Years ago, Dr. Mark Eisenberg, a cardiologist at McGill University in Canada, recommended that one of his patients—a smoker who’d tried everything to quit but still couldn’t—try vaping instead. It worked; his patient kicked the smoking habit. But recently, the same patient came back to Eisenberg’s office with a new problem.
“Now he’s addicted to e-cigarettes,” Eisenberg says. “He said, ‘I want to get off e-cigarettes. What do I do?’”
No one has a very good answer to that question. Almost 20 years after e-cigarettes were introduced in the U.S., going on to attract millions of users, there’s still not enough data on how to stop using them—which research suggests roughly 60% of vapers would like to do.
E-cigarettes are often pitched as an answer to the bane of tobacco use, which claims an estimated 8 million lives around the world per year, says Amanda Graham, chief health officer at Truth Initiative. “So far, that has not come to fruition,” Graham says. “What we see is a lot of people saying, ‘I’m using way more nicotine now than I ever did with a cigarette.’”
The U.S. Food and Drug Administration (FDA) has not approved e-cigarettes as smoking cessation tools, but many people use them for that purpose. E-cigarettes, which heat and aerosolize liquid nicotine, offer smokers not only a replacement for the nicotine in their traditional cigarettes, but also a familiar action: the motion of holding something to the lips and inhaling. This can make vapes an effective—and seemingly less-dangerous, although not totally safe—replacement for cigarettes, some studies suggest. (Other research, however, finds that many smokers use both e-cigarettes and cigarettes rather than quitting smoking outright, which may compound their health risks.)
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Not all vapers are former smokers, though. Far from it: federal data suggest that, among U.S. adults, 18- to 24-year-olds report the highest vaping rates. Given plummeting cigarette use among teenagers and young adults, many of these people likely picked up vaping without ever having been regular smokers—hence the widespread concern that e-cigarettes would addict entire new generations to nicotine.
E-cigarettes' design can make them uniquely addictive, says Benjamin Toll, a professor at the Medical University of South Carolina who researches tobacco cessation.
Cigarettes are highly addictive too, of course. But there's a limited number in a pack and each one burns out fairly quickly, offering natural cutoff points. But “if you have a 2,000-puff vape” packed with high levels of nicotine, Toll says, “there’s [almost] no stopping point.” And because vapes don’t involve fire, it’s easier to use them in places where many people wouldn’t dream of smoking. Some people “hit their vape and put it under their pillow" so they can use it first thing in the morning, Toll says. This constant use and exposure to nicotine can lead to even higher levels of dependence than smokers experience, he says.
"Many people go to vaping as a way to quit smoking, and then they can't quit vaping," Toll says. "That breaks my heart."
Breaking that addiction isn’t easy, but lots of people want to try. These days, about 60% of people who sign up for one of Truth Initiative’s nicotine-cessation programs say they primarily want help quitting e-cigarettes, Graham says.
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There aren’t many tools to help. Truth Initiative offers digital resources, including a text-based vaping-cessation support program for adolescents and young adults, which the organization’s research suggests works significantly better than trying to stop without assistance. And there's limited research, as Eisenberg laid out in a recent review article, to suggest some of the medications that cigarette smokers use to quit—including varenicline, which helps reduce nicotine cravings and withdrawal symptoms—could work for vapers, too. Already, doctors sometimes prescribe such medications, as well as products like nicotine patches and gums, off-label for adults who need help with vaping cessation.
But there’s a need for more tools specific to vaping addiction, which is “a public-health crisis hidden in plain sight,” says Richard Stewart, CEO of Achieve Life Sciences, a pharmaceutical company working to secure FDA approval for the U.S.’ first dedicated vaping-cessation aid. The company’s medication, cytisinicline, is designed to not only reduce cravings but also make using nicotine less pleasurable when someone vapes while on the drug. In a small company-funded study published in May, people who took cytisinicline were more than twice as likely to stop vaping as people who took a placebo.
The FDA recently granted the medication Breakthrough Therapy designation, which is meant to expedite the development and regulatory review process for novel and promising drug candidates. (Cytisinicline is already used for smoking cessation in parts of Europe, but not the U.S.) “We think we’ll be the first drug approved for vaping cessation,” possibly as soon as 2027 if all goes well, Stewart says.
In the meantime, some people who want to quit vaping are using their own methods. Some anecdotal evidence suggests people are using nicotine pouches like Zyn—which users tuck into their lips for a slow release of nicotine—to wean off vaping, in an ironic parallel of how e-cigarettes have been used to transition off cigarettes. Pouches seem to be less dangerous than either cigarettes or e-cigarettes, since they don’t involve inhaling anything into the lungs. But switching to yet another new product could also keep people beholden to addictive nicotine even longer, Graham says.
For people who are turning to Zyn and other nicotine products for help quitting vaping, Graham has one piece of advice: “plan to use it short-term, and then to quit using all forms of nicotine.”
But in a world where the popularity of e-cigarettes has far-outpaced research on how to quit them, that can be easier said than done.
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