CATEGORY: DISEASE PREVENTION
Plenty of young people who vape nicotine have tried to stop and discovered how hard that is. In the first placebo-controlled medication trial aimed squarely at them, a familiar quit-smoking pill changed the odds dramatically: 51% of 16-to-25-year-olds taking varenicline stayed off vapes through the final month of treatment, versus 14% on placebo and 6% with text support alone.1
Borrowing a Cigarette Treatment for the Vape Era
Varenicline has been prescribed for quitting cigarettes for nearly two decades. It works by partly occupying the brain’s nicotine receptors, which blunts cravings and makes nicotine itself less rewarding. Whether that playbook would transfer to vaping, and to much younger users, had never been tested in a rigorous trial. Vapes deliver nicotine efficiently, and daily users describe the same morning cravings and failed quit attempts that smokers do. The dependence is real. The question was whether the medicine for it would carry over.
Three Groups, One Saliva Test
Researchers at Massachusetts General Hospital recruited 261 people aged 16 to 25 who vaped nicotine daily or nearly so, wanted out, and didn’t regularly smoke cigarettes. Just over half were women. A random draw split them three ways. One group took varenicline, one milligram twice a day, for 12 weeks, and got weekly remote counseling from trained young-adult coaches plus a free texting program called This is Quitting. A second swallowed identical-looking placebo pills with the same counseling and texts. A third got the texting program alone. The counseling was delivered remotely, so nobody had to keep showing up at a clinic to take part. Nobody’s quitting was taken on their word. Abstinence had to be confirmed by saliva tests for a nicotine byproduct, and 97% of participants finished the trial.
The Lead That Outlasted the Pills
Treatment ended at week 12, and the follow-up kept going. From weeks 9 through 24, 28% of the varenicline group stayed continuously vape-free, four times the placebo group’s 7%.1 Side effects fit the drug’s long-known profile. Nausea touched 58% on varenicline versus 27% on placebo, vivid dreams 39% versus 16%, and insomnia 31% versus 19%. Nobody had a serious drug-related problem, and only 2% of the varenicline group stopped over side effects. The lead author’s summary was blunt: varenicline is very effective for this group.
Support Without Medication Barely Moved the Needle
A sobering detail hides in the comparison groups. Weekly counseling plus a placebo pill beat texting alone by only a few percentage points, and both left more than 85% of these daily vapers still vaping at the end of treatment. That echoes a trial in adults, where a different plant-derived quit-smoking pill, cytisinicline, roughly doubled vaping abstinence over placebo.2 One scope note matters. Participants averaged 21 years old, so the evidence is thickest for young adults and thinner for high schoolers, though the trial admitted people as young as 16. Whether the result holds as well at the younger end of that range will take a trial built around teens, and what happens past six months remains unmeasured. Nicotine dependence from vaping is starting to look like exactly what it is: the same old addiction in a newer package, answering to the same medicine.
Key Takeaways
- Varenicline more than tripled verified quit rates among young people who vape nicotine daily, 51% versus 14% on placebo during the last month of treatment.
- The benefit persisted after the pills stopped: 28% stayed continuously abstinent through week 24, versus 7% with placebo.
- Counseling and text support without medication helped very few of these daily vapers quit.
- Side effects matched varenicline’s known profile, led by nausea, vivid dreams, and insomnia, with no serious drug-related events in the trial.
References
- Evins AE, Cather C, Reeder HT, et al. Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial. JAMA. 2025;333(21):1876–1886. link
- Rigotti NA, Benowitz NL, Prochaska JJ, et al. Cytisinicline for Vaping Cessation in Adults Using Nicotine E-Cigarettes: The ORCA-V1 Randomized Clinical Trial. JAMA Intern Med. 2024; published online May 6. doi:10.1001/jamainternmed.2024.1313. link