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Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial.
Nicotine Tob Res. 2020 04 21; 22(5):734-739.NT

Abstract

INTRODUCTION

The major aim of this study was to test whether abstinence from e-cigarettes causes withdrawal symptoms in former smokers.

METHODS

We conducted an unblinded, within-participants, pre-post clinical trial in which 109 former smokers who were current daily electronic cigarette (e-cigarette) users used their own e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence engendered via an escalating contingency payment system. Participants monitored symptoms of nicotine withdrawal daily via an Interactive Voice Response system. They also attended three laboratory visits per week for carbon monoxide and cotinine testing to verify abstinence.

RESULTS

Half of participants completely abstained for a week. All the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) tobacco withdrawal symptoms, craving for e-cigarettes, craving for tobacco cigarettes, and the four possible new withdrawal symptoms (anhedonia, impulsivity, mood swings, and positive affect) increased during abstinence. Weight increased and heart rate decreased with abstinence. Symptoms showed the prototypical inverted U time pattern of a withdrawal state. The magnitude of withdrawal appeared to be somewhat less than that in a prior study of abstinent daily tobacco cigarette smokers. More severe withdrawal on the first 2 days of abstinence did not predict abstinence on the last day of the study.

CONCLUSIONS

Former smokers who are daily e-cigarette users transfer physical dependence on tobacco cigarettes to dependence on e-cigarettes. The severity of withdrawal from e-cigarettes appears to be only somewhat less than that from daily tobacco cigarette use. Replication tests that include placebo controls, testing for pharmacological specificity, and including never-smokers, non-daily e-cigarette users and dual users are indicated.

IMPLICATIONS

Our results indicate e-cigarettes can maintain physical dependence. This adverse effect should be included in any risk vs. benefit calculation. Also, potential and current e-cigarette users should be informed that abrupt cessation of e-cigarettes can cause withdrawal symptoms.

TRIAL REGISTRATION

NCT02825459.

Links

PMC Free PDF

Authors+Show Affiliations

Hughes JR
Department of Psychiatry, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT. Department of Psychological Science, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT.
Peters EN
Battelle Public Health Center for Tobacco Research, Baltimore, MD.
Callas PW
Medical Biostatistics, University of Vermont, Burlington, VT.
Peasley-Miklus C
Department of Psychiatry, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT. Department of Psychological Science, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT.
Oga E
Battelle Public Health Center for Tobacco Research, Baltimore, MD.
Etter JF
Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Morley N
Department of Psychiatry, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT. Department of Psychological Science, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT.

MeSH

AdolescentAdultAgedCarbon MonoxideElectronic Nicotine Delivery SystemsFemaleHealth BehaviorHumansMaleMiddle AgedSmokersSmoking CessationSubstance Withdrawal SyndromeUnited StatesVapingYoung Adult

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31352486

Clinical Trial Links

Clinical trial which this article describes

Citation

Hughes, John R., et al. "Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: a Pre-Post Clinical Trial." Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, vol. 22, no. 5, 2020, pp. 734-739.
Hughes JR, Peters EN, Callas PW, et al. Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial. Nicotine Tob Res. 2020;22(5):734-739.
Hughes, J. R., Peters, E. N., Callas, P. W., Peasley-Miklus, C., Oga, E., Etter, J. F., & Morley, N. (2020). Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial. Nicotine & Tobacco Research : Official Journal of the Society for Research On Nicotine and Tobacco, 22(5), 734-739. https://doi.org/10.1093/ntr/ntz129
Hughes JR, et al. Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: a Pre-Post Clinical Trial. Nicotine Tob Res. 2020 04 21;22(5):734-739. PubMed PMID: 31352486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial. AU - Hughes,John R, AU - Peters,Erica N, AU - Callas,Peter W, AU - Peasley-Miklus,Catherine, AU - Oga,Emmanuel, AU - Etter,Jean-Francois, AU - Morley,Nicholas, PY - 2019/05/08/received PY - 2019/07/26/accepted PY - 2019/7/29/pubmed PY - 2020/10/23/medline PY - 2019/7/29/entrez SP - 734 EP - 739 JF - Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco JO - Nicotine Tob Res VL - 22 IS - 5 N2 - INTRODUCTION: The major aim of this study was to test whether abstinence from e-cigarettes causes withdrawal symptoms in former smokers. METHODS: We conducted an unblinded, within-participants, pre-post clinical trial in which 109 former smokers who were current daily electronic cigarette (e-cigarette) users used their own e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence engendered via an escalating contingency payment system. Participants monitored symptoms of nicotine withdrawal daily via an Interactive Voice Response system. They also attended three laboratory visits per week for carbon monoxide and cotinine testing to verify abstinence. RESULTS: Half of participants completely abstained for a week. All the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) tobacco withdrawal symptoms, craving for e-cigarettes, craving for tobacco cigarettes, and the four possible new withdrawal symptoms (anhedonia, impulsivity, mood swings, and positive affect) increased during abstinence. Weight increased and heart rate decreased with abstinence. Symptoms showed the prototypical inverted U time pattern of a withdrawal state. The magnitude of withdrawal appeared to be somewhat less than that in a prior study of abstinent daily tobacco cigarette smokers. More severe withdrawal on the first 2 days of abstinence did not predict abstinence on the last day of the study. CONCLUSIONS: Former smokers who are daily e-cigarette users transfer physical dependence on tobacco cigarettes to dependence on e-cigarettes. The severity of withdrawal from e-cigarettes appears to be only somewhat less than that from daily tobacco cigarette use. Replication tests that include placebo controls, testing for pharmacological specificity, and including never-smokers, non-daily e-cigarette users and dual users are indicated. IMPLICATIONS: Our results indicate e-cigarettes can maintain physical dependence. This adverse effect should be included in any risk vs. benefit calculation. Also, potential and current e-cigarette users should be informed that abrupt cessation of e-cigarettes can cause withdrawal symptoms. TRIAL REGISTRATION: NCT02825459. SN - 1469-994X UR - https://www.unboundmedicine.com/medline/citation/31352486/Withdrawal_Symptoms_From_E_Cigarette_Abstinence_Among_Former_Smokers:_A_Pre_Post_Clinical_Trial_ DB - PRIME DP - Unbound Medicine ER -