A new study found vaping is 3 times more effective than oral nicotine replacement therapy in helping people quit smoking. Photo credit: Ruslan Alekso, Pexels.
Nicotine-containing vape products are roughly 3 times more effective at helping socially disadvantaged individuals quit smoking than oral nicotine replacement therapy (NRT) such as gum or lozenges, according to new research from the National Drug and Alcohol Research Centre (NDARC) at the University of New South Wales (UNSW) Sydney, published in the Annals of Internal Medicine in mid-July.
As part of the randomized clinical trial—one of the largest of its kind—the team led by associate professor Ryan Courtney, head of NDARC’s Tobacco Research Group, recruited 1,045 adults who smoked daily, were willing to make a quit attempt, and were receiving a government pension or allowance, which served as an indicator of social disadvantage. People in low-income groups tend to have some of the highest smoking rates, greatest nicotine dependence, and lowest quit success. While suffering more smoking-related illness and death, they also face the greatest barriers to accessing safer alternatives.
Participants were randomly assigned to an eight-week supply of either two vaping devices with flavored e-liquids or NRT in the form of lozenges or gum. All participants received minimal behavioral support in the form of encouraging, non-judgmental text messages.
The vaping group was given a tank device with 18 mg/ml nicotine e-liquid and a pod device containing 40 mg/ml nicotine e-liquid. Liquids were available in three flavors—tobacco, menthol, and fruit—and subjects could use one or both devices.
The NRT group had a choice of 4 mg nicotine gum or lozenges, both in mint flavor.
After 6 months, continuous verified quit rates were higher in the vaping group at 28.4% compared to just 9.6% in the NRT group.
According to Courtney, quit rates were consistently higher for the vaping group across age, gender, nicotine dependence, and recent mental health diagnoses or treatment. The study aimed to mirror real-world conditions by offering a choice of vaping device and flavor—components considered key to its success. Beyond delivering nicotine, Courtney noted, vapes address some of the sensory and behavioral habits people miss when quitting smoking. Cost-of-living pressures and the high price of cigarettes were also identified as possible reasons for the attractiveness of vapes as a cessation aid for people on a fixed income.
Australia has one of the lowest adult smoking rates globally, at 8.8%. It also boasts some of the highest cigarette prices: According to Quithero.com, a pack of 25 cigarettes currently retails for about AU$45 ($29.70). For someone smoking a pack a day, the monthly cost totals around AU$1,350. By contrast, legal vaping costs range from AUD 96.97 to AUD 186.87 per month, the platform calculates, noting that heavy users may require more e-liquid, frequent coil replacements, and potentially more powerful devices—placing them at the higher end of the cost spectrum.
Unlike countries that treat nicotine vape products as consumer goods, Australia classifies them as medicines, available only at pharmacies with flavor options restricted to menthol, mint, and tobacco. In 2024, regulations were relaxed to allow participating pharmacies to sell e-liquids containing up to 20 mg/ml nicotine to adults 18+ following a pharmacist consultation. According to quitclinics.com, most pharmacies dispensing vape products still require a prescription.
For e-liquids exceeding 20 mg/ml nicotine, a prescription is still needed—a process that can be challenging due to the difficulty of finding general practitioners (GPs) willing to prescribe vape products in an otherwise anti-vaping health environment. The Royal Australian College of General Practitioners recommends vaping products as a cessation tool only when other evidence-based therapies have failed.
Australia’s strict vaping laws aim to prevent a new generation from becoming addicted to nicotine but have also fueled a growing illicit vape market worth an estimated AU$2 billion, raising public health and criminal concerns.
According to the latest data from Cancer Council Australia’s nationwide Generation Vape study released on 16 July, vaping rates among 14- to 17-year-olds dropped from 17.5%in early 2023 to 14.6% in April this year. Among individuals aged over 15, rates declined by more than a third.
What makes the NDARC study notable is that it directly challenges Australia’s official stance, which has repeatedly downplayed the effectiveness of vaping and prioritized NRT and behavioral support as primary options. If vaping proves to be significantly more effective for smoking cessation, then restricting public access—particularly through prescription-only limitations—may obstruct potential public health benefits. By continuing its current path, the Australian government risks appearing driven by ideology rather than evidence.