There's no stopping point with a vape that has 20,000 puffs
At the intersection of public health and pharmaceutical science, researchers in South Carolina are asking whether a drug long trusted to help smokers put down cigarettes might offer the same liberation to a new generation tethered to vaping. The Medical University of South Carolina's VIVA trial — enrolling more than 300 adults across two states — tests varenicline against a habit that, unlike a cigarette pack, has no natural end. As e-cigarette use among young adults continues its quiet climb, the study represents both a clinical question and a cultural reckoning: society created a device with no built-in stopping point, and now science is searching for one.
- Adult vaping rates have risen steadily since 2019, with young adults aged 21–24 leading usage — and unlike cigarettes, a vape with tens of thousands of puffs offers no moment that signals 'done.'
- Varenicline, already FDA-approved to help smokers quit, has never been formally proven effective for e-cigarette users — leaving a critical gap in treatment options just as vaping becomes more widespread.
- A $3 million federally funded trial is now recruiting 300+ adults across South Carolina and Connecticut, randomly assigning participants to the drug or a placebo over 12 weeks, with a six-month follow-up.
- A prior pilot study showed enough promise to justify this larger effort, and one participant who quit during that earlier trial has since become a vocal advocate for pharmaceutical solutions.
- If the VIVA trial succeeds, FDA approval could follow within six to twelve months of submission — potentially accelerated by a prior study that may satisfy the agency's two-trial requirement.
At the Medical University of South Carolina, researchers are testing whether varenicline — the smoking cessation drug sold as Chantix — can help people quit vaping. The medication works by blocking nicotine's effects on the brain and has been federally approved for cigarette cessation for years, but its effectiveness for e-cigarette users remains unproven. That gap is what MUSC's Hollings Cancer Center is now working to close.
The urgency is grounded in data. CDC figures show adult e-cigarette use rose from 4.5 percent in 2019 to 6.5 percent in 2023, with young adults aged 21 to 24 representing the largest group. Benjamin Toll, who directs MUSC's Tobacco Treatment program and sees more than 10,000 patients a year, points to a structural problem: a traditional cigarette has a natural endpoint, but a vape device with 20,000 puffs offers none. That endless availability, he argues, makes quitting fundamentally harder.
The VIVA trial — Varenicline Interventions For Vaping Abstinence — is backed by $3 million from the National Cancer Institute. More than 300 adults across South Carolina and Connecticut are being recruited, randomly assigned to receive either the drug or a placebo by mail over 12 weeks, with a follow-up at six months. The protocol mirrors a standard clinical visit: brief counseling, then medication delivered in three separate mailings.
The study builds on a smaller pilot conducted between late 2022 and mid-2023. One Columbia participant, Bahnu Shekhawat, quit vaping during that trial after noticing her breathing had declined. Though she never learned whether she received the drug or placebo, she has become an advocate for pharmaceutical solutions — particularly as vaping companies continue aggressive marketing to young people.
If the trial succeeds, the road to FDA approval is relatively short. The agency typically requires two large-scale studies, and a prior trial involving both teenagers and adults may satisfy that second requirement, potentially accelerating approval to within six to twelve months of submission. The full study is expected to conclude in just over four years, and researchers are still accepting adult participants.
At the Medical University of South Carolina, researchers are testing whether a drug already proven to help smokers quit cigarettes might work just as well for people trying to break free from vaping. The medication is varenicline, sold under the brand name Chantix, and it works by blocking nicotine's effects on the brain. It's been federally approved for smoking cessation for years. But no one has yet proven it can help e-cigarette users, and that gap is what researchers at MUSC's Hollings Cancer Center are now trying to fill.
The numbers suggest the need is real. According to the CDC, the percentage of American adults using e-cigarettes climbed from 4.5 percent in 2019 to 6.5 percent by 2023. Young adults aged 21 to 24 make up the largest group of users. The problem, as Benjamin Toll, director of MUSC's Tobacco Treatment program, explains it, comes down to the structure of the devices themselves. A traditional cigarette offers a natural endpoint—smoke the pack, crush it, throw it away. A vape cartridge with 20,000 puffs has no such stopping point. That endless availability, Toll notes, makes quitting fundamentally different and harder.
The study, called VIVA—the Varenicline Interventions For Vaping Abstinence trial—is backed by $3 million in funding from the National Institute of Health's National Cancer Institute. Researchers are recruiting more than 300 adults across South Carolina and Connecticut, with half coming from each state. The design is straightforward: participants will be randomly assigned to receive either the actual drug or a placebo, delivered by mail over a 12-week period. The process mimics a standard doctor's visit. Patients get five minutes of counseling, then receive their medication in three separate mailings, each covering four weeks of treatment. A follow-up check happens six months later.
Toll sees more than 10,000 patients a year seeking help to quit vaping. The research builds on a smaller pilot study conducted between November 2022 and May 2023, which showed enough promise to justify the larger trial. One participant from Columbia, Bahnu Shekhawat, successfully quit vaping during that earlier study. She had noticed her breathing was suffering and found she couldn't keep pace with her young niece and nephew during activities. Though she doesn't know whether she received the actual drug or a placebo, Shekhawat has become an advocate for finding pharmaceutical solutions. She points out that as vaping companies continue to market aggressively to young people, having a federally approved medication becomes increasingly important—especially if policy changes don't materialize.
If the trial succeeds, the path to federal approval is relatively clear. The FDA typically requires two large-scale studies before granting approval. Toll says a prior study that included both teenagers and adults could potentially serve as the second trial, accelerating the process. Once the VIVA results are submitted, he expects a decision within six to twelve months. The full study is projected to wrap up in just over four years. For now, researchers are still accepting adult participants. Anyone interested can contact the study coordinator at 843-737-1516.
Notable Quotes
For a vape that has 20,000 puffs, there's no stopping point— Benjamin Toll, MUSC Director of Tobacco Treatment program
If we're not going to have those policy changes, then we need to at least have other resources like drugs, or more assistive therapy that is specifically tailored towards vaping— Bahnu Shekhawat, study participant
The Hearth Conversation Another angle on the story
Why does vaping seem harder to quit than smoking, from a biological standpoint?
It's not just biology—it's the design. A cigarette burns down. You finish it. With a vape, there's no endpoint. Twenty thousand puffs means someone can keep going indefinitely, which changes how the brain relates to the habit.
So varenicline works the same way in both cases—blocking nicotine on the brain?
Yes, but we don't actually know yet if blocking nicotine is enough when the device itself has no natural stopping point. That's what this study is trying to answer.
Why does it matter that half the participants are from South Carolina and half from Connecticut?
Geographic diversity helps ensure the results aren't skewed by regional differences in vaping patterns or demographics. It makes the findings more generalizable.
What happens to someone like Bahnu Shekhawat if the drug gets approved?
She's already quit. But her point is bigger—if approval comes through, thousands of people struggling right now will have a real medical option, not just willpower.
How confident are the researchers that this will work?
Confident enough to invest three million dollars and four years. The pilot study showed promise. But confidence and certainty are different things. That's why they're doing the larger trial.