BY DEBBIE PAGE
The Drug & Alcohol Coalition of Iredell recently held a two-day “Truth About Vaping” virtual conference to help the community understand how dangerous vaping is to the health of their community and the lessons learned addressing nicotine and associated addictions among youth in Iredell County.
Many people see vaping as a safer alternative to tobacco use, but the reality is that inhaling any kind of chemical will result in serious consequences, especially for young people whose bodies are still developing.
Congress raised the age to purchase vaping products to age 21 in 2019, but more than 3.6 million teens used vaping products in 2020. One in five high school students and 1 in 20 middle school students are inhaling harmful substances through these products.
Vaping product companies initially marketed their products to young people, using flavors (now mostly banned) and fashionable young people in their ads. They also employed social media influencers to promote the products
Parents and teachers sometimes have difficulty discerning vaping devices, which may look like USB flash drives, pens, and other everyday items. Some “vapers” may use larger tank systems, or “mods.”
According to a National Institute of Health (NIH) teen survey, nearly two-thirds of teens tried vaping as an experiment, with about 40 percent vaping because of taste, to have a good time with friends, or to relax or relieve tension.
About 30 percent vaped to feel good or get high or because of boredom. Fifteen percent thought vaping looks cool, while nearly 10 percent were hooked on the nicotine. About 5 percent vaped to quit cigarettes or because regular cigarette use was prohibited.
A survey of Iredell Statesville-Schools students indicate that electronic vapor product use is dropping slightly after continuing prevention efforts.
Nearly 50 percent of I-SS students who responded to the N.C. Youth Behavioral Risk Survey in 2015 had tried one of these products, a number that dropped to 47.5 percent in 2017. In 2015, 28.5 percent had used a vaping product in the last 30 days, with the number dropping to 27.3 percent two years later.
Students are also increasingly more aware of the dangers of vaping, with nearly 60 percent calling vaping extremely or very harmful, up from 25 percent in 2015, according to the N.C. Youth Tobacco Survey.
The Centers for Disease Control warn that the use of e-cigarettes is especially unsafe for kids, teens, and young adults. Most e-cigarettes contain highly addictive nicotine that harms youths’ brain development through their early to mid-20s. E-cigarettes also contain other harmful chemicals.
Nicotine use can harm the parts of the brain that control attention, learning, mood, and impulse control. Nicotine alters the way brain synapses — or connections — form as youths create memories or learn new skills. Teens who use nicotine are also more at risk for future addiction to other substances.
A teen guest speaker, 17-year-old Luka Kinard, shared his difficult journey with severe nicotine addiction. He began with chewing tobacco in eighth grade and started smoking a JUUL vaping device in ninth grade.
Luka said friends presented the JUUL as harmless fun. He soon progressed to four or more pods per day, working up eventually to the equivalent of 80 to 160 cigarettes per day. He spent $150 per week to keep up his nicotine habit and sold his own and others’ possessions and pods to other teens to pay for it.
Luka’s grades dropped from A’s to failure, and he nearly dropped out of school. A six-minute grand mal seizure from nicotine overuse and his erratic behavior led his mother Kelly to search for resources available for nicotine addiction. Luka ended up in rehab in California for treatment.
Kelly knew Luka had a Juul but thought it was safer than smoking cigarettes. After just days of use, Luka became impulsive, violent, and angry — a total and nearly overnight personality change. Kelly said he quit sports and Scouts and isolated from everyone.
She did not know that the pods had enormous amounts of nicotine and could cause these kinds of symptoms and behavior. Even his doctors and psychiatrists did not realize Luka’s nicotine habit was causing his seizures and behavior problems until Kelly discovered its effects.
She said Luka was one of the first patients in the country treated for nicotine addiction, but many have followed in Luka’s shoes. Kelly is proud of Luka’s progress and recovery, and they are spreading the word of his experiences to educate others to treat vaping addiction like other substance use disorder.
