SALT LAKE CITY — The first time you try nicotine you might feel the incredible urge to throw up. You might be young enough to not let the biological reaction deter you from trying it again.
The second time you try it, the slight rush, the spike in dopamine and serotonin, and the novelty of fire in your throat might just make you try it a third and a fourth time, until a few years have passed and you’re confronted with the undeniable truth that you’re dependent.
It’s a tough road to quitting nicotine.
Now, the world is facing a new wave of young people picking up a nicotine habit, albeit, in a sleeker, flash-drive-esque, form: the electronic cigarette.
The Trump administration proposed banning all flavored e-cigarettes last week, which health officials say are marketed to young people. The move has been applauded by public health organizations, but bemoaned by the industry and those who see the devices as a useful way for adult smokers to trade in their cigarettes.
The ban could help prevent a new crop of teens from picking up vaping, drawn in by the taste of mango, creme, and perhaps even cucumber. But what about the kids who came for cotton candy and stayed for the neurological rewiring that hacked their rewards system, making them wake up every day to a craving and drift off to the crackle of heated up nicotine?
Nicotine dependence isn’t always taken as seriously as other drugs, death usually comes slowly, and unlike addiction to say, heroin, people will ask “Why don’t you just quit?”
While nicotine is sometimes considered a “mild” drug, it joins the ranks of substances such as cocaine, heroin and alcohol in its level of addictiveness, and smoking kills close to half a million people each year.
Vaping and smoking have been normalized and are readily available, unlike other substances, according to Suzanne Harris, the co-founder of the University of California, San Francisco Fontana Tobacco Treatment Center, which provides support and courses for those trying to quit smoking.
Kids’ brains have been taught to vape, even if their minds know the habit is dangerous. Harris explained that children are especially susceptive to nicotine addiction. From the moment a young person inhales vapor or smoke, it takes five heartbeats for nicotine to reach the brain and set off the release of dopamine, Harris said.
Plus, nicotine has a very short half life, which means it only takes the body about two hours to metabolize, kicking off the drive to smoke or vape again.
A ban may not be enough to stop the already addicted teens and 20-somethings.
After reports of illness and death linked to vaping, some young people are already heading back to cigarettes, or trying them out for the first time, according to U.S. News, while others have started stockpiling their favorite flavored pods.
In a recent statement, Ned Sharpless, the acting commissioner for the FDA, outlined the agency’s plan to address e-cigarettes. The FDA focused the plan on restricting kids’ access to the products and adding e-cigarettes to the “The Real Cost,” tobacco prevention campaign. These campaigns have been effective in alerting kids to the dangers of cigarettes in the past.
But it’s unclear how these plans will address the 21% of high schoolers who have already vaped. The vaping cohort is already looking for ways to skirt restrictions and maintain its supply.
“If you’re just sitting back concerned about yourself and how you’re going to get flavors, I think you’ll find a way,” said one Youtuber with a slew of vaping related content, including a video titled “How to Vape: Best Vapor Products for Beginners!” which garnered 99,000 views. He pointed to the blackmarket and online sites as a way to get the flavored pods.
Banning a product, raising the age for legally purchasing tobacco products, and increasing prices helps deter a certain percentage of the population, but not all. For instance, although 35 states banned tobacco sales to people under 18 and 15 states banned sales to people under 21, the vast majority of cigarette smokers tried smoking by the age of 18.
Studies at the University of Pittsburgh School of Medicine found that nicotine heightens enjoyment of “non-drug rewards,” meaning that cup of coffee, or evening stroll actually actually does feel a little better while smoking.
No one form of treatment works for every person addicted to nicotine, although many people who try to quit on their own find the process much more difficult.
In a 2014 Surgeon General report, use of “evidence-based tobacco control interventions” were still “underutilized,” and a study published in the Journal of the American Heart Association found in 2018 that only 16% of patients that were active smokers with peripheral artery disease were offered counseling and 11% were prescribed medications designed to help quit.
The effectiveness of nicotine replacement therapies (like the patch, lozenges, or gum) is mixed. In one study conducted by Harvard researchers, they found no difference between quitters using nicotine replacement and those who did not.
Other methods include medications, behavioral therapy, hypnosis and even acupuncture. But, as one Los Angeles Times article put it, “Successful quitters tend to have one thing in common: Most of them tried to quit many times before succeeding.”
Approaches to drugs like heroin are often discussed in terms of restricting access and providing treatment, sometimes in the form of substitution therapy, with other drugs like methadone.
Megan McArdle, an author and columnist, wrote in The Washington Post, “instead of harm reduction — which they might be quick to suggest for opioid addicts — they advise politicians to restrict vaping as much as possible, even if that means more deaths from cancer, stroke and lung disease.”
In the meantime, parents are still looking for ways to help their children who don’t know how to quit consuming nicotine on their own.
Harris at the Fontana Tobacco Treatment Center, said they get distressed calls from parents whose children have become very nicotine dependent. They’re trying to find a pediatrician to work for the center, but most facilities are still working to develop treatment for kids who got hooked through vapor instead of smoke.
Vinay Saranga, a child and adolescent psychiatrist, said the main tool he has been able to offer his young patients so far is to text “DITCHJUUL” to 88709, a line that provides support and “inspirational stories.”
While Harris said the ban on flavored e-cigarettes was a crucial step, she also acknowledged, “There’s still this huge population that’s already been trapped.”
As one parent of a vaping teen told Time, “The only way to fight the epidemic is to help and treat them, because it is an addiction.”