Associate Professor Natalie Walker and Professor Chris Bullen
Associate Professor Natalie Walker and Professor Chris Bullen

10 September 2019

News article courtesy of the University of Auckland

New evidence from a large New Zealand vaping study suggests that hundreds of thousands more smokers worldwide could successfully quit the killer habit if they used nicotine-containing e-cigarettes (vapes) – illegal in a number of countries – together with nicotine patches.

Nicotine patches and other forms of nicotine replacement therapy (NRT), such as nicotine gum and nicotine lozenges, are medically approved and widely used to help smokers quit by quelling their nicotine craving. NRT roughly doubles a person’s chances of stopping smoking compared with a placebo, and using two forms together is more effective than using one. In contrast, currently marketed nicotine containing e-cigarettes are not medicines – they are consumer products that offer a convenient, effective and safer way of replacing nicotine that would otherwise be obtained by smoking. 

The new study is the first ever to test the effectiveness and safety of using nicotine e-cigarettes with nicotine patches as combination NRT.

Explains lead investigator, University of Auckland Associate Professor Natalie Walker, “Nicotine is what makes people want cigarettes, but it’s the tar and around 4000 other harmful chemicals in tobacco smoke that cause cancer, heart disease, lung problems and other smoking-related illnesses. It’s those other chemicals, not the nicotine, which kill up to two out of every three smokers.”

In New Zealand, around one in eight (13 percent) adults aged 15 years and over smoke tobacco every day (NZ Health Survey 2017/8). Rates are much higher among people living in the most deprived areas (23.2 percent), young adults (18.9 percent for 25-34 year olds), indigenous Māori (35 percent for Māori women, 27 percent for Māori men) and Pacific Island peoples (20 percent).

This compares with only 2.6 percent of adult New Zealanders vaping every day.

The study, published in a top medical journal, The Lancet Respiratory Medicine, was a randomised clinical trial, the gold standard in scientific research. The 1124 participants – adults from all over New Zealand who were motivated to quit smoking – were randomly split into three groups: nicotine patches only, patches plus nicotine-free e-cigarettes, and patches plus an e-cigarette with 18mg of nicotine. Participants were advised to start using their study products two weeks before their quit date, and continue for a further 12 weeks. They were also offered six weeks of phone-based behavioural support.

People who used patches plus nicotine e-cigarettes were the more likely to have gone without smoking for six months following the treatment, than those who used patches plus nicotine-free e-cigarettes (seven percent vs four percent based on the most conservative analysis undertaken, ranging up to 17 percent vs 10 percent for the least conservative analysis).

“That may not sound like much of an effect, but it adds up,” says Dr Walker, a clinical trialist at the University-based National Institute of Health Innovation (NIHI). “If we promoted using patches with a nicotine e-cigarette in New Zealand, where about 512,000 people smoke regularly, we would support 15,000 to 36,000 more people to become smokefree compared to using patches with a nicotine-free e-cigarette, and potentially 24,000 to 50,000 more people than if patches only were used.

“That’s a lot of people whose lives could be changed for the better – along with the health of their families and communities – simply by promoting the combination treatment,” says Dr Walker.

Findings also showed that side effects of all treatments were uncommon and decreased with time, with no treatment-related serious adverse effects, and that participants preferred using e-cigarettes alone or with patches, to using patches alone.

Four other clinical trials – including one by the same research team published in 2013 – have already shown that nicotine e-cigarettes significantly increase six-month quit rates compared to using nicotine-free e-cigarettes and to using approved forms of NRT.

Study co-investigator, University of Auckland Professor Chris Bullen, says that although using e-cigarettes combined with patches does not work for everyone, the new findings demonstrate they should be offered as one of the many smoking cessation aids available.

“People using e-cigarettes should be encouraged to fully switch away from tobacco to e-cigarettes, with the aim of eventually also stopping vaping (if possible), given the lack of any long-term safety data for these devices.”

Co-investigator Dr George Laking (Te Whakatōhea), a medical oncologist at the University, says “Almost 500, or 40 percent of participants were Māori, making it the largest randomised trial in the world of e-cigarette use involving indigenous people. Moreover, eight in every 10 Māori participants were women. The trial has shown the feasibility of combining nicotine e-cigarettes with patches for Māori who seek to quit smoking.”

Researchers from the University, NIHI, and the University of Canterbury conducted the study from 2016-2018. The e-cigarettes used in the study were purchased from NZVAPOR. Funding came from the Health Research Council of New Zealand.