Trial of Varenicline With Nicotine Lozenges and a Smartphone Medication Adherence Intervention for Smoking Cessation

Inclusion Criteria: * Able to provide documentation of identity (to prevent fraudulent enrollment) and Oklahoma residence (due to limitations on prescribing to out-of-state residents) * Reports daily smoking ≥5 cigarettes per day * Provides a breath CO sample ≥6ppm to verify current smoking * Willing to schedule a smoking cessation attempt within the next 1-2 weeks * Willing to abstain from smoking cannabis or other combustible products during the study * Willing to use varenicline and nicotine lozenges * Willing to participate in the study for ≈6 months * Able to demonstrate \>6th grade literacy which is necessary to read intervention materials and complete study assessments Exclusion Criteria: * Does not own a smartphone that is compatible with the study app * Using an FDA-approved smoking cessation medication within the past 30 days * Using oral nicotine products (e.g., pouches, chewing tobacco, snus) more than once per week (5+ times) during the past 30 days * History of seizures (varenicline contraindication) * History of allergic reaction to varenicline * Pregnant, planning to become pregnant, or currently breastfeeding * Unwilling or unable to use varenicline or nicotine lozenges for other reasons (e.g., severe dry mouth, past history of severe medication side effects) * Other medical reasons at the discretion of the prescribing physician (e.g., uncontrolled hypertension, recent myocardial infarction) * Weekly or more frequent use of combustible cannabis during the past 30 days with a score ≥2 on the Cannabis Use Disorder Identification Test-Short Form