Smoking cessation drugs prescribed over the internet are as safe and effective as in-person treatment

Smoking-cessation drugs prescribed exclusively over the internet in a clinical trial were as safe and effective as when prescribed in a clinician’s office, according to a newly published CAMH study in the journal Drug and Alcohol Dependence.

The study, the first internet-based trial for smoking cessation using prescription medication, found that 30.3 per cent of study participants given the drug varenicline were smoke-free after 12 weeks and 19.6 per cent given the drug bupropion were no longer smoking at the end of the trial. Notably, the quit rate was substantially lower for an unassisted attempt (without aids or intervention) and hovered between 3-5 per cent.

“This study demonstrates that internet-based smoking cessation intervention using prescription pharmacotherapy is feasible and effective—as effective as what was found in in-person clinical trials,” said lead author Dr. Laurie Zawertailo, Senior Scientist, Campbell Family Mental Health Research Institute and Addictions Division at CAMH. “The study findings can be used to inform the design of future web-based randomized controlled medication trials as well as virtual treatment delivery methods for tobacco dependence.”

Currently in Ontario, patients typically see a prescriber in person for smoking cessation drugs like varenicline which is the most effective quit-smoking medication available. The authors state that expanding the use of internet-based smoking cessation treatment programs is particularly important because the rate of smoking is disproportionately higher among marginalized populations, and those in rural areas, who may have more difficulty accessing in-person clinical trials and treatment programs.

Study co-author Dr. Peter Selby, Clinician Scientist at Campbell Family Mental Health Research Institute at CAMH, says the finding that these drugs are just as effective when used in an internet-only clinical trial is significant because it is common for smoking-cessation drugs to have better success rates in a clinical trial than in a real world setting. People in clinical trials are often situated close to the academic hospital and are also more motivated. This study is more real world and was available across Ontario.

Although this study was conducted before the COVID-19 pandemic began, its validation of internet-based smoking cessation interventions is timely, according to Drs. Zawertailo and Selby. This is because many smokers have had a harder time trying to quit during the pandemic due to a combination of increased stress, the absence of workplace-related no-smoking restrictions for people not going to the office, and reduced access to clinical services. In fact, the number of patients attending CAMH’s Nicotine Dependence Clinic has dropped by nearly half during the pandemic.

“As devastating as COVID-19 has been for Canadians, the hidden issue is that smoking continues to cause twice as many deaths each year, and we can do something about it,” said Dr. Selby. “Not only does quitting smoking cut your risk of heart disease by half within the first year, if you continue to smoke you are more likely to become hospitalized or get very sick from COVID-19. Now that this study is published, we are looking at ways to make internet-based treatment programs like our own STOP on the Net more available to the public.”

CAMH smoking-cessation tools include:

Nicotine Dependence Clinic: Offers virtual and in-person services from a specialized treatment team that includes a nurse, therapists and physicians, for people who want to change their tobacco or e-cigarette use. Offering access to individual and group counseling and medications.

STOP on the Net: Offers eligible participants a free kit containing an eight-week supply of nicotine replacement therapy (patches and choice of gum/lozenges) mailed directly to their address, with no healthcare provider intervention or in-person travel required. In order to join STOP on the Net, individuals must be 18 years or older, reside in Ontario, be willing to a quit attempt within 30 days of enrollment and meet other specific eligibility criteria. STOP on the Net is available in both English and French.

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