Category: From Newswise – Substance Abuse

Newswise — For years, even as opioid overdose deaths dramatically increased, doctors and other prescribers in the United States needed special permission from the federal government if they wanted to prescribe buprenorphine, a medication that helps patients overcome opioid addiction and prevents fatal overdoses.

That requirement, called an “X waiver”, was eliminated on January 12, 2023 due to an item in a major federal budget bill. This meant that suddenly, any clinician who had a license to prescribe controlled substances could prescribe buprenorphine.

Now, a new study by University of Michigan researchers looks at what happened in the year after that federal policy change.

Published in the New England Journal of Medicine, the study finds that the number of buprenorphine prescribers increased rapidly after the policy change. By December 2023, more than 53,600 clinicians prescribed buprenorphine, an increase of 11,500 over December 2022. 

But the rise in available treatment providers didn’t spark meaningful increases in patients getting care in 2023, the new findings show. In any given month of 2022, about 810,000 to 830,000 Americans were prescribed buprenorphine, but these numbers changed little after January 2023. 

“Our findings suggest that elimination of the federal waiver requirement reduced barriers to buprenorphine prescribing but unfortunately was insufficient to increase overall use,” said Kao-Ping Chua, M.D., Ph.D., the study’s first author.

“The fact that this policy failed to increase the number of patients with buprenorphine prescriptions through the first year of implementation highlights the many other barriers to buprenorphine prescribing that must be overcome,” added Thuy Nguyen, Ph.D., the senior author of the manuscript.

The study found a small jump in January 2023 in the number of patients starting buprenorphine for the first time. And in December 2023, more than 48,200 patients started taking the medication – up from the 46,500 patients who started in December 2022. These numbers include any patient who hadn’t received buprenorphine in at least six months.

People with opioid addiction often need to take buprenorphine daily for months to years to overcome addiction to the opioid they are trying to quit – whether it’s heroin, prescription painkillers such as hydrocodone and oxycodone, or synthetic opioids like fentanyl.

The government’s decision to eliminate the waiver was designed to decrease barriers to buprenorphine prescribing and promote access to this lifesaving drug.

The January 2023 change came after the federal government tried other tactics during the COVID-19 era, including allowing telehealth-based prescribing of buprenorphine and allowing prescribers to obtain an X waiver to prescribe buprenorphine to 30 or fewer patients without undergoing 8 hours of training.

Chua and colleagues previously showed that even with these earlier changes, the number of new patients using buprenorphine for the first time was flat between 2019 and 2022. 

The stigma against treating people with opioid addiction, and the challenge of adding new types of care and support in primary care clinics and pain clinics that are already overburdened by other patient demands may be affecting the number of patients seeking or getting care.

Chua is co-director of the Research and Data Domain at the U-M Opioid Research Institute (ORI), as well as being an assistant professor of pediatrics in the Medical School with a joint appointment in the School of Public Health, and a member of the Susan B. Meister Child Health Evaluation and Research Center and the Institute for Healthcare Policy and Innovation (IHPI).

Nguyen is a health economist at the U-M School of Public Health and member of ORI and IHPI. Co-authors include ORI co-director Amy Bohnert, Ph.D., and ORI/IHPI members Mark Bicket, M.D., Ph.D., and Pooja Lagisetty, Ph.D., as well as Rena Conti, Ph.D. of Boston University.

Several of the authors have been involved in the Michigan Opioid Collaborative, which since 2017 has helped primary care providers, hospitals and others increase the availability of buprenorphine to patients in Michigan through free consultations, training events and more.

Recently, the MOC team, including Bohnert, published findings from the effort’s first years in JAMA Network Open.

Because the MOC effort rolled out gradually across Michigan’s 83 counties, they were able to track how the number of prescribers offering buprenorphine, and the number of patients receiving it, changed in counties where MOC had a presence, compared with those where it wasn’t yet available.

The study showed a clear, sharp rise in both prescribers offering the treatment, and people receiving it, starting soon after MOC became available to support prescribers in a county. Meanwhile, no such rises happened in counties that had not yet become part of the MOC coverage area. MOC now covers all areas of the state, though the study covers a time period through 2020 when there were still more than 20 counties not yet participating.

