Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study

Abstract

Background: Cigarette smoking is a tough addiction to break. This dependence is the most common dual diagnosis for individuals with schizophrenia. Currently three effective drugs are approved for smoking cessation: nicotine replacement therapy (NRT), varenicline and bupropion. However, some serious side effects of varenicline have been reported, including depression, suicidal thoughts, and suicide. The use of bupropion also has side effects. It should not be used by people who have epilepsy or any condition that lowers the seizure threshold, nor by people who take a specific class of drugs called monoamine oxidase inhibitors. Hence, there are pharmacodynamic reason to believe they could precipitate or exacerbate psychosis. For its capacity to deliver nicotine and provide a coping mechanism for conditioned smoking cues by replacing some of the rituals associated with smoking gestures, electronic-cigarettes may reduce nicotine withdrawal symptoms without serious side effects. Our recent work with ECs in healthy smokers not intending to quit consistently show surprisingly high success rates. We hypothesised that these positive findings could be replicated in difficult patients with schizophrenia This tool may help smokers with schizophrenia remain abstinent during their quitting attempts or to reduce cigarette consumption. Efficacy and safety of these devices in long-term smoking cessation and/or smoking reduction studies have never been investigated for this special population. Methods: In this study we monitored possible modifications in smoking habits of 14 smokers (not intending to quit) with schizophrenia experimenting with the “Categoria” e-Cigarette with a focus on smoking reduction and smoking abstinence. Study participants were invited to attend six study visits: at baseline, week-4, week-8, week-12 week-24 and week 52. Product use, number of cigarettes smoked, carbon monoxide in exhaled breath (eCO) and positive and negative symptoms of schizophrenia levels were measured at each visit. Smoking reduction and abstinence rates were calculated. Adverse events were also reviewed. Results: Sustained 50% reduction in the number of cig/day at week-52 was shown in 7/14 (50%) participants; their median of 30 cig/day decreasing significantly to 15 cig/day (p = 0.018). Sustained smoking abstinence at week-52 was observed in 2/14 (14.3%) participants. Combined sustained 50% reduction and smoking abstinence was shown in 9/14 (64.3%) participants. Nausea was observed in 2/14 (14.4%) of participants, throat irritation in 2/14 (14.4%) of participants, headache in 2/14 (14.4%) of participants , and dry cough in 4/14 (28.6%) of participants. However, these adverse events diminished substantially by week-24. Overall, one to two cartridges/day were used throughout the study. Positive and negative symptoms of schizophrenia are not increased after smoking reduction/cessation in patients using e-cigarettes. Conclusions: We have shown for the first time that the use of e-cigarette substantially decreased cigarette consumption with...

South African tobacco smoking cessation clinical practice guideline

“…In a small pilot study, they appeared to decrease cigarette consumption, [41] and they may be especially useful in reducing consumption in chronic psychiatric (schizophrenic) patients. [42] Sideeffects include mouth and throat irritation, dry cough, nausea and headache, although these appear to decrease over time. Concerns have been raised about the long-term safety of e-cigarettes, particularly with regard to the flavouring used.…”

Expectancies for Cigarettes, E-Cigarettes, and Nicotine Replacement Therapies Among E-Cigarette Users (aka Vapers)

“…[11][12][13][14] However, although there is evidence that e-cigarettes may help some people reduce or even quit smoking, available prospective studies suggest that e-cigarettes are similar to NRT in that most users do not quit smoking. [15][16][17][18][19][20][21] Despite these concerns, a recent cross-sectional, retrospective study found that e-cigarette users in the general population were more likely than NRT users to have quit cigarette smoking. 22 In comparison to cigarettes, available evidence suggests that e-cigarettes are a safer nicotine delivery system.…”

A New Area to Fight: Electronic Cigarette

“…Of these studies, in the study by Polosa et al (52), only 5 of 40 people could quit smoking in the second year (12.5%). This rate was 14.3% (2 of 14 patients) in the study conducted by Caponnetto et al (53). In another randomized controlled study of Caponetto et al (54), no difference was observed with regard to the rates of smoking cessation between people using and not using e-cigarettes.…”

“…In 3 of the 4 existing studies investigating the effect of e-cigarettes on smoking cessation, there was no control group (52)(53)(54). In the fourth study, the efficiency of e-cigarette was compared with 21 mg nicotine patch treatment (55).…”