Varenicline for Treatment of Nicotine Vaping in Adolescents

A new study in JAMA shows varenicline’s effectiveness and safety for treatment of nicotine vaping in youth and young adults

A recent study published in the peer-reviewed Journal of the American Medical Association (JAMA) shows promising results on use of the varenicline (generic Chantix) in adolescents and young adults who vape nicotine. When compared to placebo or behavioral counseling alone, participants taking varenicline had more than three times higher abstinence rates. Overall, varenicline was well tolerated, with only two participants leaving the study due to adverse effects.

These results are huge, because there are currently no FDA approved medications for the treatment of e-cigarette use, and few treatments have been studied in youth who vape. E-cigarettes are the most popular tobacco product used by youth—and have been for over a decade. According to the 2024 National Youth Tobacco Survey, 1.63 million students (5.9%) reported current use of e-cigarettes (7.8% of high school students, 3.5% of middle school students).

While no pharmacotherapeutic agents are currently approved for treatment of tobacco use in youth, the American Academy of Pediatrics supports the use of nicotine replacement therapies in youth with moderate to severe nicotine dependence. Current labeling on varenicline states that the drug is not recommended for patients 16 and under due to a lack of evidence demonstrating efficacy in this population.

This study offers much-needed initial evidence on the efficacy and safety of varenicline— the most effective medication for smoking cessation in adults—as a potential treatment for nicotine vaping during adolescence.

See the box below for details about the study.

Study Aim	To evaluate the effectiveness and tolerability of varenicline for treating nicotine vaping in youth and young adults.
Participants	261 US youth ages 16 to 25, who vaped nicotine daily or nearly daily, were not regular cigarette smokers, and wanted to reduce or quit vaping.
Intervention	This randomized controlled trial compared varenicline (dosed at 1 mg twice daily, titrated up over 1 week) to placebo and to behavioral counseling alone. Participants in the varenicline and placebo groups also received weekly behavioral counseling and referral to a text messaging vaping cessation support program. Participants were evaluated for biochemically verified, 4-week continuous vaping abstinence at 12 and 24 weeks.
Results	Continuous abstinence rates were 51% vs. 14% at 12 weeks and 28% vs. 7 % at 24 weeks in the varenicline and placebo groups, respectively.
Relevance	In this study, varenicline + behavioral counseling increased abstinence rates in youth and young adults who exclusively used a nicotine vape.

To learn more about tobacco treatment during adolescence, take our NEW on-demand CE course: Addressing Youth Tobacco Use in Healthcare, School, and Community Settings: Principles for Tobacco Use Treatment and Prevention. Visit https://www.dukeunctts.com/courses/introduction-to-youth-tobacco-treatment to learn more and enroll.

About the Author

Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certification in Nicotine and Tobacco Treatment and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.