Sarah Todd , 2025-04-23 15:00:00
The young people who wanted to quit e-cigarettes didn’t necessarily think they were addicted. But they did think nicotine cravings were a problem. When they enrolled in a Massachusetts General Hospital trial, they told researchers they couldn’t study in the library or work at their desks for long before getting the urge to vape. “They really didn’t like that loss of control,” said Eden Evins, director of the Center for Addiction Medicine at Mass General.
Using the oral pill varenicline in combination with behavioral counseling is the most effective way for young people to get that control back, according to the results of the study co-authored by Evins, published Wednesday in the Journal of the American Medical Association. Of participants ages 16 to 25, half of those who took varenicline for 12 weeks were able to abstain from e-cigarettes for the last month of that period, compared to 14% of the placebo group. After a total of six months, 28% of people in the varenicline group were still vape-free, compared to 7% of the placebo group.
The study was fairly small, following 254 people. But as what its authors believe to be the first trial of a vaping cessation medication in young people, the findings have significant implications for how pediatricians and school health care providers treat nicotine addiction.
“I think that this should change practice, because as it stands now most clinicians treating youth who are vaping would not reach for a medication,” said Evins. “When clinicians are treating somebody, they shouldn’t wait for the patient to identify the problem. They should ask if they’re vaping, ask if they have withdrawal symptoms or cravings, and if they do, they should recommend treatment with varenicline.”
Benjamin Toll, a professor at the Medical University of South Carolina who researches tobacco cessation and was not involved with the study, said, “It’s a very rigorous trial that was extremely well done.” He noted, “there are almost no options for people who vape and want to quit.”
Varenicline, now available as a generic, was approved by the Food and Drug Administration in 2006 under the brand name Chantix in 2006. It works by blocking the dopamine-releasing effects of nicotine in the brain, lowering withdrawal symptoms and cravings. Nausea and sleep difficulty are the most common side effects.
While vaping rates among high-school students have fallen from their height in the Juul era, a 2024 survey found that 7.8% of that group reported using e-cigarettes in the past 30 days. Vaping is even more common among young adults, with 24% of people 18-25 saying they’d used e-cigarettes in the past month. Just 34 e-cigarette brands are authorized for sale in the U.S. by the FDA, but illegal products in a variety of fruit and candy flavors remain easy to access in convenience stores and gas stations around the country.
“It is especially concerning that 42% of high school e-cigarette users report frequent or daily use, a strong sign of nicotine addiction,” Dennis Henigan, vice president for legal and regulatory affairs at the Campaign for Tobacco-Free Kids, told STAT via email. “E-cigarettes pose serious risks to kids’ health. They expose kids to massive doses of nicotine, which can harm their developing brains, and to toxic chemicals such as formaldehyde, lead and benzene.”
Not only do e-cigarettes pose health risks in their own right, research suggests nicotine exposure in adolescence increases the likelihood of addiction to drugs like cocaine and heroin.
A 2020 survey found that 64% of students who vaped in grades 6-12 wanted to quit. But because previous research showed that varenicline wasn’t effective in helping young people quit combustible cigarettes, most health care providers haven’t explored the possibility of pharmacotherapy for young people who vape. Research into the best ways to help people of all ages quit vaping is also generally limited because the product is relatively new.
Going into the study, Evins thought behavioral treatment was likely to be the most effective way to help wean young people off vapes. Both the medicated and placebo groups received weekly counseling sessions for 12 weeks as well as referrals to the text message-based support program This is Quitting, and researchers added a third control group that received only referrals to This is Quitting, run by the nonprofit Truth Initiative. Much to Evins’ surprise, she said, “behavioral treatment alone did not work.”
Previous studies on young people and smoking cessation medications may have given a muddled picture of medication’s efficacy because dropout rates were high and young people can be inconsistent about taking pills, Evins said. The vaping study got around that tendency by paying participants a dollar for each time they uploaded twice-daily videos of themselves taking the medications.
Researchers verified that participants really were steering clear of vapes with saliva samples that measured their levels of cotinine, a biomarker of nicotine use. The study’s authors note its results may not be applicable to young people who both smoke and vape, who weren’t included in the study.
“Treatment for nicotine vaping in young people is sorely needed,” Judith Prochaska, a professor of medicine at Stanford University who researches addiction and was not involved with the study, said via email. “A whole generation of youth got enticed to take on kid-friendly flavored, high-nicotine, highly addictive products marketed as the evolved cigarette without any exit strategy.”
Despite its small size, the study had meaningful results, Prochaska said, and the side effects look tolerable. (Dropout rates were low.) The medicated group reported lower withdrawal symptoms, cravings, and feelings of distress compared to the placebo group. Toll said there are more than 10 generic versions of the tablets available. Without insurance, it costs about $100 a month, and $20 a month at his clinic with insurance.
“It’s very important that we as scientists and providers create new and impactful treatments to help people quit not just smoking, but vaping and pouch use and cannabis use,” said Toll. “Those three fields are exploding in popularity.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
