Study Finds Varenicline Significantly Boosts Vaping Cessation Rates in Youth

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In recent years, vaping has become increasingly common among adolescents and young adults. A study published in JAMA suggests that varenicline combined with brief, remotely delivered behavioral counseling significantly improves cessation outcomes in individuals between 16 and 25 years of age.

E-cigarettes are now the most widely used nicotine product among youth, with 7.8% of high school students in 2024 and 24.1% of adults between 18 and 25 years of age in 2023 reporting recent use, according to the study. Prevalence is highest among individuals between 16 and 25 years of age. Despite this trend, as of 2025, few treatments have been rigorously evaluated in this age group to support nicotine vaping cessation.

Researchers conducted a three-arm randomized clinical trial comparing 12 weeks of double-blind varenicline to placebo, with both groups also receiving brief remote counseling. These were further compared to an enhanced usual care group, which received only a referral to a text-based cessation program. The trial enrolled 261 participants from a single US state between June 2022 and May 2024, of whom 254 completed the study. Eligible participants vaped nicotine daily or near daily, did not smoke tobacco regularly, and were seeking to reduce or quit vaping. The study’s primary endpoint was biochemically verified continuous abstinence during the final four weeks of treatment.

The results show that varenicline was significantly more effective than placebo, achieving a 51% continuous abstinence rate compared to 14% in the placebo group during weeks 9 through 12. From weeks nine through 24, the varenicline group maintained a 28% abstinence rate compared to 7% in the placebo group. No significant difference was observed between the placebo and enhanced usual care groups.

In terms of safety, varenicline was generally well tolerated, with nausea, vivid dreams, and insomnia being reported as the most common adverse events (AEs). Treatment-emergent AEs (TEAEs) were reported in 86% of participants in the varenicline group, 79% in both the placebo and enhanced usual care group. Additionally, neuropsychic AEs were reported in 81% of the varenicline group, 71% of the placebo group, and 91% of the enhanced usual care group. Two participants in the varenicline group and one in the placebo group discontinued treatment due to TEAEs.¹

“To our knowledge, this is the first pharmacotherapy trial for nicotine vaping cessation in youth,” explained the study authors. “Discovering and delivering effective treatments for nicotine addiction, particularly in youth, is important because of converging evidence that earlier age of drug initiation is associated with more rapid transition to substance use disorder and that adolescent nicotine exposure specifically increases subsequent tobacco smoking and other sub- stance use disorders. Most youth who develop addiction to vaped nicotine have never regularly smoked tobacco and wish to quit vaping, highlighting the importance of these findings that an available pharmacotherapy is effective and well tolerated for vaping cessation in this population.”

The authors also acknowledged limitations of the study. Although retention was high across groups, intervention uptake was lower in the placebo group, potentially due to differences in early treatment effects. Among highly adherent participants, varenicline with counseling significantly outperformed placebo. The study was underpowered for some comparisons and may not generalize to individuals who regularly use both combustible tobacco and e-cigarettes.¹

“Varenicline, when added to brief, remotely delivered behavioral counseling, is well-tolerated and promotes vaping cessation compared with placebo in youth with moderate to severe addiction to vaped nicotine,” concluded the authors of the study.

Reference

1. Varenicline for Youth Nicotine Vaping Cessation A Randomized Clinical Trial. JAMA. April 23, 2025. Accessed April 24, 2025. https://jamanetwork.com/journals/jama/article-abstract/2833137