And when there is secretive vaping going on all day in school, he said, young people may be more likely to develop a physiological dependence on nicotine than they were with traditional cigarettes.
Someone who is using a high-concentration nicotine cartridge every day or two, Dr. Hadland said, is probably taking in the equivalent of about a pack of cigarettes a day, much more than adolescents typically smoke.
Nicotine is a stimulant, and like other stimulants, at low doses it can make people feel more alert and attentive; higher doses, Dr. Levy said, do just the opposite, making people jittery, revved up and unable to concentrate. The high-concentration cartridges deliver a bigger, faster hit of nicotine than was possible with traditional cigarettes. “What Juul did was it perfected nicotine delivery,” Dr. Levy said.
“My sense, and there are not data to guide this yet, is that the more severe the nicotine use disorder, the more necessary to give medication,” Dr. Hadland said. That includes nicotine replacement, with patches, and then lozenges or gum to deal with breakthrough cravings. It can also include a medication called Chantix, which can help with cravings, but has not been found to be effective for those 16 and under, and is generally used cautiously in older adolescents and younger adults. The antidepressant medication Wellbutrin is also sometimes used.
“Nicotine replacement doesn’t work as well as it does in adults, but it does increase the quit rate,” Dr. Levy said. “We do a lot of coaching of our pediatric colleagues, we tell them go ahead and be generous,” that is, for example, helping parents understand that because vaping can mean an adolescent is accustomed to a very high dose of nicotine, that kid may go through a lot of lozenges.
All of these medications are more effective with cognitive behavioral therapy to help you deal with your emotions and manage cravings, Dr. Levy said. Counseling is an important part of treatment, and one reason I try hard to refer my patients to specialty clinics is that I want them to have experienced counselors. And treatment is much more likely to be successful when there is support from a parent.
Because of the high nicotine concentrations and the physiological dependence, Dr. Hadland said, young people who are trying to quit vaping may experience symptoms that go well beyond the cravings that those who smoke traditional cigarettes experience when they try to quit. In addition to those very strong cravings, there may be general irritability, headaches or a sense of feeling sick to your stomach.