. We hypothesized that providing nicotine from ENDS in addition to nicotine skin patches would promote smoking reduction relative to non-nicotine control ENDS.
  • The use of nicotine in ENDS led to significant reductions in smoking (ENDS nicotine vs. placebo difference in CO change = −9.2 ppm; 90% CI (−1.5 ppm, −16.9 ppm)) and was highly correlated with reductions in self-reported cigarettes per day (r=0.6). The effect of nicotine in nicotine patches was not statistically significant (patch nicotine vs. placebo difference in CO change = −0.1 ppm; 90% CI (−7.8 ppm, 7.6 ppm)).
  • The presence of nicotine in ENDS was associated with a large reduction in smoking. Additional studies will be needed to determine whether there may be additive effects of nicotine ENDS and nicotine patches on smoking abstinence.
  • Note: Some success has been had with NHS stop smoking services, particularly after the 20mg nicotine cap. It might be that if nicotine is restricted in ENDS then additional sources of nicotine become more important? (Sadly the NHS have not provided numbers yet, but we welcome more research and data. (ed.))

2023: Varenicline and counseling for vaping cessation: a double‑blind, randomized, parallel‑group, placebo‑controlled trial

  • Just published the first RCT of varenicline and vaping cessation counseling for vaping cessation:
  • Caponnetto P, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Busa B, Polosa R. Varenicline and counseling for vaping cessation: a double-blind, randomized, parallel-group, placebo-controlled trial. BMC Med. 2023 Jul 5;21(1):220. doi: 10.1186/s12916-023-02919-2.
  • E-cigarette abstinence rate in the varenicline + counseling group was 34.3%, significantly higher than the abstinence rate of 17.2% in the placebo + counseling group. Notably, no subject in the study relapsed to tobacco cigarette smoking.
  • Note: Varenicline has risks, it should be discussed with a doctor aware of vaping, if the risks outweigh the benefits of stopping vaping (as they may in many vapers), then it would not be warranted.