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A large clinical trial examining smoking cessation strategies for people with substance use disorders found that e-cigarettes and combination nicotine replacement therapy produced similar quit rates when combined with behavioral counseling.
The pragmatic randomized controlled trial recruited 363 participants from five smoke-free inpatient alcohol and drug withdrawal services across Australia. Participants were heavy smokers motivated to quit who received either a 12-week supply of e-cigarettes or combination nicotine replacement therapy along with telephone counseling support after discharge.
At nine months of follow-up, 11% of participants in the e-cigarette group achieved seven months of continuous smoking abstinence compared to 10% in the nicotine replacement therapy group. This difference was not statistically significant, with researchers concluding there was little evidence of any treatment effect between the two approaches.
The study population had characteristics that typically make smoking cessation challenging. Most participants had mental health conditions alongside their substance use disorders, with 85% receiving government benefits as their primary income. Alcohol was the predominant substance of concern for 78% of participants, and baseline smoking averaged 20 cigarettes daily.
Despite the lack of difference between treatments, both groups showed promising results compared to typical outcomes for this population. The 10% sustained quit rate represents a substantial improvement over the near-universal return to smoking typically seen within 24 hours of discharge from smoke-free facilities.
Secondary outcomes supported the primary findings, with similar rates of 30-day abstinence, cigarette reduction, and withdrawal symptoms between groups. Safety profiles were comparable, with 15 serious adverse events in the e-cigarette group and 13 in the nicotine replacement group, none deemed treatment-related.
The researchers noted that providing any evidence-based smoking cessation support to people leaving substance use treatment facilities represents an important opportunity. The study suggests that offering free nicotine therapies combined with quitline counseling could significantly reduce smoking rates in this high-risk population.
These findings indicate that both e-cigarettes and combination nicotine replacement therapy are viable options for supporting smoking cessation in people with substance use disorders when combined with behavioral support.
