What helps beat multi-pronged nicotine addiction?

Professor Chris Bullen has received $1.44 million from the Health Research Council to compare the effectiveness of a newly approved drug in New Zealand – cytisine – with gradually tapering off nicotine products.

The study will be unique in assessing the effectiveness of these treatments on people who have used a variety of nicotine products over long periods, but now want to make a clean break, he says.

Some people switch to different nicotine products to try to quit smoking cigarettes, but wind up using alternative products regularly as well, he says.

“Some smokers use alternative nicotine products because they are cheaper than cigarettes, or they find them more convenient or more socially acceptable.

“But using multiple products is associated with an increased risk of nicotine dependence and harmful health effects,” he says.

Smoking cigarettes is the most harmful, followed by using heated tobacco and vapes, but more research is needed on the long-term effects of vaping, says

Bullen, who currently heads the University of Auckland Department of General Practice and Primary Care, is Director of the Transform Faculty Research Centre, and is involved in the centres for cancer, heart and addiction research.

In 2024 to 2025, about 17 percent of New Zealanders reported smoking and/or vaping daily. This soars to 39 percent for Māori, 28 percent for Pacific people, 26 percent for people aged 18 to 24, and 22 percent for people with disabilities.

Almost 500 people will take part in the three-year study that will launch later this year. One group will take cytisine and the other will use gradual tapering, a technique that appeals to many people who want to quit.

Cytisine blocks nicotine receptors in the brain, reducing the appetite for nicotine and easing withdrawal symptoms. It’s also a compound found in kōwhai trees.

If the study proves cytisine’s effectiveness, kōwhai could be grown commercially in New Zealand to manufacture drugs to treat nicotine dependence, Bullen says.

However, he warns it’s dangerous to try to use any material from kōwhai trees.

Bullen’s interest in finding ways to help people quit smoking was sparked during his years working as a GP in areas such as South Auckland.

“I was seeing so many people suffering from smoking-related illnesses.

“Perhaps most heart-breaking were the children who developed respiratory illnesses in homes where parents were smoking.

“After many years of smoking, people’s lifespan is cut by about a decade, on average. And often they have a lower quality of life before their premature death,” he says.

Bullen decided to train in public health and has spent the past 20 years spearheading world-leading research into methods to help people stop smoking, including the first-ever study comparing vapes to nicotine patches.

Last year, the Health Research Council funded another study he is leading, examining whether oral nicotine pouches help people stop smoking.

Bullen is concerned the ban on retail sale of oral nicotine pouches could soon be overturned in New Zealand.

“Cabinet has approved these oral pouches in principle to be legally available for sale as a smoking cessation product, but there's no evidence they actually help people quit smoking.

“The way they're marketed isn’t based around helping people quit – it promotes the idea they’re a cool lifestyle product to help you be alert and full of energy.”

Over the years, Bullen’s team has helped test nicotine replacement therapies, vapes, cytisine, text messages, reduced nicotine cigarettes, and selection boxes of nicotine replacement products.

Their research has been picked up and developed internationally.

“Cumulatively over time, we have helped thousands of people to quit smoking. So that's very motivating.”

While drugs to help people stub out smoking are helpful, changes to government policy are also required, Bullen says.

“Reducing and removing nicotine from all tobacco products would enable many users to stop smoking,” he says.