The 16-year-old looked sick. Tubes snaked around her face to deliver oxygen through her nose. Medication coursed into her veins through an IV. The culprit, her doctors said, was something in the e-cigarettes she used to inhale both nicotine and THC. Such reactions are rare though potentially serious: Of the 805 Americans reported to have this vaping-related lung injury, at least 12 have died.
But last week, when Dr. Melodi Pirzada, the chief pediatric pulmonologist at New York University’s Winthrop Hospital, on Long Island, told the teenager she needed to quit vaping, the response came as a surprise. “She was one of the patients who looked at me and said, ‘OK, the THC, that is fine, but the nicotine — I really love the feeling that I get with it. I don’t know if I’m ready to give that up,’” Pirzada recalled.
Her patient’s unwillingness or inability to go without an e-cig isn’t new. Yet as anxiety about these acute pneumonia-like symptoms has grown, what had once seemed like a hazy possibility of negative health effects has become a lot more concrete. “Kids are scared,” said Meredith Berkman, one of the co-founders of Parents Against Vaping E-cigarettes. “This is the first time I’ve heard this from moms I’ve been speaking to for a while. Their kids never wanted to quit but now they do. I think we need to strike while the iron is hot.”
Easier said than done. Banning the sale of vapes and their accouterments — as the governor of Massachusetts ordered temporarily — may send a clear warning message, but it doesn’t mean that those who are already addicted know how to quit. E-cigarettes might have been viewed as a way of giving up the old-fashioned equivalent, but it turns out the newfangled version can be just as hard, if not harder, to quit.
As Pirzada put it, “These kids who are hooked on nicotine, they are going to have the withdrawal symptoms. They will either continue vaping or they will go to traditional cigarettes, which is horrendous.”
When the public health nonprofit American Legacy Foundation — now called the Truth Initiative — was founded in 1999 as part of the settlement of a lawsuit against tobacco companies, vapes were hardly the organization’s chief concern. So, in 2018, to figure out how best to help people quit e-cigarettes, the staff began to poll users about how giving up these devices might be different from kicking traditional cigarettes. What they’ve heard is that some of the usual social incentives for quitting smoking simply aren’t there. Vaping is socially acceptable in spaces where you wouldn’t be able to light up, such as indoors or at family events. Smells don’t linger on clothing or hair the way they do with cigarettes.
That can change patterns of use — what researchers sometimes call “puff topography” — which, combined with the workings of the device itself, influences the burst of relief a user feels in his or her body. “People who use these products can get a much higher spike of nicotine delivered to their brains. When you deliver drugs in that way, they can become much more addictive,” explained Dr. Sharon Levy, director of the adolescent substance use and addiction program at Boston Children’s Hospital. “If you’ve ever looked at a pod, it’s just a couple of drops of fluid that’s got all the nicotine that’s in a packet of cigarettes.”
On the night in October 2018 when he found out his parents were sending him to a residential facility to kick his vaping habit, Luka Kinard was so angry he threw books against the wall, sent a fan crashing down the stairs, and punched his mother’s car door enough to bloody his knuckles and break the handle.
He’d been introduced to tobacco at a Boy Scout leadership camp. Almost as soon as he got to high school, he started vaping in the bleachers during Friday night football games to fit in. At 15, he’d had a grand mal seizure, which his parents attribute to his nicotine use. But even when they confiscated his vapes, they just kept finding more beside his bed or hidden among the old costumes in his closet. “I realized he needed to be locked up and forced to quit,” said his mother, Kelly Kinard.
The family lives in North Carolina, but, Kinard said, the closest addiction program that would take someone with a vape addiction and that the family’s insurance would help cover was in California. He spent 39 days living with five other boys; all of them were forced to quit cold turkey. “I was there for Juuling. I know there was some people there for coke, some people there for weed, some people there for pills,” Luka said.
The hardest part about quitting, he said, was the withdrawal. “You feel trapped,” he recalled. “You feel scrambled, you feel very scared.” He’s since become an anti-vaping advocate, traveling to schools and meetings around the country with his mother — “I call her the mom-ager,” he said — to talk about kicking his vaping habit.
The response to his advocacy has been mixed. From some, he’s gotten questions and support; from others, he’s gotten threats. When he returned to his high school as a speaker, the reaction from his old classmates was hardly enthusiastic. But in the last few months, as news of vaping-related lung injuries has spread, he’s found himself answering questions in the grocery store and outside the movie theater. “The same people that were giving me criticisms are now saying, ‘I really need to stop, how do I stop?’” Luka said.
It’s hard to imagine most families sending their kids to a residential program to quit vaping. More common are the methods normally used for tobacco cessation: the nicotine patches, gums, or lozenges that smokers can use to wean themselves off the chemical. These medications are sold over the counter, but only to people 18 and over, so minors need a prescription.
“We’re basing whatever we do on what we know about cigarettes and it’s clearly a different product,” Levy said. Even for traditional smoking, she added, nicotine replacement generally works better for adults than for adolescents.
In the past few weeks, she’s seen some patients who were suddenly open to quitting who’d had no interest before, while others were still dead set against the idea of even being in her office at all. “I saw a patient on Wednesday who uses Juuls and dabs, so he’s vaping both nicotine and marijuana. He wasn’t really tuned into the lung disease piece of it,” she said. “Like so many kids I see, he was very ambivalent [about vaping] but that was being buried under, ‘My mother should stay out of my business.’”
In those for whom the strategy does work, she doesn’t think lozenges or patches will necessarily address all vaping-related issues.
“We’re seeing a whole group of kids who are coming in and saying, ‘I think I developed ADHD.’ Of course that doesn’t make sense: ADHD is something you’re born with,” she said. “We think that it’s the nicotine that’s doing it. I’m not convinced that the nicotine replacement is going to fix that. Will that get better on its own? Or are we going to have to think of new strategies for working with those other problems?”
The Truth Initiative, meanwhile, has developed an automated line that teens can text to get help quitting their vapes. “We guide users on how they can practice getting through one craving or one class period at school without vaping,” said Megan Jacobs, who leads the team in charge of developing such products.
Some messages might counsel someone to leave a vape at home or in a locker, to see what it feels like to go without it. Others might suggest strategies besides an e-cig hit to cope with anxiety or stress. Jacobs and her team have amassed a library of message submissions from teens themselves, allowing kids to get encouraging texts written by someone their own age. So far, more than 54,000 adolescents and young adults have enrolled in the program.
The recent spate of lung illnesses might have inspired some kids to look into quitting. But the urgency of a public health scare is, in some minds, counterbalanced by the urgency of a hit. As one student said, outside the public high school in Somerville, Mass., “I still have a cartridge at home. When it’s done, I’m going to try stopping.”