Vaping and Nicotine Addiction

     The news media reports that the U.S. Food and Drug Administration has increased the federal minimum age for tobacco purchases from 18 to 21.  This applies to tobacco and vaping products such as e-cigarettes (5).  The article has appeared in USA Today a few days before New Year 2020.

     This is not the first time the FDA placed restrictions on these products.  For example, in 2016, there were limitations on tobacco products, and these included e-cigarettes.  There has also been concern about Juul vaping devices which two Stanford graduates created.  However, in 2018, the FDA requested information about adolescent usage, research, marketing, and public health issues.  The federal government decided that the products should not have too much appeal to youth (2).

     Tobacco products always create risk, and this includes e-cigarettes.  Whenever someone experiences clinical signs and symptoms after the use of these substances, he or she must visit a physician for evaluation (1, 2, 3, 4, 5).

     A mistake of many people is the inhalation of an aerosol which may have nicotine.  It may resemble pipes, cigars, USB flash drives, or writing pens.  There may be flavorings, and this leads young people to believe that medical dangers do not exist.  In other words, one may believe that he or she is safe.  Adolescents may not know that this is present in some of them (1, 2, 3, 4).

     Moreover, it is easy for kindergarten through twelve students to hide these from parents and teachers. This makes it difficult to control as well (1, 2, 3, 4).  There is also much discussion about the Juul method.  It does contain nicotine, and its use may lead to addiction.  Children who use it may suffer from poisoning when they swallow the substance.  Also, there have been fires when batteries from these materials do not operate well (1, 2, 3, 4).

     “Adolescents who vape are three times as likely to become traditional cigarette smokers” (2).  It is also true that their use is especially common among young minorities in the United States.  Such an observation especially occurs with Hispanics.  The occurrence of lung injury in these clients may result from hypersensitivity pneumonitis, acute respiratory distress syndrome, organizing pneumonia, and acute eosinophilic pneumonia (2). 

     These devices have been in the United States market since 2007.  In 2016, the United States Surgeon General stated that their use was a major public health concern.  These items can lead to death of the patient when the chemicals enter the human lung.  Well-known substances include acetone and heavy metals.  The sales of these materials currently are approximately $7 billion yearly (1, 2, 3).

     As early as 2003, researchers in Beijing made e-cigarettes which were effective.  Four years later they came to the United States (2).

     A major concern is that youth do not recognize the serious nature of chemical exposure.  There may be methamphetamine, lysergic acid diethylamide (LSD), crack cocaine, and synthetic cannabinoid receptor agonists.  Though cigarette advertisements in the United States have not existed since 1971, the promotion of e-cigarettes has continued.  They reached a cost of $115 million in 2014 (2).

     Obviously, the chemicals in vape liquids may be toxic.  Examples include formaldehyde, propylene glycol, carcinogenic nitrosamines, metals, and particulate matter.  Furthermore, some e-liquids may be cytotoxic to lung epithelial cells as well as human embryonic stem cells (1, 2, 3, 4).

     The effects of nicotine are well-known to researchers.  Specifically, it affects the nervous system of young people.  This has an adverse effect in terms of learning, reward processing, emotional regulation, and memory.  One must remember that in the United States each year, there are 480,000 deaths from cigarette smoking.  Whereas cessation can be an effective remedy for many, there is generally little progress as patients have relapses (1, 2, 3, 4). 

     In any event, the U.S. Food and Drug Administration has approved nicotine replacement therapies such as nasal spray, inhalers, lozenges, patches, or gum.  The obstacle to these approaches is that those who use these methods may find themselves switching to e-cigarettes         (1, 2, 3, 4).  There are restrictions on the use of Juul as the U.S. Food and Drug Administration has explored this method.  One restriction, however, is the age limitation of at least 21.  Though these matters have been items of debate, there is, nevertheless, some scrutiny.

     Additionally, the Child Nicotine Poisoning Prevention Act became available in 2015.  Its purpose is to prevent small children from opening packages which may have chemicals that are dangerous to them (2).  In the meantime, “There are currently no established treatment approaches for adolescents who have become addicted to vaping” (2).  However, there may be benefit from cognitive behavioral therapy.  Moreover, price increases may help the situation.  Parents must communicate with health care professionals.  Naturally, removal of e-cigarettes which have flavor is another approach (2). 

     The use of vaping devices means that one uses e-cigarettes.  Some who use them do not know that they may contain tetrahydrocannabinol (THC) which is a well-known agent in marijuana.  These preparations may contain several things together such as oil, nicotine, and flavorings.  Also, there is serious concern about vitamin E acetate which worsens the medical situation of those who try these chemicals.  Nevertheless, vitamin E acetate does not pose a health issue when one applies it to the skin or swallows it by mouth (1, 2, 3, 4).

     The clinical picture of those who experience medical issues from vaping may include chest pain, shortness of breath, fever, and diarrhea.  Without question, pregnant women must never engage in the use of e-cigarettes or other vaping products.  Adolescents should never participate in these practices.  Those who have substance use disorders will require medical evaluation and treatment.  Of great importance is the distribution of these devices to teen age individuals. They should never accept any of them regardless of whether they come from friends, relatives, online sellers, or anyone else (1, 2, 3).

     The public health issues which arise from vaping have existed in the United States for many years.  Its solution will require a multidisciplinary approach with family, school systems, mental health personnel, and community involvement.  Government regulations will be necessary to stop some of the factors which worsen this problem.  As with other health issues, this one will require data collection, literature review, and analysis of this complex matter.

1. National Institute on Drug Abuse.  (2019).  Vaping devices (Electronic cigarettes). 
2. Dinardo, P. and Rome, E.  (2019).  Vaping:  The new wave of nicotine addiction.  Cleveland Clinic Journal of Medicine, 86, 789-798.
3. U.S. Centers for Disease Control and Prevention.  (2019).  Outbreak of lung injury associated with the use of e-cigarette or vaping products. 
4. Blaha, M.  (2019).  The Johns Hopkins Hospital.  Five vaping facts you need to know.
5. Joshua Bote.  USA Today.  (2019).  FDA officially raises federal minimum age to purchase all tobacco products from 18 to 21.
6. Copyright 2020.  Michael Koger, Sr., M.D.  All rights reserved.

     The information contained in this article is for educational purposes only, and one should not use it for diagnosis or treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.