A new study in Nicotine & Tobacco Research, published by Oxford University Press, finds that the use of high-strength nicotine e-cigarettes can help adults with schizophrenia spectrum disorders quit smoking

“Some 60-90% of people with schizophrenia smoke cigarettes, compared to 15-24% of the general population”

A new study in Nicotine & Tobacco Research, published by Oxford University Press, finds that the use of high-strength nicotine e-cigarettes can help adults with schizophrenia spectrum disorders quit smoking.

Smoking prevalence among people with mental disorders is about two to four times higher than in the general population. People with schizophrenia spectrum disorders smokes more heavily and is more dependent on tobacco cigarette than those without mental illness.

As a result of high smoking rates, people with a mental health condition also have high rates of morbidity and mortality from smoking-related diseases compared with the general population. Therefore, quitting smoking is particularly important for this group.

Progress in reducing smoking prevalence in people with mental health diagnoses has been very slow compared to the general population. Successful implementation of smoking cessation in people with schizophrenia is challenging, mainly because – in people with schizophrenia – the undesirable neurobiological and psychosocial consequences from stopping smoking are more pronounced and result in early relapse.

Randomized clinical trials of smoking cessation treatment (varenicline, bupropion, nicotine replacement therapy) in schizophrenia have shown modest efficiency and only in the short term. Consequently, there is a pressing need for alternative and more efficient interventions to reduce or prevent morbidity and mortality in smokers with schizophrenia spectrum disorders. A realistic alternative is to encourage these people to eliminate or substantially reduce their exposure to tobacco smoke toxicants by switching to less harmful sources of nicotine delivery (such as electronic cigarettes).

While the number of studies examining ECs effectiveness for smoking cessation and relapse prevention in the general population is now fairly substantial, far fewer studies have been conducted with people with schizophrenia spectrum disorders and that is why we have decided to conduct this trial.

The research

The researchers from the University of Catania (Italy) and University of Stirling (UK), in collaboration with colleagues from the City University of New York (USA) and Weill Medical College of Cornell University (USA), have assessed the feasibility of using a high-strength nicotine e-cigarette to modify smoking behavior in people with schizophrenia spectrum disorders who smoke cigarettes.

In this study 40 adults with schizophrenia spectrum disorders who smoked and did not intend to reduce or quit smoking participated in a 12-week study using Juul e-cigarettes loaded with 5% nicotine pods with a follow-up visit at 24 weeks.

Researchers measured smoking frequency, smoking reduction, carbon monoxide expired air reduction, smoking cessation, and continuous abstinence 24 weeks after the study began.

Key findings

  • Some 40% of participants had stopped smoking traditional cigarettes by the end of 12 weeks.
  • Researchers observed an overall, sustained 50% reduction in smoking or complete smokinga bstinence in 92.5% of participants at the end of 12 weeks.
  • Researchers also observed an overall 75% reduction in median daily cigarette consumption from 25 to 6, by the end of the 12 weeks.
  • After six months, 24 weeks after the study began, 35% of participants had completely stopped smoking conventional tobacco cigarettes, while continuing to use e-cigarettes.
  • Researchers here also measured a significant decrease in daily cigarette consumption was also confirmed at the end of 24 weeks.
  • The study’s authors report that 57.5% of participants reduced their cigarette usage by over 50%.
  • Additionally, researchers found that participants’ mean blood pressure, heart rate and weight measurably decreased between the start of the study and the 12-week follow up.
  • Positive and negative symptoms of schizophrenia were not significantly different after using e-cigarettes throughout the whole duration of the study.
  • At the end of the study 61.9% of participants reported feeling more awake, less irritable, and experiencing greater concentration, and reduced hunger.

“Smoking is the primary cause of the 15-25 years mortality gap between users of mental health services and the general population, said one of the paper’s authors, Riccardo Polosa, professor of Internal Medicine at the University of Catania (Italy). “This study demonstrates that switching to high-strength nicotine e-cigarettes is a feasible highly effective smoking cessation method for smokers who have schizophrenia. And it improves their quality of life too!”

International guidelines for the treatment of schizophrenia spectrum disorder include the treatment of smoking and this discovery can help provide an additional tool to live more healthy and longer. Moreover being able to dominate cigarette addiction can lead to an increase in the sense of self-efficacy and self-esteem” – said Pasquale Caponnetto, adjunct professor of clinical and addiction psychology at University of Catania.

Link to the study: A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes 

Authors: Pasquale Caponnetto, Jennifer DiPiazza, Jason Kim, Marilena Maglia, Riccardo Polosa


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