A pragmatic strategy that provides patients who smoke with a short sample of varenicline and minimal guidance may increase smoking cessation rates, according to a recent randomized clinical trial.1 The findings could have clinical implications for pulmonary and critical care clinicians seeking scalable approaches to tobacco treatment.
The study, led by Matthew J. Carpenter, PhD, and colleagues at the Medical University of South Carolina, enrolled 651 adults who smoked and were not necessarily seeking treatment. Participants were randomized to receive a four-week sample of varenicline, a four-week sample of nicotine replacement therapy (NRT), or a quitline referral without medication. The trial was designed to test whether medication sampling and providing cessation medication without requiring an immediate quit attempt could engage patients who smoke and improve cessation outcomes.
Investigators reported that participants who received varenicline achieved higher smoking cessation rates than those assigned to no medication and, on several measures, outperformed those who received NRT samples.
At six months, self-reported seven-day point-prevalence abstinence was 17% in the varenicline group compared with 10% in the control group (P = .048). The varenicline group also had higher rates of “floating abstinence,” defined as achieving at least one seven-day smoke-free period during follow-up, than the control group (34% vs 20%; P = .003). In addition, one-third of participants receiving varenicline reduced cigarette consumption by at least 50% at six months, compared with 19% of individuals from the control group (P = .002).
Six-month self-reported abstinence was 17% among individuals receiving varenicline vs 8% among individuals receiving NRT (P = .01). Floating abstinence rates were 34% and 25%, respectively (P = .04). Participants in the varenicline group were also more likely to achieve a 50% reduction in daily cigarette consumption at eight weeks compared with those in the NRT cohort (35% vs 22%; P = .005).
The results were notable because varenicline is not a medication that easily lends itself to casual experimentation. It requires dose titration, can cause side effects, and remains affected by lingering safety misconceptions. Even so, the minimal-intervention approach appeared effective.
“Our study demonstrated that varenicline sampling, even among those not yet ready to quit, led to increases in cessation,” Dr. Carpenter said.
Not all outcomes favored varenicline. Carbon monoxide-verified abstinence rates did not differ significantly between groups at the primary six-month end point. The authors noted that adherence to remote carbon monoxide verification was limited, potentially affecting interpretation of those results.
For clinicians, the study’s relevance may extend beyond varenicline’s efficacy. Current smoking cessation interventions often require dedicated counseling, repeated follow-up, and motivated patients. In contrast, the medication-sampling model is intended to function as a low-intensity behavioral nudge. Participants were encouraged to use the medication as they wished, with decisions regarding initiation, adherence, and cessation goals largely left to the individual.
According to Dr. Carpenter, the strategy may work because it allows patients to test a proven treatment without making an immediate commitment to quit.
“It can serve as a bit of an ‘aha moment’ to give people the belief that they can do this and that this might be the tool to do it,” he said. “By lowering the barrier to engagement, medication sampling may help patients begin considering cessation on their own terms.”
The findings also challenge a longstanding assumption that people who smoke must be highly motivated before treatment begins. The intervention was specifically designed to engage patients across a spectrum of readiness to quit rather than targeting only those actively seeking treatment.
Traditional views of treatment readiness are increasingly difficult to justify, Dr. Carpenter said.
“The notion that so-called ‘unmotivated patients’ are untreatable is nonsense,” he said.
Tracy Smith, PhD, Professor in the Addiction Sciences Division at the Medical University of South Carolina and a co-author of the study, said the findings reinforce the idea that motivation to quit is not fixed.
“People who smoke are more likely to tell you they want to quit if you offer them medication before you ask,” she said. “People might not be planning to quit yet, but when you have the medication at home with you, they may decide it’s worth a try.”
Beyond its potential effect on motivation, medication sampling is appealing for its scalability, Dr. Smith said.
“Medication sampling is an approach that maximizes reach. It’s easy for clinicians to do, so it can be used with a high volume of patients,” she said. “Getting stop-smoking medications into the hands of as many people who smoke as possible can really move the needle.”
References
1. Carpenter MJ, Smith TT, Wahlquist AE, et al. Medication samples and smoking cessation among adults: a randomized clinical trial. JAMA Netw Open. 2026;9(5):e2611418. doi:10.1001/jamanetworkopen.2026.11418
