Varenicline Light Smoking Pilot

Phase 4

Completed

Brief Summary: The goal of this study is to assess varenicline vs. placebo for its effect on decreasing cue reactivity in light and intermittent smokers.

Detailed Description: The study will consist of randomization to receive either varenicline or placebo over 6 weeks and include 5 study visits. Participants are offered an optional additional 6 weeks of active varenicline. Cue reactivity will be assessed in both a lab-based setting (viewing series of images and rating cravings) and in a real-world setting (text-based daily interaction).

Recruitment & Eligibility

Inclusion Criteria

Age 18 years or above
Daily smoker using 10 or less cigarettes per day but a minimum of at least 1 cigarettes per week or 4 cigs/month.
Must be able to make it through a 24-hour period without nicotine withdrawal symptoms (specifically does not have new onset of irritability, headaches, insomnia, or intense cravings).
Willing to quit smoking in the next 30 days
Is able to provide written informed consent (in English) to participate in the study and is able to read/understand the procedures and study requirements.
Is willing to voluntarily sign and date an informed consent form that is approved by an institutional review board before the conduct of any study procedure.
If female and of childbearing potential, is willing to use medically acceptable contraceptive measures for the duration of the study. Acceptable methods of contraception include (1) surgical sterilization (such as tubal ligation or hysterectomy, (2) approved hormonal contraceptives (such as birth control pills, patches, implants or injections), (3) barrier methods (such as condom or diaphragm) used with a spermicide, or (4) an intrauterine device (IUD). Contraceptive measures such as rhythm method or Plan B™, sold for emergency use after unprotected sex, are not acceptable methods for routine use.
Have access to a cell phone that can send and receive SMS text messages.

Exclusion Criteria

Use of a smoking cessation medication (e.g. nicotine replacement, varenicline, bupropion) in last 30 days.
Current use of tobacco product other than cigarettes (e.g. e-cigarettes, smokeless tobacco) in the last 30 days
Answer > 0 on suicidality question of Patient Health Questionnaire (PHQ-9) Depression Scale
Active alcohol use disorder or hazardous drinking. This will be screened with the AUDIT-C, and positive scores (4 or greater for men and 3 or greater for women)54,55 will result in study clinician assessment and discretion.
Use of illicit drugs in the last month (marijuana, cocaine, opiates, benzodiazepines, and/or methamphetamine)
Severe symptomatic depression and or anxiety (study medical provider discretion)
Diagnosis of bipolar disorder, schizophrenia, PTSD and or adult ADHD (study medical provider discretion)
Chronic medical illness including diabetes with the use of insulin, Hemoglobin A1c > 7 (study medical provider discretion), heart disease diagnosed by angiogram, or COPD diagnosed by pulmonary function testing and requiring an oxygen supply
Specific medications (Appendix 1)
Abnormal finding on physical exam (study medical provider discretion)
Positive Urine Pregnancy Test (women of child bearing potential only; QuickVue Urine Pregnancy)56
Positive Urine Toxicology-5 Screen (methamphetamine, cocaine, opiates, benzodiazepines, THC)
Unstable hypertension (Blood pressure > 160/100)
Renal failure with active or pending hemodialysis

Arm && Interventions

Group	Intervention	Description
Varenicline	Varenicline	Varenicline BID
Placebo	Placebo oral tablet	-

Primary Outcome Measures

Name	Time	Method
Change in Self-Reported Craving Level Via Lab-Based Cue Reactivity	Baseline, Visit 4 (week 6)	Participants were asked to self-report craving level to smoke on a scale of 1-10 with 1 corresponding to no craving and 10 corresponding to intense craving. Self-reported craving level was requested following presentation of multiple images on a screen over a 20 minute period. Four types of images were presented - neutral affect, negative affect, smoking and social images.

Secondary Outcome Measures

Name	Time	Method
Change in Self-Reported Craving Level Via Real-World Cue Reactivity	Baseline, Visit 4 (week 6)	Craving level in "real world" situations was assessed through electronic momentary assessment (EMA). Participants were instructed to send a text to the study team each time they experienced craving to smoke a cigarette. Self-report craving level to smoke was reported on a scale of 1-10 with 1 corresponding to no craving and 10 corresponding to intense craving.
Changes in Smoking Abstinence	Screening visit, Visit 4 (week 6)	7-day point prevalence smoking abstinence confirmed by CO \<7ppm. This will be measured through biochemical confirmation (CO breath test).
Changes in Smoking	Screening visit, Visit 4 (week 6)	7-day point prevalence smoking abstinence. This will be measured through self-reported daily smoking diaries and daily text messaging.
Medication Adherence	Screening visit, Visit 4 (week 6)	Medication adherence is measured by composite self-reported diaries and daily text messaging responses.
Medication Tolerance by Self-Reported Side Effects	Up to 12 weeks	Self-reported side effects (open ended survey questions) with a ranking scale of 1-2 (mild), 3-5 (moderate), and 6-7 (severe). Any side effect 3 or greater will be reviewed by a study medical provider.