MOC recently merged with another U-M opioid effort to become the Overdose Prevention Engagement Network, and continues to offer consultation, on-demand online training to comply with the current federal requirement, and more as well as screening tools for opioid use disorders and opioid-sparing surgical prescribing tools.  Visit https://michigan-open.org/ for more information or to seek a consultation about prescribing buprenorphine.

The study was funded by the National Institute on Drug Abuse, part of the National Institutes of Health (R01DA056438). This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Buprenorphine Dispensing after Elimination of the Waiver Requirement, New England Journal of Medicine, DOI:10.1056/NEJMc2312906, https://www.nejm.org/doi/full/10.1056/NEJMc2312906

BYLINE: Patti Zielinski

Newswise — People with a nonfatal opioid overdose who have access to a peer support program while in the emergency department are more likely to initiate treatment and less likely to have repeated overdoses, according to a Rutgers Health study.

The study is the largest study on outcomes associated with emergency department-based peer support for opioid use disorders and was published in JAMA Network Open.

According to the Centers for Disease Control and Prevention, nonfatal drug overdoses are treated in emergency departments, which historically have stabilized and then discharged patients without linking them to treatment options.

The study analyzed the outcomes of the Opioid Overdose Recovery Program, a New Jersey Division of Mental Health and Addiction Services–supported program that connect patients admitted for opioid overdose to emergency departments with peer recovery specialists—people who have lived experiences with substance use disorders who provide nonclinical assistance, recovery support and referrals for assessment and substance use disorder treatment.

“People who themselves are in recovery can relate to someone who is going through the same experience,” said Nina Cooperman, associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School, a member of the Addiction Research Center at Rutgers and an author of the study. “If a patient is ready to enter treatment, the peers will facilitate the transfer; if they are not, the peers maintain a relationship with the patient after discharge for eight weeks to provide support and facilitate linkage to treatment if they later become motivated.”

Researchers looked at 12,046 adults on Medicaid between ages 18 to 64 who were treated for nonfatal opioid overdose from 2015, when New Jersey launched the program, to June 2020 at 70 acute care hospitals. They compared the 180-day outcomes with those treated in hospitals that offered a peer intervention and those at hospitals that didn’t.

They found an increase in the probability that a patient treated for opioid overdose in hospitals that were affiliated with the peer recovery program would initiate medication for opioid use disorder treatment within 60 days of discharge and a decrease in the probability of repeat overdoses as compared to patients treated in hospitals that did not offer the program.

“However, we found a lot of variability among hospitals in achieving those outcomes,” Cooperman said. “Our findings suggest that emergency department-based peer recovery support programs are associated with increased initiation of medication for opioid use disorder, but that outcome likely depended on additional factors, such as program characteristics, program implementation success and availability of other substance use disorder services either in the hospital or in the community. Evaluating these factors is the focus of our ongoing research.”

“Peer recovery support can help reduce repeat overdoses, but it may be more effective when implemented alongside other hospital-based interventions, like emergency department buprenorphine initiation and naloxone distribution,” said lead author Peter Treitler, an assistant professor at Boston University School of Social Work who performed this research as a research program manager at the Rutgers Institute for Health, Health Care Policy and Aging Research.

Other authors include Rutgers faculty, Stephen Crystal, Joel Cantor, Sujoy Chakravarty, Anna Kline, Cory Morton and Kristen Gilmore Powell and Suzanne Borys at the New Jersey Division of Mental Health and Addiction Services.

Newswise — Compared to taking a daily pill, a monthly dose of long-acting injectable (LAI) buprenorphine can be a simpler and more effective treatment for people with opioid use disorder. But do substance use treatment facilities in the United States take advantage of this highly effective medication?

To answer that question, researchers from the University of Chicago spent nearly a year analyzing data from the National Substance Use and Mental Health Services Survey. They found that only 32.6% of substance use treatment facilities that offered medications for opioid use disorder offered LAI buprenorphine to their patients. The researchers suggested that administrative obstacles make it more difficult — and often more expensive — to obtain LAI buprenorphine compared to the oral version of the medication.

