JAMA Netw Open
No-pressure varenicline samples help smokers quit
Clinical Takeaway: Brief, low-guidance sampling of varenicline may help engage adults who smoke in quit attempts and improve smoking cessation, even among patients not actively seeking treatment. This pragmatic approach could be feasible in primary care and other clinical settings where intensive counseling is difficult to provide.
Despite the availability of effective smoking cessation medications, most adults who smoke do not use evidence-based pharmacotherapy during quit attempts. Medication sampling — providing a short course of cessation therapy with minimal instruction and no requirement to quit — has emerged as a potentially scalable strategy to increase treatment uptake in routine clinical settings.
In this decentralized randomized clinical trial, 651 adults who smoke across South Carolina were assigned to receive a 4-week mailed sample of varenicline, nicotine replacement therapy (NRT), or quitline referral alone. Participants were not required to be actively trying to quit smoking, and both medication groups received only brief guidance emphasizing self-directed use.
At the 6-month mark, self-reported smoking abstinence during the prior 7 days occurred in 17% of participants receiving varenicline, compared with 10% in the quitline referral group (P=.048) and 8% in the NRT group (P=.01). Varenicline sampling also increased the likelihood of achieving at least one smoke-free period during follow-up and reduced cigarette consumption relative to both comparison groups. However, when smoking abstinence was confirmed with carbon monoxide testing, differences between groups were not statistically significant.
The study population had a mean age of 52 years, 66% were female, and participants smoked an average of 18 cigarettes daily at baseline. Many were not actively using cessation medications despite generally high stated motivation to quit.
Adverse effects were not a major focus of the report, though investigators noted that participants received counseling regarding common varenicline-related symptoms such as nausea, insomnia, and disturbed sleep. The intervention emphasized participant-driven medication use with minimal clinician involvement.
Provision of brief varenicline samples in an unguided setting improved smoking cessation outcomes and may represent a pragmatic strategy to engage adults who smoke in quit attempts, concluded the study investigators. They added that medication sampling warrants further evaluation in real-world clinical settings.
Source: Carpenter MJ, et al. (2026, May 8). JAMA Netw Open. Medication Samples and Smoking Cessation Among Adults