Some teens having trouble quitting e-cigarettes

BOSTON, Mass. — It should come as no surprise -- but that doesn’t make the problem any less distressing: teens using e-cigarettes are sometimes struggling to stop using them.

A recent study finds the percentage of teens making an attempt to quit e-cigarettes, but failing, is more than double the proportion trying and failing to quit regular cigarettes. The research appears in the Journal of the American Medical Association.

“A lot of kids want to quit, a lot of kids are trapped by these products,” said Jonathan Winickoff, MD, MPH a pediatrician at Massachusetts General Hospital whose research focus is on tobacco use.

What’s trapping kids is the same substance that trapped generations of cigarette smokers before them: nicotine, a substance so addictive that Winickoff said one disposable e-cigarette device can be enough to get a teen hooked.

“Both on the mental health side and the physical health side, these products are an absolute disaster,” Winickoff said. But, he adds, the extent of that disaster may not be known for years. “These substances haven’t been around for long enough to know all of the long term effects but what we know so far is scary.”

Winickoff said what we know is that lab animals exposed to e-cigarette aerosol developed lung cancer -- and that among the substances commonly found in the products are chemicals that can irritate or even damage the lungs. But of most immediate concern is what nicotine can do to the developing teen brain.

“Nicotine affects the part of the brain involved in rewards,” Winickoff said. “When nicotine stimulates that nucleus accumbens -- the reward center of the brain -- it does increase rewards for other drugs of abuse, such as cocaine and possibly THC. So, you mess up this reward center to the brain and you may be more and more susceptible to other drugs, as well.”

And, as with any addiction, the need for nicotine only increases.

“You have to buy more and more,” Winickoff said. “And, unfortunately, you find yourself getting to the store daily to purchase your next electronic cigarette device, just like we saw with cigarettes.”

At the S.A.F.E. Coalition in Norfolk, workers deal with teens addicted to e-cigarettes every day.

“The problem has skyrocketed,” said Executive Director Jennifer Knight-Levine. “What we’re hearing from students and from school systems is that vaping and e-cigarette use is on the rise.”

The S.A.F.E. Coalition offers a suspension alternative program for teens caught vaping at school. It primarily focuses on education.

“We try to highlight medical things that are going on in a teen’s body, the social emotional wellness piece of utilizing e cigarettes and also ways to decrease or stop use completely,” said Knight-Levine.

About half of those who come through the program wind up kicking the e-cigarette habit, she said -- but it can take nine months to a year.

“Every single student that’s come through our program has tried to stop and struggles to stop because of that addiction piece,” Knight-Levine said.

Winickoff said the success rate out of his office is similar -- with some highly addicted teens requiring treatment with ‘slow nicotine.’

“Slow nicotine is non-addictive nicotine,” he said. “It’s government approved by the FDA to help you ease the craving.”

Winickoff likens its use to that of methadone with heroin dependency.

But treatment doesn’t help every teen, he said.

“Once you’re highly addicted to these products, it’s just very hard to quit,” Winickoff said. “Sadly, I have to send some kids off into adulthood after I’ve seen them for years and they are unable to quit.”

Of course, the key strategy is to never get them to start -- which was part of the intent behind Massachusetts banning flavored vape products.

“The National Youth and Tobacco Survey of 2021 found that the majority of adolescents who do use e-cigarettes, use flavored e-cigarettes,” Knight-Levine said. Teens can’t buy those products in-state, but that hasn’t stopped their use.

“Any adolescent with a driver’s license can go to a state or have items mailed to their home that have flavors in them,” Knight-Levine said.

And now that pandemic restrictions are off in most places, Winickoff suggested availability is rising. “We are seeing it in high schools, I see it in my patients,” he said. I’m very concerned about what’s happening. E-cigarettes are accounting for twice as much of the addiction in kids as regular, combustible cigarettes. They’re designed to attract kids and they do just that.”

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