The study, published in the Journal of the American Medical Association in January, also revealed that facilities offering primary care were more likely to offer LAI buprenorphine. The researchers hypothesized that the difference may be due to those facilities facing fewer regulatory and administrative hurdles to prescribe the medication as a monthly injection.

“This paper highlights gaps that exist in the system,” said Nitin Vidyasagar, the study’s lead author and a second-year student at the University of Chicago Pritzker School of Medicine. “We can now use the information to help treat people who need it the most.”

Samuel R. Bunting, MD, MSHA, a UChicago Medicine adult psychiatry resident and the study’s second author, hopes the study will serve as “a guidepost in the sand” to measure future progress with this underused and potentially lifesaving medicine.

“The takeaway is, we still have a lot of work to do to make the full complement of opioid treatment options available to patients,” he said.

Vidyasagar and Bunting came up with the idea for this paper while studying how resources for HIV prevention were distributed in healthcare facilities. Bunting is also studying the use of LAI medications for psychiatric conditions, research prompted by frustration with difficulties getting these medicines for his own patients.

Vidyasagar and Bunting collaborated with two UChicago Medicine staff members for this JAMA study: addiction medicine specialist and primary care doctor Mim Ari, MD, and Pritzker Dean for Medical Education Vineet Arora, MD, MAPP.

Given the epidemic levels of opioid addiction, Ari said she hopes the paper sparks conversations on how to design better health policies, remove barriers and build partnerships that will support sustainable recovery for people with opioid use disorder.

“I hope it’s seen as a call to action, to say there’s more that we can be doing as clinicians with this treatment,” she said.

Pritzker School of Medicine has been nationally recognized for its work training medical students to address patients with opioid use disorder in the emergency room.

Students developed an O.P.I.A.T.E. initiative — Outpatient Principles in Addiction Training and Education — that was implemented in UChicago Medicine’s Emergency Department in 2019 and scaled up to all incoming students as part of the new Pritzker Phoenix curriculum.

The initiative involves screening patients who may be at risk for opioid overdose and supplying them and their close contacts with a life-saving naloxone kit to take home.

BYLINE: Patrick Luce

Newswise — KINGSTON, R.I. — March 21, 2024 — Substance use disorder, particularly involving opioids, is a continuing crisis in the country, impacting not just the person suffering from addiction, but also those closest to them. While treatment is naturally focused on the person facing the disorder, it is critical to include the patient’s family members, who are also impacted by addiction and play a key role in recovery.

Despite the importance of familial involvement, Rhode Island has a shortage of Licensed Marriage and Family Therapists who are qualified to treat substance use disorders. The University of Rhode Island Department of Human Development and Family Science is working to fill that gap, launching a workforce development initiative that will guide marriage and family therapists from training to full licensure to serve families in Rhode Island affected by substance use disorders. The initiative will allow therapists with provisional licenses to provide supervised treatment while working toward their full licenses, significantly adding to the pipeline of therapists qualified to treat those facing addiction and their family members.

“When someone with a substance use disorder is treated as an individual, of course that can be helpful and effective to help them heal, but what happens when that person goes back into an unchanged family system, or an unchanged social support system? Sometimes it doesn’t stick,” said Assistant Professor Jessica Cless, who leads the program. “What is important as part of that process is the involvement of the family. Couple and family therapists see the entire system that person lives in—and you really have to address the whole system in order to give people a more effective chance at healing. It is less common for a treatment center to have family services embedded into the treatment. There’s this gap of need.”

Cless has secured a $250,000 contract through the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to build a network of family therapists trained to treat substance use disorders. As the only accredited trainer of Licensed Marriage and Family Therapists in the state, URI professors Cless, Tiffani Kisler, Gina MacLure and Kate Wolfe will prepare graduating students to be associate LMFTs. They are recruiting family therapists and student family therapists, providing the accredited training, and helping place them in substance use treatment facilities around the state. Critically, the URI professors will also provide supervision of the associate therapists, lifting an additional burden from the often over-extended therapy centers.

“That’s an important piece because there are not enough supervisors for these positions,” Cless said. “As the only accredited LMFT training program, we already have the capacity to provide this supervision, and we have a pipeline of eligible students. So when the state put out this call for expanding family therapy, it really made sense for URI to respond.”

