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. 2023 Sep;240(9):1901-1909.
doi: 10.1007/s00213-023-06401-y. Epub 2023 Jul 17.

Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

Jed E Rose  1 , Suzanne Frisbee  2 , David Campbell  2 , Alfred Salley  2 , Susan Claerhout  2 , James M Davis  2   3
Affiliations

Smoking reduction using electronic nicotine delivery systems in combination with nicotine skin patches

Jed E Rose et al. Psychopharmacology (Berl). 2023 Sep.

Erratum in

Abstract

Rationale: Electronic nicotine delivery systems (ENDS) are used by smokers seeking to reduce combustible cigarette (CC) use, but the role of nicotine replacement vs. behavioral and sensory factors is still poorly understood. We hypothesized that providing nicotine from ENDS in addition to nicotine skin patches would promote smoking reduction relative to non-nicotine control ENDS.

Objectives: To assess the effects on smoking behavior of using nicotine vs. placebo ENDS in smokers using nicotine vs. placebo patches.

Methods: Ninety-four daily smokers were enrolled in a study that randomly assigned them to receive ENDS with nicotine vs. without nicotine and skin patches with vs. without nicotine. Smoking reduction and cessation were assessed over an 8-week period by self-report and by expired air carbon monoxide (CO) measurements. The primary outcome was defined as reduction in expired air CO.

Results: The use of nicotine in ENDS led to significant reductions in smoking (ENDS nicotine vs. placebo difference in CO change = -9.2 ppm; 90% CI (-1.5 ppm, -16.9 ppm)) and was highly correlated with reductions in self-reported cigarettes per day (r=0.6). The effect of nicotine in nicotine patches was not statistically significant (patch nicotine vs. placebo difference in CO change = -0.1 ppm; 90% CI (-7.8 ppm, 7.6 ppm)).

Conclusions: The presence of nicotine in ENDS was associated with a large reduction in smoking. Additional studies will be needed to determine whether there may be additive effects of nicotine ENDS and nicotine patches on smoking abstinence.

Keywords: Cigarette; E-cigarette; ENDS; Electronic nicotine delivery system; Harm reduction; Nicotine patch; Smoking; Smoking cessation.

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Conflict of interest statement

JER discloses research support from Foundation for a Smoke-Free World, Philip Morris International, Altria, Embera Neuro Therapeutics, Inc., Otsuka Pharmaceutical, JUUL Labs, consulting with Revive pharmaceuticals, and consulting and patent purchase agreements with Philip Morris International.

JMD discloses financial support from Predictably Human Inc., including funding for research, consulting fees, and equity. Predictably Human Inc. is focused on development of a prescription treatment for smoking and e-cigarette use.

Figures

Fig. 1
Fig. 1
Mean (± s.e.m.) expired air carbon monoxide (CO) readings at baseline and at 8 weeks for nicotine vs. placebo ENDS in daily smokers receiving nicotine patches. The nicotine ENDS condition showed a 42.6% reduction in CO (significant), whereas the placebo ENDS condition showed a 6.4% reduction in CO (nonsignificant)
Fig. 2
Fig. 2
Relationship between ENDS use (pods/week) and cigarettes smoked per day at week 8. A square root transform was used to normalize the skewed distribution of pods/week. Upper panel, nicotine ENDS condition (r=−0.61, p=0.0002). Lower panel, placebo ENDS condition (r=−0.13, p=0.52)
See this image and copyright information in PMC

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