Nicotine Replacement Therapy: Harm Reduction for Quitting Cigarettes or Vaping

When I decided I wanted to quit vaping nicotine about six months ago, I knew there was no world in which I could quit “cold turkey.” The amount of nicotine my brain relied on each day was comparable to 3-4 packs of cigarettes. After wanting to quit in the past, I returned to vaping because of psychological and physical cravings. But the Reddit forum I joined for support (r/quitvaping) made it clear that using nicotine replacement therapy (NRT), which I had chosen to do based on the recommendation of my psychiatrist, wasn’t really quitting. 

Seeing my comrades in quitting turn up their noses at my cessation tool first hurt my feelings, and then pissed me off. If it was working for me, why was it a problem? Who were these strangers and vape-quitting purists to tell me that NRT wasn’t legitimate? It reminded me of the many people who like to dictate how others stop drinking instead of supporting whatever works for them.

I’ve now been vape-free for six months. My experience in the face of the naysayers of r/quitvaping has made me an even bigger believer in what I chose to do: carve out my own path to meeting my goals (with the help of a doctor to quit smoking). Keep reading to learn what NRT is, how it works, how effective it is for quitting smoking (very) and vaping (limited research so far), and how you can get started with using it today (Oar can help!).

First up: What is nicotine replacement therapy?

NRT covers a range of safe and effective over-the-counter and prescription smoking cessation tools that do exactly what the name implies: replace some of the nicotine you’d get from cigarettes without the harmful effects of tobacco and carcinogens (1).

There are currently three types of over-the-counter NRTs that are approved for use by the FDA in quitting smoking:

- Nicotine patches: Thin, transparent patches you wear on your skin for 24 hours to absorb the nicotine and reduce cravings (2).

- Nicotine gum: Pieces of gum you can chew every few hours or when cravings hit (3).

- Nicotine lozenges: Hard candies you leave between your gums and cheek every few hours until they dissolve — or when cravings hit (4).

There are two types of prescription NRTs that are approved for use by the FDA in quitting smoking:

- Nicotine inhaler: A small, plastic cigarette-shaped tube you can puff for up to 20 minutes every few hours or when cravings hit (5).

- Nicotine nasal spray: A spray you can use in each nostril every few hours or when cravings hit (6).

Different NRTs can be used on their own or in combination (e.g., the long-acting patch plus short-acting gum or lozenges) to reduce cravings and support someone as they work their way toward cutting nicotine out entirely. They may even be used alongside prescribed smoking-cessation medications like varenicline that don’t include nicotine (7).

Talking to a medical expert can help you figure out which NRT or other smoking-cessation medication would be right for you.

Take the quiz.

How does nicotine replacement therapy work?

How NRT works relies on the science of nicotine addiction (8). When nicotine is used, it sends a jolt of endorphins to the brain that’s reinforced by higher levels of dopamine. Sustained use over time can actually rewire the brain and form a dependence on the chemical. If someone whose brain is dependent on nicotine goes without the chemical, withdrawal symptoms like cravings and irritability can occur. This can make it more difficult to keep abstaining from smoking or vaping.

The point of NRT is to reduce nicotine cravings, making it easier to go without cigarettes (1). While NRT won’t get rid of cravings or other withdrawal symptoms completely, it can still be a major help. Over time, you can switch to NRT with lower levels of nicotine or less frequent dosing so you can taper down to no nicotine at all.

While each product will have its own recommended dosing and protocol, here’s an overview of how it may work:

- Patches: The amount of nicotine to start with depends on your current nicotine consumption levels. If you smoke more than 10 cigarettes a day (roughly equivalent to more than half of a vaping pod a day, though there’s no protocol for vaping), you may start with 8-12 weeks of 21 mg patches, then two weeks each of the lower doses (14 mg and 7 mg) (9).

- Gum: The amount of nicotine to start with depends on your current nicotine consumption levels. If you smoke within 30 minutes of waking up, you may start with six weeks of using one piece of 4 mg gum every 1-2 hours (at least nine pieces a day) — then reducing to one piece every 2-4 hours, followed by one piece every 4-8 hours. If you’re also using the patch, you may need the gum less frequently (10).

- Lozenges: The amount of nicotine to start with depends on your current nicotine consumption levels. If you smoke within 30 minutes of waking up, you may start with six weeks of using one 4 mg lozenge every 1-2 hours, then reduce the dose and frequency over time. You may start with a lower dose if you’re also using patches (11).

- Inhaler: You may go through more than six cartridges a day (no more than 16) for the first 3-6 weeks before using fewer cartridges when you’re ready. The inhaler should be used with short, frequent, shallow puffs (like sipping from a straw) for four 5-minute sessions or continually for 20 minutes (12).

- Nasal spray: You may use the spray in each nostril between eight and 40 times per day in the first six weeks then start using it less frequently when you’re ready (13).

After going through a full NRT protocol, your body’s need for nicotine should be so low that you can go without the chemical entirely.

How effective is nicotine replacement therapy for quitting cigarettes?

Very. A 2018 Cochrane systematic review found that using NRT can increase the likelihood of completely quitting smoking by 50-60%. The type of NRT and the amount of nicotine don’t appear to matter (14).

NRT is so effective at cigarette cessation that the tobacco industry saw it as a massive threat when it was first approved by the FDA in 1984. They were successful in pressuring the drug company selling NRT to decrease marketing aimed at quitting smoking. In an almost comical turn of events, the tobacco industry has since joined in on the NRT game so as not to miss out on its money-making potential (15).

How effective is nicotine replacement therapy for quitting vaping?

Robust research looking into the effectiveness of various tools for quitting vaping is extremely limited, despite a call to arms from the Surgeon General (16, 17). This could be in part because vaping nicotine can itself be an effective harm-reduction tool for people who smoke cigarettes — or maybe it’s just because vaping is so much newer than smoking (18). Either way, we don’t have recommended medication protocols for quitting vaping or research to back them up quite yet.

Here’s what we do have (to the best of our knowledge):

- A 2016 case study demonstrating effectiveness for one 24-year-old and suggesting NRT as a possible intervention (19).

- Content analyses of an internet forum and thousands of tweets showing anecdotal reports of using NRT for vaping cessation (20, 21).

- A 2021 randomized controlled trial in which a text-based intervention that provided education on NRT had promising results (22).

- 2020 preliminary guidelines from expert clinicians recommending that youth be offered NRT to help with quitting vaping (23).

While there isn’t much research specifically examining the impact of NRT on vaping, what we do know signals the therapy as a worthwhile intervention for people who want to quit.

How can you get started with nicotine replacement therapy?

It’s always a good idea to talk to a medical expert about the right quitting plan for you, whether you’re quitting smoking or vaping. Depending on the type of NRT they recommend, they can either give you a prescription or you can pick up items over the counter at your local drugstore. You would then follow the directions to understand dosing.

Oar can help you get started quickly and easily. After a health assessment, those who may benefit from nicotine-cessation support will meet with our team of experts to find the right treatment for them. You’ll also get ongoing support from your care team, helpful digital tools, and a community of people on similar journeys.

Learn more about Oar’s evidence-based plans for quitting smoking right here.