The state’s granting of associate licenses to trained therapists is important in ensuring insurance companies will cover the treatment for patients. Previously, therapists would have to complete 2,000 hours of supervised training before they could get a license in order to bill insurance. The associate license allows them to work with patients, under supervision, while continuing work on their 2,000 hours, adding to the therapist workforce.

“Our students qualify for an associate license as soon as they graduate,” Cless said. “Being licensed enables them to provide supervised care, and for insurance companies to cover the treatment. LMFTs and LMFT-As are in such high demand today, as is mental health treatment, especially for substance use problems. There just aren’t enough clinicians, so this associate level license is really a game changer.”

With only about 20 total licensed marriage and family therapist associates in Rhode Island, Cless is hoping this program becomes a model going forward, and that incorporating family therapy into substance use disorder treatment becomes the norm.

“Addiction is a crisis in the country. We’ve got a lot of families out there that are hurting,” Cless said. “There are lots of resources for the people themselves who are addicted, but we know the family system is also significantly impacted by addiction. Family therapy can help uncover dynamics that are barriers to successful treatment, or those that could be part of the solution. So we’re really trying to increase services and support for those families, both for their sake and for the ultimate success of the person who has the addiction.”

Cless continues to recruit therapists and seek treatment centers interested in benefiting from the program. Any therapist or treatment center interested in taking part can contact Cless at [email protected].

Newswise — Rosemont, Ill. (AANA) – In a recent final regulation issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), CRNAs, also known as nurse anesthesiologists or nurse anesthetists, have been permanently added to the definition of a practitioner who is appropriately licensed by a state to prescribe and dispense medications for the treatment of opioid use disorder (OUD).

This final rule was an update from an original rule proposed in December 2022 and went through several modifications, including those from American Association of Nurse Anesthesiology (AANA) advocacy outreach.  

“We applaud SAMHSA for its decision to include CRNAs in the definition of practitioner as it supports practitioner autonomy and creates a patient-centered view while reducing barriers to OUD care,” said AANA President Dru Riddle, PhD, DNP, CRNA, FAAN.  “AANA shares the healthcare community’s concern about the increase in opioid drug use, abuse and deaths and is committed to working collaboratively to achieve comprehensive solutions to curb the opioid epidemic in the United States. This is especially true in areas with a high level of provider shortages, such as rural and underserved areas.”

CRNAs, as professionals in the science of nurse anesthesiology, work in rural and underserved communities where the need to decrease reliance on opioids is great. CRNAs have been on the front lines of developing novel non-opioid based treatments for both chronic and acute pain, and AANA supports maximum flexibility in allowing pain treatment plans that rely on the clinical judgment of the practitioner directing care. CRNAs are chronic pain management practitioners, managing pain through a multimodal approach that includes opioid-sparing or non-opioid pharmacologic and non-pharmacologic pain mitigation strategies. 

“As a main provider of pain management services, CRNAs are uniquely skilled to provide both acute and chronic pain management in a patient-centered, compassionate, and holistic manner,” said Riddle. “As members of one of America’s most trusted professions, CRNAs have always served on the front lines of patient care from the beginning, and we continue to answer the call to help keep patients healthy and safe.”

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Newswise — Alexandria, Va. (February 20, 2024) — The 988 Suicide and Crisis Lifeline launched across the U.S. nearly 2 years ago. But college students — who are particularly vulnerable to substance use problems and related mental health crises — appear disinclined to use it, according to new research published in the Journal of Addiction & Offender Counseling, a publication of the American Counseling Association.

“While the 988 Lifeline is intended to be used for substance use crises, the majority of students would not refer to this service for said concern,” Georgia State University doctoral student Afroze N. Shaikh and her colleagues concluded in their research. “Further effort is needed to assist college students in gaining awareness of crisis resources while supporting the agency to make informed decisions regarding their substance use.”

According to federal government data, 8.2 million adults ages 18–25 meet the criteria for a substance use disorder. Researchers have identified a link between substance use, depression and suicidal thinking, but studies also show that college-age students are unlikely to seek help for substance use and mental health problems.