Introduced by the U.S, Surgeon General, Luka recently spoke to the U.S. Academy of Pediatrics about his experiences. The group is developing a program to teach pediatricians about growing youth vaping addiction problems and symptoms.
Luka and his mom are continuing his recovery with meetings and weekly outpatient treatment. Now a high school senior and attending school online, Luka hopes to go to college next year to study finance.
E-cigarettes, like tobacco, often pave the way toward teen marijuana use.
The N.C. Tobacco Use Survey revealed that 24 percent of high school students and 7 percent of middle school students have vaped marijuana.
Nationally, the NIH 2019 Monitoring the Future Survey indicated 7 percent of ninth graders, just over 19 percent of 10th graders, and just under 21 percent of 12th graders vaped marijuana in the past year. Seniors who vaped marijuana during the past month increased from 7.5 percent in 2018 to 14 percent in 2019.
The survey also reported that 3.5 percent of seniors, 3 percent of 10th graders, and nearly 1 percent of eighth-graders vaped marijuana daily.
Vaping THC and smoking marijuana is vastly different. A Johns Hopkins study found vaping delivers substantially more THC to the bloodstream, which magnifies its absorption. Researchers found greater cognitive effects from vaping THC rather than smoking.
Cannabis concentrate sales are on the rise, expected to reach $8.4 billion in 2022, according to marketing firm Arcview.
“Dabbing” involves inhaling vapors from a highly concentrated form of marijuana made by extracting THC using butane gas. “Dabs” (the common name for butane hash oil (BHO), also nicknamed “budder” or “crumble”) has very high levels of THC, sometimes as high as 90 percent.
The “dabbing” dance move popularized by former Carolina Panther Cam Newton is based on the cough produced from inhaling from BHO.
Commercial marijuana is now legal in 15 states and legal for medicinal use in 35 states, but today’s pot is much stronger than that of the 1970s, which was 1 to 4 percent THC. The percentage rose to 12 percent in the 2000s and to 20 to 30 percent today.
THC concentrates in dabs, edibles, and THC oils range from 30 to 90 percent.
Regular marijuana use causes brain changes that affect attention, memory, decision-making, and motivation. Impaired learning and a decline in IQ also occur.
Impaired movement, timing, and coordination also result, as do psychological concerns such as paranoia, anxiety, agitation, psychosis, and psychotic disorders.
Deterioration of overall life satisfaction, increased suicide attempts, and a greater likelihood of misusing opioids also can occur.
Regular users also have higher rates of school absence and of dropping out. Impaired social performance also jeopardizes professional and social achievements.
Chronic marijuana use can lead to marijuana use disorder, which affects 8 to 10 percent of users. Those who start using marijuana before age 18 are more likely to develop addiction. Not all who smoke are chemically dependent but may be addicted to the euphoria THC causes.
Though death from overdose is rare, marijuana use does increase the chance of death from vehicular accidents, lung cancer, heart and lung disease, injuries and accidents, and violence and suicide related to depression and psychosis.
Medical marijuana is expected to be legal in the next few years in North Carolina, and with legalization comes easier access to THC concentrates by youth.
COVID-19 AND OTHER HEALTH RISKS
Avoiding vaping and smoking is more important than ever during the pandemic. People who inhale substances into their lungs are more likely to develop infections and to suffer more serious symptoms.
Research shows that young people who had used cigarettes or e-cigs in the past 30 days were almost five times more likely to experience COVID-19 symptoms, including coughing, tiredness, fever, and difficulty breathing.
Acute Respiratory Distress Syndrome (ARDS), a result of severe infection, sepsis ,or trauma, is one of the main causes of death for people suffering from severe COVID-19 virus symptoms. Even second hand exposure increases the risk of ARDS.
Smokers have impaired ability to clear their lungs, increased lung permeability, and more ACE-2 receptors that give the COVID virus easier entry into the lungs.
Since the virus can spread more easily, the immune system can go into overdrive, resulting in a cytokine storm of massive and possibly deadly inflammation.
