- The Washington Times - Monday, January 7, 2019

Throughout college, Erin Brock would have an occasional cigarette when she was drinking at parties. But she always felt bad about smoking, knowing of the health risks and disgusted by the smell and taste left in her mouth the next day.

Juul was totally different. The discreet vaping device, shaped like a USB stick, provided the head rush of nicotine without any of the drawbacks of a traditional cigarette and offered appealing flavors like cucumber, mint and fruit medley.

“You could go out and, like, everyone at the bar had Juuls, literally everyone. Everyone had different flavors,” the 22-year-old said in an interview with the Washington Times.

A whole culture developed around it too — sharing Juuls at parties, posting photos and memes on Instagram and social media, joking about the addictiveness of the device and nicotine.

But within a few months of buying her own Juul, Ms. Brock wasn’t laughing: She had a full-fledged nicotine addiction.

“I moved from taking it to go out to hitting it in my room, to taking it to school, to taking it to work, I ended up just literally always having it on me,” she said. “It made me feel bad, it made me feel gross. I was embarrassed because it wasn’t a joke anymore. I was like, ‘Oh damn, now I have a nicotine addiction,’ and I never wanted to have a nicotine addiction.”

An estimated 3.6 million teenagers and adolescents use electronic cigarettes — and Juul, in particular — a number that has increased so rapidly over the past two years that the U.S. Surgeon General has declared vaping an epidemic among youth.

In the most recent survey on youth use of e-cigarettes, about 21 percent of high schoolers and 5 percent of middle schoolers said they had used a vaping device in the previous 30 days.

Scrambling to reduce the numbers of teens who vape, health officials are struggling with how to treat a new group of young people addicted to nicotine, with no clear path to help them break it.

“We know that there’s next to no research on e-cigarette cessation — for youth or adults,” said Cliff Douglas, vice president for Tobacco Control at the American Cancer Society and director of its Tobacco Control Center. “It’s not clear that what works for smoking will work for vaping.”

E-cigarettes sit in the middle of a tug-of-war between being a device that is harmful to children, but potentially helpful to adult cigarette smokers. It’s this confusion in messaging that has, in part, allowed the vaping epidemic to take hold. In surveys of teenagers, smoking cigarettes is viewed as unacceptable, but e-cigarettes are the “healthier alternative.”

This month the Food and Drug Administration will hold a town-hall meeting to discuss tools for helping break nicotine addiction among teens.

“We now have for the first time in this country, in a long time, the prospect of a lot of kids being currently addicted to nicotine,” FDA Commissioner Dr. Scott Gottlieb said last month. “The question is, how do you address that as a matter of clinical medicine?”

There are approved medications for cessation of tobacco products, but none is approved for use in the youth population. These include skin patches, chewing gum and lozenges, as well as prescription medication for nicotine replacement therapy.

Joanne Ebner, manager of cancer prevention services at the Anne Arundel Medical Center in Annapolis, said the hospital has seen an uptick in the number of parents looking for nicotine addiction treatment for their children over the past six months.

“We’ve actually seen one of the teens already and we worked with their pediatrician to provide nicotine replacement therapy because he was so addicted,” Ms. Ebner said.

“Nicotine is an addictive drug, it’s a very powerful drug and there are actual withdrawal symptoms that go along with it,” she said. “Irritability, anxiety, sometimes there’s depression, there’s fatigue, appetite changes, changes in sleep habits — it’s a whole range of withdrawal symptoms and that’s what makes it so uncomfortable for people to quit.”

Many municipalities and state health departments have cessation services that provide counseling and products to help alleviate the symptoms of withdrawal and replace nicotine at certain levels for people who want to quit smoking.

In Colorado, which has the highest rate of youth e-cigarette use in the country, officials have lowered the age of eligibility for such services from 15- to 12-years-old.

“What we really have been hearing from our partners in the school is that kids were vaping more, kids were getting caught vaping more frequently … so there was really a need to provide some services that could help kids quit,” said Alison Reidmohr, tobacco communication specialist at the Colorado Department of Health.

The department works in partnership with the National Jewish Health Quitline to provide phone and web-based services for anyone who wants to quit tobacco and nicotine products.

But Ms. Reidmohr said this is only a piece of a comprehensive approach that needs to be taken to shift public opinion that these devices are harmful in the same way cigarettes are now viewed. They include hard-hitting media campaigns, indoor air laws and restrictions on purchases.

“So those are all policies we’re really pursuing,” she said. “But at the same time, we really understand that once these policies come into effect and people are sort of pushed to think about quitting, then they need the resources to help them succeed because nicotine is powerfully addictive and it’s very difficult to quit.”

For teens, the social factor is another layer of pressure.

Thomas Ylioja, a tobacco cessation expert at National Jewish Health, said 95 percent of teen callers to the national quitline are reporting nicotine addiction from vaping and the most effective ways to talk to them about quitting is focusing on why they use these devices, when and with whom.

“We talk a lot about the social setting they’re in — we know that for youth in particular, social influences are very important when it comes to tobacco use, nicotine use, how to navigate their peer group, school networks of their peers,” Mr. Ylioja said.

He cited as an example a 15-year-old girl whose parents had taken away her Juul but whose friends would let her use theirs.

“That’s a really big part of social networks for teens is that their friends are offering them a product to sort of solidify their status within their social group, so for her to be able to say no to that is a challenge,” Mr. Ylioja said.

For Erin Brock, the cost of her nicotine addiction was becoming unsustainable. A Juul device can cost about $35 and a pack of four pods — self-enclosed cartridges with a flavored-nicotine liquid mixture — is about $16. Ms. Brock had moved from going through a pod a week to a pod a day.

“I actually ended up quitting just because I was, like, I can’t afford this anymore and, two, I was getting pretty grossed out at how much I felt I needed it,” she said.

In September, she broke her Juul and quit cold-turkey.

“It sucks quitting, but I’m glad I’m not addicted to a USB stick honestly,” she said.

• Laura Kelly can be reached at lkelly@washingtontimes.com.

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