The U.S. Department of Health and Human Services helped launch the 988 Lifeline in 2022 to provide an easy-to-remember dial code, akin to 911, for people in need of emergency help during a mental health crisis. Shaikh and her colleagues wanted to assess college students’ intentions to call or text 988 for substance use concerns. They recruited 446 undergraduates at a university in the southeastern U.S. and had them anonymously fill out a battery of questionnaires. The participants anonymously rated their level of tobacco, alcohol, marijuana and other drug use within the previous three months. They also were asked about their use of and experience with the 988 service.

More than 60% of the students reported using drugs or alcohol less than once a month or not at all. Roughly 18% reported daily or near-daily substance use, and another 10% reported weekly use.

Overall, the students said they were most likely to seek help from a friend or intimate partner for mental health problems and suicidal thoughts. They indicated that if they ever were to call 988, it would be for help with depression, anxiety or emotional distress. Only 15% said they’d use it for help with substance use problems. Fewer than 20% of the heaviest substance users indicated they would use the Lifeline for help.

The researchers cautioned that their study relied on self-reports — which can’t account for participants’ biases or lies — and involved mostly heterosexual, cisgender students at a single university. They called for more research involving a wider range of settings and cultural identities. 

However, the findings signal the need for colleges and universities to guide students in making informed decisions about their substance use, they wrote. In addition, state governments can make sure students and other individuals in crisis know about the new crisis number. College counselors may consider developing resource guides for students that include suicide risk factors and crisis resources, including the 988 Lifeline, they added.

Shaikh’s collaborators on the study were her Georgia State colleagues Alec Prince and Mark Burgan; San Diego professional counselor Lauren Flynn; Virginia Tech doctoral student Alexis Isaac; and Jamian Coleman, PhD, of the University of Tennessee, Knoxville.

The study, “Implications of the 988 suicide and crisis lifeline among college students experiencing substance use crises,” is available at https://doi.org/10.1002/jaoc.12131.

NOTE TO JOURNALISTS: To schedule an interview with the authors, please contact ACA at [email protected].

Founded in 1952, the American Counseling Association (ACA) is a not-for-profit, professional and educational organization that is dedicated to the growth and enhancement of the counseling profession. ACA represents nearly 60,000 members and is the world’s largest association exclusively representing professional counselors in various practice settings. Driven by the belief that all people can benefit from the power of counseling, ACA’s mission is to promote the professional development of counselors, advocate for counselors, and ensure that ethical, culturally inclusive practices protect our members’ clients and all people who seek counseling services.

People worldwide are living longer.  According to the World Health Organization, 1 in 6 people in the world will be aged 60 years or over by 2030.  By 2050, the world’s population of people aged 60 years and older will double (2.1 billion). The number of individuals aged 65 years or above across the world will be twice the number of children under age 5 by the year 2050. That makes this population one of the fastest-growing groups in the world.

Below are some of the latest research and features on this growing population of older adults in the Seniors channel on Newswise.

Older adults rely more on trust in decision making. It could open them up to scams.

-University of Florida

Language barriers could contribute to higher aggression in people with dementia

-Edith Cowan University

Sexually transmitted infections among older adults pose a global public health challenge

-University of Oslo

Experts Comment on Aiming for a Romantic Relationship at Any Stage of Life

-University of New Hampshire

Third Major Study Finds Evidence that Daily Multivitamin Supplements Improve Memory and Slow Cognitive Aging in Older Adults

-Brigham and Women’s Hospital

Smartphone app could help prevent falls in older adults

-Binghamton University, State University of New York

Adults With Cognitive Disabilities Are More Likely to Have Worse Experiences With Health Care System

-Institute for Health, Health Care Policy and Aging Research at Rutgers University

Caring for LGBTQ+ nursing home residents in culturally appropriate and inclusive ways

-Regenstrief Institute

Following a Mediterranean diet reduces the risk of cognitive decline in older people

-University of Barcelona

Infection with common cat-borne parasite associated with frailty in older adults

-University of Colorado Boulder

Research Highlights:

• Despite drops in overall cardiovascular disease deaths from 1999-2019, cardiovascular disease deaths in which substance use was cited as a contributing factor increased an average of 4% per year, with the death rate accelerating to 6.2% from 2012-2019.
• Prominent increases in cardiovascular deaths associated with substance use were most notable among women, American Indian or Alaskan individuals, younger individuals, rural area residents and users of cannabis and psychostimulants.
• Identifying high-risk groups is crucial for prioritizing preventive measures to reduce substance use linked with cardiovascular disease deaths, particularly in high-risk populations.

