Parents see their teens struggle with e-cig addiction
When her son was a high school freshman, Kristin Beauparlant noticed a change. The hockey player began getting gassed more easily on the ice. Ms. Beauparlant could hear her son’s coughing and wheezing from the stands. But it was his demeanor that scared her most. Cade Beauparlant’s anxiety and mood swings worsened, his outbursts so sudden and so explosive that his mother said she came to fear him.
It took more than three years — and help from a renowned pediatrician — to understand what was going on: Her son was addicted to nicotine, delivered by a Juul, a sleek electronic cigarette that looks like a USB drive.
As e-cigarettes have skyrocketed in popularity among teenagers in the past two years, pediatricians report seeing teens who behave less like tobacco users and more like patients with substanceabuse disorders.
Some young people have resorted to stealing from their parents or selling e-cigarette paraphernalia to support their habits, addiction treatment specialists said. And even though many teens assume e-cigarettes are safe, some turn up with signs of nicotine toxicity, a condition previously seen in young children who accidentally ingested nicotine gum. Others are reporting respiratory problems. After more than three years of vaping daily, Cade Beauparlant was diagnosed with restrictive lung disease. His mother said she is working with an attorney to file a classaction lawsuit against Juul that would force it to set up treatment centers.
“We were thinking about vapes just like we thought about cigarettes. Over time we realized no, no. This is something really different,” said Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital. She and other doctors said they believe they are witnessing for the first time the damage that repeated exposure to high levels of nicotine wreaks on young bodies.
Although the phenomenon has yet to be described in medical literature, anecdotal evidence from leading addiction specialists in Boston and New York and from families grappling with adolescent e-cigarette addiction points to previously unseen consequences of use among teens. Several families have sued Juul, accusing it of causing nicotine addiction in their children and describing extreme addiction symptoms.
Doctors said they believe the behaviors of teens addicted to e-cigarettes could be linked to their design: Many products, including
Juul, allow users to ingest far more nicotine than they would with traditional cigarettes. Concerns over teen use fueled a ban on e-cigarette sales that was adopted in June by San Francisco — a move that made it the first major city to prohibit the nicotine-delivery devices.
“With the Juuls, kids are able to get a much higher dose of nicotine — and dose matters,” Dr. Levy said. “These kids have behaviors that we often see in patients who have opioid or marijuana addiction, but we didn’t typically see with kids who developed addiction to traditional tobacco cigarettes.”
This week, a House subcommittee accused Juul Labs of targeting children and teens, including at schools and summer camp. Company officials said the effort — involving about a half-dozen schools and youth programs — ceased last fall and was designed to educate youths about the dangers of nicotine addiction.
Juul has defended the design of its products, saying they were engineered with adult smokers in mind. The company says its own clinical trials show that nicotine is absorbed more slowly through use of its e-cigarette than through traditional cigarettes.
But doctors say teens consume e-cigarettes at far faster rates than they do traditional cigarettes, with some consuming a pod or more a day — equivalent to the amount of nicotine in a pack of cigarettes. E-cigarette vapor does not burn the throat as much as cigarette smoke does, and its discretion allows consumers to use ecigarettes more frequently.
Because of a variety of factors — genetics, trauma, peer behavior — some teens develop a strong attachment to the products, bonds that are unshakable even in the face of escalating consequences. Experts say teen brains are particularly vulnerable to addiction because they are still developing and that it is easier for teens to fall victim to addictive products because they have less impulse control.
They worry the chemical will shape the brains of teens, priming their “reward pathways” and making them more vulnerable to other kinds of substance abuse. They worry, too, that many pediatricians lack the expertise and treatments to help young people who cannot quit. And there are few treatment options for teens addicted to nicotine.
While adult smokers seeking to quit have benefited from nicotine patches and the drug varenicline, better known as Chantix, there is scant evidence those treatments work for young people, according to Jonathan Winickoff, a pediatrician and researcher at Massachusetts General Hospital who specializes in tobacco cessation and who treated Cade Beauparlant.
“We have millions of kids now, millions of adolescents who are using mostly Juul — and in some cases other devices — who are unable to quit,” Dr. Winickoff said. “It’s something we don’t have the infrastructure to deal with.”
In response to criticism and scrutiny from the Food and Drug
“With the Juuls, kids are able to get a much higher dose of nicotine — and dose matters.”
Dr. Sharon Levy
Administration, Juul Labs has taken steps to counter teen use. The company has removed fruit-flavored pods, the cartridges filled with nicotine-laced liquids, from retail stores — although they remain available online. The company has also shifted marketing to feature adults using the device to quit smoking, abandoned social media and backed laws that raise the minimum age of purchase for e-cigarettes to 21.
‘The Fiend’
Luka Kinard took his first puff of a Juul during the homecoming football game his freshman year at High Point High School in North Carolina. Within a couple of weeks, he said it had become a habit, and within a few months, he had started selling the pods. His classmates called him “The Fiend,” he said.
At home, he said, he grew erratic, sometimes punching walls, destroying furniture or throwing things when he was angry at his parents for confiscating his e-cigarettes. He once kicked down the back door of his house when his parents had told him to go outside to cool off.
“I became very explosive,” said Luka, now 16.
Parents seeking help have encountered pediatricians who did not understand the magnitude of the addiction or had few answers. Eventually, Luka’s mother, Kelly Kinard, started researching inpatient substance abuse programs, but struggled to find one that would take a teenager dependent on nicotine.
In Martinsburg, W.Va., a community reeling from the opioid crisis, Martinsburg High suspended 27 students in the just-completed school year — 20 more than the previous school year — in connection with vaping. The school’s resource officer also gave out criminal citations to many of those students under the state’s ban on tobacco on public school campuses.
About 70% of students at Martinsburg High come from low-income households, and about a third of students are people of color, demographics that contradict earlier assumptions about the epidemic being confined to wealthier white communities where smoking rates had dropped steeply.
The Washington Post’s Laurie McGinley and William Wan contributed to this report.