In just two months, more than 400 cases of severe pulmonary disease among users of electronic cigarette products have been reported in no fewer than 25 states.
According to the Centers for Disease Control and Prevention (CDC), the cases, which have been primarily among adolescents, are currently under investigation and may be related to high levels of vitamin E in cartridges of cannabis vaping products. Amid this vaping investigation, Michigan became the first state to ban the sale of flavored e-cigarettes.
Electronic cigarettes, or e-cigarettes, have many names, including e-cigs, vape pens, e-hookahs and e-cigars. Using an e-cigarette is often called ‘vaping’, but the ubiquity of one e-cigarette company has given rise to another brand-centric term for use, JUULing.
E-cigarettes come in many shapes and sizes. Some, like JUULs, resemble USB flash drives or pens while others are larger tank systems or ‘mods’. In any form, e-cigarettes work by heating a liquid solution, which usually contains nicotine and flavoring, to a high enough temperature that it produces an inhalable aerosol.
While nicotine levels in e-cigarettes are highly variable, one pod from the top-selling e-cigarette brand, JUUL, contains as much nicotine as a pack of 20 regular cigarettes.
Although there has been some debate as to whether e-cigarettes may be used by adult smokers to transition away from combustible cigarettes, e-cigarettes have not received Food and Drug Administration approval as smoking cessation devices and even JUUL’s CEO has warned against their use.
Among adolescent never-smokers, there is evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future. Even if young adults do not progress to future cigarette smoking, vaping is unsafe and addictive.
Although smoking rates among adults reached an all-time low in 2017, there has been a dramatic rise in youth vaping.
From 2017 to 2018, the National Youth Tobacco Survey results confirm that there was a 78% increase in e-cigarette use among high school students and a 48% increase among middle school students. By 2018, the total number of middle and high school students currently vaping rose to 3.6 million.
Although there is a large body of research on adult smoking cessation methods, there is little information about how drug or behavioral interventions may support youth e-cigarette cessation.
Among adolescents, motivational interviewing and face-to-face cessation counseling appear to increase quit attempts and cessation.
While nicotine replacement therapies (NRTs) have been shown to increase quit attempts in youth, they have not been shown to have long-term improvements on cessation. Moreover, NRTs have not been approved for use in youth under the age of 18.
Transcranial magnetic stimulation (TMS), a noninvasive neuro-modulatory therapy, has emerged as a promising therapeutic treatment for addiction. In adults with nicotine use disorder, TMS treatment has been shown to be highly effective in reducing craving and increasing cessation of tobacco use.
As vaping-linked respiratory illnesses surge among school-aged youth, parents, clinicians and policy makers are desperate for adolescent e-cigarette addiction treatments. In an attempt to close this treatment gap, the Truth Initiative launched a text-based e-cigarette quit program. Additionally, the FDA has begun to investigate ways to help young adults who are addicted to vaping.
When other causes of pulmonary disease are not identified, the CDC urges clinicians to consider the possibility of vaping in patients who report e-cigarette use within the past 90 days. Although there is insufficient understanding of vaping-related pulmonary disease to provide clinical recommendations, a recent study concluded that patients have improved with prolonged courses of glucocorticoid therapy.
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August 22-23, 2019, Barcelona, Spain
Dr. Martha Koo, M.D. served as a plenary speaker and presented on transcranial magnetic stimulation in the treatment of addiction.
When : September 21, 2019
Where : Palos Verdes, CA
What : Dr. Martha Koo, M.D. is presenting on advancements in neuroscience and technology: transcranial magnetic stimulation and photobiomodulation.