Embargoed until 4 a.m. CT/5 a.m. ET Wednesday, Jan. 10, 2024

Newswise — DALLAS, Jan. 10, 2024 — Cardiovascular disease deaths involving substance use rose an average of 4% per year from 1999 to 2019, despite a drop in overall cardiovascular disease deaths, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

“The study results were generally consistent with what we see in our clinic while caring for patients with cardiovascular disease,” said study senior author Dmitry Abramov, M.D., a cardiologist and associate professor of medicine at Loma Linda University Health in Loma Linda, California.

“Although alcohol and opioids were the substances most associated with cardiovascular deaths, the increases in cardiovascular deaths related to stimulants (predominantly amphetamines) during the study period were particularly prominent,” he continued. “This highlights both the ongoing risk of common substances, including alcohol and opioids, and also demonstrates the need to tackle amphetamines as a substance whose contribution to CVD deaths is growing more rapidly.”

The researchers reviewed publicly available data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to investigate death trends related to substance use from 1999 and 2019. The WONDER database aggregates death certificate data across the U.S. from the National Vital Statistics System.

The analysis found:

• The overall rate of substance use-related cardiovascular deaths increased from 9.9 per 100,000 population in 1999 to 21.4 per 100,000 population in 2019, representing an average annual increase of 4%.
• Increases in substance use-related average annual percent changes were noted across all subgroups and were pronounced among women (4.8%); American Indian or Alaskan individuals (5.4%); younger adults, ages 25-59 (5.3%); people living in rural areas (5%); people who used cannabis (12.7%) and psychostimulants (16.8%).
• 65% of cardiovascular disease deaths were related to alcohol, followed by opioids (13.7%), cocaine (9.8%), stimulants (6.5%), sedatives (4.1%) and cannabis (0.5%).
• The highest rate of change was noted among adults ages 25-39 (5.3%), followed by adults ages 55-69 (4.9%).
• The age-adjusted death rate was 15.2 per 100,000 in adults living in non-metropolitan/rural areas, 22.5 per 100,000 in men; and 37.7 per 100,000 in American Indian or Alaska Native adults.

“We were surprised to see significant increases among individuals ages 25 to 39, compared to other age groups and among people in certain racial and ethnic groups, including white adults and American Indian/Alaska Native adults. Identifying high-risk groups will be crucial for prioritizing preventive measures to reduce substance use-related cardiovascular disease deaths,” Abramov said.

“In addition, while the rates of cardiovascular disease mortality related to substance use were higher in men than women, women demonstrated larger increases during the study period. Data from prior studies have found notable increases in substance use among women over the last 20 years, and women may face unique societal risks that may contribute to the increases noted in our study,” he said. “These sex-based differences, in addition to the differences by race and ethnicity, age and living in an urban or rural community, require additional research.”

Study background and details:

• Data from the CDC WONDER database from 199-2019 included 636,572 substance use-related cardiovascular deaths. Of these, 75.6% were among men, and 70.6% of the individuals were non-Hispanic white people.
• Smoking/tobacco use was not included as a form of substance use in this study.
• The increases in substance use found in rural areas have been connected to socioeconomic vulnerabilities, access to health care and substance abuse treatment differences and will require further evaluation, the researchers noted.

The study’s limitations included that causes of death noted on death certificates may have some miscoding errors, therefore, it would affect the data analysis since deaths attributable to cardiovascular disease were the original data source. In addition, the authors did not have information regarding cardiovascular disease risk factors, family histories of cardiovascular disease or initial measurements of other health conditions (such as high blood pressure and/or Type 2 diabetes diagnosis), as this information is not included in the WONDER database.