E-cigarette vapor is not harmless. Consumers often do not know what chemicals the e-cigarette products actually contain. Though e-cig flavorings may be safe to eat, inhaling them is dangerous because the digestive system can process more substances than the lungs.
E-cigarette aerosol can contain potentially harmful chemicals, including nicotine, ultra-fine particles, diacetyl (a chemical linked to a serious lung disease), volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.
In 2019, an outbreak of mysterious illness occurred among vape product users. Called E-cigarette or vaping use-associated lung injury (EVALI), the sometimes severe lung damage is believed to be caused by inhaling vitamin E acetate, an additive in some THC e-cigarettes, as well as some other substances in the products.
Symptoms include shortness of breath, fever and chills, cough, vomiting, diarrhea, headache, dizziness, rapid heart rate and chest pain. Chest X-rays showed hazy spots on the patients’ lungs from inhaling the chemicals.
Nationwide, 2,807 cases were reported, with 68 deaths in 29 states. North Carolina reported 77 cases and one death. All patients reported a history of vaping, with 80 percent reporting vaping of THC products.
Researchers suspect thickeners used to stretch costly THC oil contributed to EVALI. While vitamin E oil is safe as a supplement and in topical products, its chemical structure makes it harmful when inhaled.
KICKING THE HABIT
Nicotine withdrawal is not an easy process. Symptoms include depressed mood, anxiety, irritability, urges to smoke, difficulty concentrating, restlessness, insomnia, increased appetite, and feelings of frustration, impatience, and anger.
Experts recommend using the “Five A’s” to help teens get on the road to stopping their tobacco or vaping habit. First, ASK about the extent of their tobacco use and ADVISE them to quit, tying the reasons to increased athletic or artistic performance, cost, appearance effects such as yellowing teeth or skin damage, smell, and other motivations that will more likely influence teens.
Next, ASSESS if they are interested in evidence-based cessation treatment, and ASSIST them with getting connected with treatment if they are willing. Then ARRANGE for follow-up care as needed to maintain their tobacco-free status.
A motivational interviewing approach, consisting of collaboration and partnership, acceptance of the teen, evocation (creating an opportunity to share their story), and compassion to understand and respect the teen’s experiences, is most effective.
Instead of telling the patient what to do, motivational interviewing focuses on the patient’s concerns, why these things concern them, and asking what help they need. The counselor is a guide or facilitator to help the teen explore feelings that led to nicotine addiction.
In addition to counseling, treatment for teens usually uses a combination of the nicotine patch and either gum or lozenges. Follow-ups to talk about progress toward cessation goals, medication adherence and any side effects, withdrawal symptoms, successes and challenges, and setting new goals are important to helping the teen be successful in quitting vape use.
Engaging the teen’s social and family networks as supports, if appropriate in the situation, can also be helpful.
COSTS OF VAPING AND TOBACCO USE
Statewide evidence-based tobacco prevention is money well spent. Comprehensive, sustained, and accountable prevention programs reduce the number of people who smoke and lower tobacco-related diseases and associated costs, and prevent deaths.
The CDC estimates that smoking costs the United States $300,000,000,000 in productivity and medical expenses.
Smokers may not be eligible for individual health coverage or may have to pay higher premiums. Most health insurance questionnaires ask about smoking or vaping habits to ascertain potential health risks. Life insurance costs are also normally higher for tobacco or vape users as well.
For every dollar spent on evidence-based tobacco prevention, the CDC estimates that states reduce tobacco-related health care expenses and hospitalizations up to $55 per dollar spent. The longer states invest in effective and targeted tobacco and vaping prevention programs, the larger the reductions in both youth and adult smoking and vaping.
RESOURCES FOR TEENS
♦ QuitlineNC: 1-800-QUIT-NOW and quitlinenc.com
♦ THIS IS QUITTING: https://truthinitiative.org/thisisquitting
♦ The EX Program: theexprogram.com
♦ Smoke Free Teem: teen.smokefree.gov