电子烟戒烟者戒断症状：一项前后临床试验。
Withdrawal Symptoms From E-Cigarette Abstinence Among Former Smokers: A Pre-Post Clinical Trial.
机构信息
Department of Psychiatry, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT.
Department of Psychological Science, Vermont Center for Behavior and Health, University of Vermont, Burlington, VT.
出版信息
Nicotine Tob Res. 2020 Apr 21;22(5):734-739. doi: 10.1093/ntr/ntz129.
INTRODUCTION
The major aim of this study was to test whether abstinence from e-cigarettes causes withdrawal symptoms in former smokers.
METHODS
We conducted an unblinded, within-participants, pre-post clinical trial in which 109 former smokers who were current daily electronic cigarette (e-cigarette) users used their own e-cigarette for 7 days followed by 6 days of biologically confirmed abstinence engendered via an escalating contingency payment system. Participants monitored symptoms of nicotine withdrawal daily via an Interactive Voice Response system. They also attended three laboratory visits per week for carbon monoxide and cotinine testing to verify abstinence.
RESULTS
Half of participants completely abstained for a week. All the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) tobacco withdrawal symptoms, craving for e-cigarettes, craving for tobacco cigarettes, and the four possible new withdrawal symptoms (anhedonia, impulsivity, mood swings, and positive affect) increased during abstinence. Weight increased and heart rate decreased with abstinence. Symptoms showed the prototypical inverted U time pattern of a withdrawal state. The magnitude of withdrawal appeared to be somewhat less than that in a prior study of abstinent daily tobacco cigarette smokers. More severe withdrawal on the first 2 days of abstinence did not predict abstinence on the last day of the study.
CONCLUSIONS
Former smokers who are daily e-cigarette users transfer physical dependence on tobacco cigarettes to dependence on e-cigarettes. The severity of withdrawal from e-cigarettes appears to be only somewhat less than that from daily tobacco cigarette use. Replication tests that include placebo controls, testing for pharmacological specificity, and including never-smokers, non-daily e-cigarette users and dual users are indicated.
IMPLICATIONS
Our results indicate e-cigarettes can maintain physical dependence. This adverse effect should be included in any risk vs. benefit calculation. Also, potential and current e-cigarette users should be informed that abrupt cessation of e-cigarettes can cause withdrawal symptoms.
TRIAL REGISTRATION
NCT02825459.
简介
本研究的主要目的是检验电子烟戒除是否会导致前吸烟者出现戒断症状。
方法
我们进行了一项非盲、个体内、前后临床试验，109 名曾是每日吸食电子烟的前吸烟者使用自己的电子烟 7 天，然后通过逐步增加的应急支付系统实现 6 天的生物确认戒断。参与者通过交互式语音应答系统每天监测尼古丁戒断症状。他们还每周参加三次实验室访问，进行一氧化碳和可替宁测试以验证戒断情况。
结果
一半的参与者完全戒断了一周。所有《精神疾病诊断与统计手册》第五版（DSM-5）烟草戒断症状、对电子烟的渴望、对香烟的渴望以及四个可能的新戒断症状（快感缺失、冲动、情绪波动和积极情绪）在戒断期间都有所增加。随着戒断，体重增加，心率下降。症状呈现出典型的戒断状态倒 U 型时间模式。戒断的严重程度似乎比之前一项关于每日吸食香烟的戒烟者的研究要低一些。戒断前两天的症状越严重并不预示着研究最后一天的戒断情况。
结论
每日吸食电子烟的前吸烟者将对香烟的身体依赖转移到了对电子烟的依赖上。电子烟戒断的严重程度似乎只是略低于每日吸食香烟。需要进行复制性测试，包括安慰剂对照、测试药理学特异性以及包括从未吸烟者、非每日电子烟使用者和双重使用者。
意义
我们的结果表明电子烟可以维持身体依赖。这种不良反应应该纳入任何风险与收益的计算中。此外，潜在和当前的电子烟使用者应该被告知，突然停止使用电子烟可能会导致戒断症状。
试验注册
NCT02825459。
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