“We would like to see additional public health efforts to support comprehensive evaluation and management of substance use in the U.S. that includes clinician and patient education, as well as attention to socioeconomic factors that contribute to substance use,” Abramov said. “Such efforts are critical in reversing the trends in CVD deaths associated with substance use and will hopefully lead to further reduction in the overall burden of heart disease and stroke.”

Co-authors, disclosures and funding sources are listed in the manuscript.

Studies published in the American Heart Association’s scientific journals are peer reviewed. The statements and conclusions in each manuscript are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 – our Centennial year – we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

Newswise — Nicotine e-cigarettes are more effective in helping people quit smoking than conventional nicotine-replacement therapy (NRT), according to the latest Cochrane review co-led by a University of Massachusetts Amherst public health and health policy researcher.

The review of studies published on the Cochrane Database of Systematic Reviews found high certainty evidence that e-cigarettes, which allow users to “vape” nicotine instead of smoke it, lead to better chances of  quitting smoking than patches, gums, lozenges or other traditional NRT.

“In England, quite different from the rest of the world, e-cigarettes have been embraced by public health agencies as a tool to help people reduce the harm from smoking,” says Jamie Hartmann-Boyce, assistant professor of health policy and promotion in the School of Public Health and Health Sciences.

Worldwide, smoking is the leading cause of preventable disease and death, resulting in more than seven million deaths per year. “Most of the adults in the U.S. who smoke want to quit but many find it really difficult to do so,” says Hartmann-Boyce, who conducted research at the University of Oxford in England before joining UMass Amherst earlier this year. “We need a range of evidence-based options for people to use to quit smoking, as some people will try many different ways of quitting before finding one that works for them.”

Hartmann-Boyce, a Cochrane editor, is senior author of the review, which included 88 studies and more than 27,235 participants – an addition of 10 studies since the last update in 2022. Most of the studies analyzed took place in the U.S., United Kingdom or Italy.

E-cigarettes do not burn tobacco but rather heat liquids with nicotine and flavorings, allowing users to inhale a vapor that contains nicotine rather than inhale tobacco smoke. With conventional cigarettes, people who smoke are exposed to a complex mix of chemicals that are known to cause diseases.

“We have very clear evidence that, though not risk free, nicotine e-cigarettes are substantially less harmful than smoking,” Hartmann-Boyce says. “Some people who haven’t had success in the past with other quit aids have found e-cigarettes have helped them.” 

The analysis found that for every 100 people using nicotine e-cigarettes to stop smoking, eight to 10 would be expected to successfully stop, compared with six of 100 people using traditional nicotine-replacement therapy, and with four of 100 trying to quit with no support or behavioral support only.

The regular review of smoking cessation studies continues to offer strong evidence that can inform public health policies and strategies, offering people who smoke better tools to quit for good. Hartmann-Boyce emphasizes that the public health message is a nuanced and complex one, especially in the U.S. 

While those who don’t smoke tobacco should avoid the use of e-cigarettes for their potential negative health effects, Hartmann-Boyce says, some people who smoke can improve their health and reduce their risks by quitting tobacco with the help of e-cigarettes.

“Not everything is either entirely harmful or beneficial,” Hartmann-Boyce says. “Different things can have different impacts on different populations. Evidence shows that nicotine e-cigarettes can help people quit smoking, and that people who don’t smoke shouldn’t use e-cigarettes.”

She compares the tobacco smoking vs. e-cigarette scenario to treatment for a substance-use disorder involving opioids. “We’re not going to prescribe methadone to people who aren’t addicted to opioids,” Hartmann-Boyce says. “But for people addicted to opioids, we recognize that methadone is a helpful thing.”

The U.S. Food and Drug Administration (FDA), which regulates e-cigarettes, has approved seven different medicationsthat have been shown to help adults quit smoking. E-cigarettes are not one of them. Earlier this year, in an update on the FDA’s tobacco program, FDA commissioner Dr. Robert Califf stated, “While certain e-cigarettes may help adult smokers transition completely away from, or significantly reduce their use of more harmful combusted cigarettes, the law’s public health standard balances that potential with the known and substantial risk with regard to youth appeal, uptake and use of these highly addictive products.”