Trading Vapes for Pills: Are We Really Helping Young People Quit, or Just Handing Over Their Health to Big Pharma?

Al Gor 25 April 2025

A new study out of the US is making waves, particularly in Australia, where policymakers are eager to latch onto anything that might resemble a “solution” to youth vaping. Framed as a breakthrough by some in public health and already gaining traction in the media, the study was published in the respected Journal of the American Medical Association (JAMA) and backed by funding from the National Institutes of Health.

At its centre is a familiar prescription drug: varenicline, long used to help adult smokers quit. But this time, the target is different. The study focuses on young people aged 16 to 25 who vape nicotine but don’t smoke.

The idea? Give them a powerful anti-smoking pill and see if it helps them quit vaping.

At first glance, it sounds promising. The headlines will say, “Half of youth quit vaping with a simple pill.” But look a little closer, and the story starts to unravel. Because what this really represents isn’t a breakthrough it’s a pivot. Away from harm reduction. Away from understanding. And straight into the hands of pharmaceutical intervention.

We need to go beyond the headlines and look at the facts and why we should be deeply concerned.

What Did the Study Actually Show?

Here’s the basic setup:

Researchers enrolled 254 young people aged 16–25 who vaped frequently but didn’t regularly smoke. These participants wanted to quit or cut down, and they were divided into three groups:

1. Group 1 received varenicline, weekly counselling, and a text message support program.

2. Group 2 got a placebo (dummy pill) with the same counselling and text support.

3. Group 3 received only the support, with no pill at all.

After 12 weeks:

• 51% of those on varenicline had stopped vaping (at least temporarily).

• That dropped to 28% at 24 weeks.

• The placebo and support-only groups had much lower success rates, around 14% and 6%, respectively.

Sounds like a win, right?

Except… this study only tracked behaviour for six months, and only the final four weeks of pill use counted toward success. That’s not long enough to say if people really quit, or just stopped temporarily.

And it gets murkier: some participants had previous tobacco use, many likely had different levels of motivation, and all three groups had access to counselling. That matters, because behavioural support alone is known to help quit with or without meds.

Varenicline Isn’t a Tic Tac

Let’s not sugar-coat it: varenicline is a powerful drug.

It binds to the same receptors in the brain as nicotine, reducing cravings and dulling the buzz from cigarettes or vapes. That’s why it’s been prescribed to adult smokers for years.

But it also comes with a laundry list of potential side effects: nausea, insomnia, abnormal dreams, mood swings, depression, and even suicidal thoughts. In fact, safety concerns led to the drug being withdrawn from some markets after contamination issues and ongoing psychiatric warnings.

Are we really comfortable prescribing this to 16-year-olds?

This isn’t a minor decision, it’s a serious medical intervention. And we’re talking about teens and young adults whose brains are still developing. The long-term effects of varenicline on adolescents are completely unknown.

It’s hard to imagine this kind of approach being greenlit for any other behavioural issue affecting youth. But for nicotine? Suddenly, it’s a green light.

This Is the Wrong Diagnosis

Here’s the bigger problem: we’re trying to “cure” a behaviour without even asking why it started.

Young people don’t vape just because of nicotine. They vape because of stress, trauma, anxiety, peer influence, boredom, or just plain curiosity. It’s no different from why previous generations smoked, drank, or tried other substances.

But instead of addressing these drivers through proper education, mental health support, or honest dialogue, we’re going straight to medication.

In effect, we’re telling young people: “Your behaviour is broken. Here’s a pill.”

That’s not public health. That’s pathologising youth culture while doing nothing to actually engage with it.

Meanwhile, Real Harm Reduction Is Being Blocked

Let’s not forget the broader context.

In countries like Australia, access to safer vaping products is being crushed by prohibitionist policies. Flavoured liquids, open-system vapes, and evidence-based harm reduction tools are all being swept aside in a moral panic, even as smoking rates stall or rise.

At the same time, big pharmaceutical companies continue to dominate the “cessation” market, offering expensive prescription products with poor long-term success rates.

It’s not hard to see what’s going on here. Instead of embracing safer consumer products that empower people to quit smoking on their terms, we’re medicalising everything, funnelling people toward pharma-controlled treatments that often do more harm than good.

Who Really Wins?

If this study leads to widespread varenicline prescriptions for teens, who benefits?

Not the young people. They’re not being offered autonomy or understanding. They’re being medicalised, their behaviours pathologised, and their risks outsourced to pharmaceutical companies.

Not adult smokers, who still face demonisation for switching to vaping and are increasingly cut off from access to the very products that helped them quit.

And not the public, who are being fed a false narrative: that pills are progress, and harm reduction is a threat.

The winners? Pharma shareholders. Moral crusaders. And the bureaucrats who get to say they “did something.”

So What Should We Do Instead?

If we really care about young people — and want to support those who want to quit vaping — there are better options:

• Regulate the market, don’t ban it. Allow access to adult-only, refillable vaping products through controlled channels. Shut down the black market by offering legal, age-restricted alternatives.

• Invest in education, not just scare campaigns. Give youth the tools to understand nicotine and make informed decisions, without stigmatising or moralising.

• Support community-based help, not just prescriptions. Behavioural support, peer-led initiatives, and trusted resources matter more than one-size-fits-all pills.

• Listen to young people. They’re not passive recipients of policy, they’re active participants in their own lives. Engage with them honestly and build trust.

Final Thoughts

This new study might sound like good news. The media is already hailing it as "exciting."

But it’s neither.

It’s just another example of how youth vaping is being over-medicalised, understood in isolation, and used to justify interventions that benefit powerful interests more than public health.

We need to do better, not just for the young people being prescribed pills, but for everyone who deserves access to safer choices and respect for their right to make them.