The Vaping Deception: Depression, anxiety, nicotine withdrawal
Health reporter Jayne O’Donnell talks to Food and Drug Administration commissioner about opioids, cigarettes and addiction. USA TODAY
Andrea “Nick’ Tattanelli quit vaping in August.
“Oh man,” the 39-year-old Kansas City man says. “It was hell.”
The mortgage banker was depressed for three days. He felt a void in his life.
“it’s delicious. It’s too attractive,” he says. “You don’t make something you can vape in a watermelon flavor and think people aren’t going to do it all the time.”
Vaping did help Tattantelli stop smoking, a habit since he was 17. That’s ostensibly the purpose of e-cigarettes: To help smokers quit. So for that he’s thankful.
But it can be so hard for users to wean themselves off vaping that the Food and Drug Administration is considering some addiction specialists are questioning whether it’s the best way to stop smoking.
Dr. Malissa Barbosa has her doubts. Barbosa, the area medical director at CleanSlate Outpatient Addiction Medicine in Orlando, says vaping is more addictive than smoking because the concentrated liquid form is more quickly metabolized.
She says nicotine is more difficult to quit than alcohol or any of the drugs her patients were addicted to. Receptors in the brain “grab onto the nicotine molecule because it’s similar to something we make naturally,” she says, and it’s more difficult to release from the body.
“The thing is, the studies aren’t fully available around vaping and I’m very conservative,” Barbosa says. “This is new, and I say, ‘Why aren’t we thinking of traditional means of quitting?”
Dr. Jonathan Winickoff’s patients include middle and high school students. The withdrawal from nicotine is so difficult, the Boston pediatrician says, that most don’t even try to stop.
The Food and Drug Administration (FDA) has scheduled a hearing Jan. 19 on therapies for young people who are addicted to nicotine. There currently aren’t any drugs approved for minors.
“The fact that the FDA even has to hold this hearing is telling,” says Becky Wexler, a spokeswoman for the Campaign for Tobacco Free Kids. “It shows us that the rise in popularity of JUUL and other e-cigarettes has created a new generation of kids who are addicted to nicotine and need help quitting.”
About 3.6 million middle and high school students use electronic cigarettes, according to the most recent federal data. Federal regulators now describe youth vaping as an “epidemic.”
Nearly 21 percent of high school seniors say they vaped a nicotine product within the past 30 days, according to the National Institute for Drug Abuse, up from 11 percent a year ago.
The increase, reported this month in the annual Monitoring the Future survey on drug use among adolescents, was the largest for any substance n the report’s 43-year history.
Surgeon General Dr. Jerome Adams last week called on states to consider adopting new price policies that could include taxes, along with indoor vape-free policies to curb use by adolescents.
Food and Drug Administration Commissioner Dr. Scott Gottlieb announced plans last month to tighten tobacco enforcement, ban menthol cigarettes and many flavored small cigars, and restrict sales of sweet-flavored electronic cigarette liquid.
The moves have raised the ire of vaping advocates, who say they will hamper the ability of adult smokers to use vaping to quit their cancer-causing addictions.
Kevin Kee, 22, quit smoking and then vaping a year ago. He says vaping was a harder habit to break.
“There are many moments when I want to take a drag or a puff, especially at the end of the day,” the Reston, Virginia, man says. “It was weird when I stopped because I had gotten accustomed to vaping as a part of my life.”
Barbosa treats addictions to opioids, alcohol and other substances. She says smoking is often “the last of the holy grail,” because it’s “best to get off all of it.”
Barbosa says she sometimes helps patients use vaping to “step down” from a minimal level of nicotine to none – but always with “a note of caution.”
To date, Barbosa says, only one of her patients has quit vaping – after experiencing headaches, nausea and agitation. Barbosa has about 20 more to go.
Elvijs Arnicans, 25, posted recently on WhyQuit.com’s Facebook forum that he wished he knew how hard it was going to be when he stopped vaping two weeks ago.
At his peak, the Dublin, Ireland, man says, he was vaping about 24 milligrams of nicotine a day – the equivalent of two cigarettes. He got that down to about 12 mg, and then to 6 mg, before he stopped completely.
Arnicans, an electrical apprentice in a factory, started smoking at 13. He says it took him about a year of trying to finally quit.
He started vaping in high school, where he did it throughout class, and through classes for his apprenticeship. He often fell asleep with the device in his hand.
Quitting was horrible, he tells USA TODAY.
“I feel like my brain gets turned down and only works at about 20 percent capability,” he says.
His withdrawal symptoms included “intense tiredness for the first three days, and then the cravings intensify as the brain fog clears, and no enjoyment in pleasurable activities experienced until about day three.”
“I found myself unconsciously reaching for my vape every 10 minutes or so,” he says. “I found it incredibly difficult to concentrate on simple tasks.”
Winickoff describes more troubling withdrawal symptoms in his young patients. Winickoff, a pediatrician at Massachusetts General Hospital for Children, directs translational research at the American Academy of Pediatrics’ Richmond Center for Excellence, which focuses on tobacco control.
“They have an inability to concentrate and a pervasive desire to use the substance,” says Winickoff. “It overwhelms anything else the adolescent is doing. They become annoyed, anxious, and don’t want to do anything but get the nicotine their brain needs.”
Winickoff points to the capture of the youth vape market by JUUL, a leading e-cigarette manufacturer, and the recent investment in JUUL Labs by Altria, the company formerly known as Philip Morris.
Just as smoking has hit its lowest level since World War II, a new generation of young people is now hooked on nicotine.
If vaping is too difficult for them to quit, these unlikely tobacco users can become long-term vapers or, possibly, dual users with cigarettes or other combustible tobacco products.
“It’s almost as if JUUL Corp. had been planning this from the beginning, because it’s Big Tobacco’s dream scenario,” says Winickoff.
JUUL Labs spokeswoman Victoria Davis rejects the claim.
“JUUL is intended for current adult smokers only. We cannot be more emphatic on this point: no young person or non-nicotine user should ever try JUUL,” she wrote in an email.
“Underage use of JUUL and any other vaping products is completely unacceptable to us and is directly opposed to our mission of eliminating cigarettes by offering existing adult smokers a true alternative to combustible cigarettes.”
Tattanelli is alarmed so many young people are addicted.
“You’re going to end up hooked and probably have good decade-long fight to quit, if you’re even able,” he says.
Dr. Michael Blaha is a cardiologist and professor at the Johns Hopkins medical school in Baltimore.
“We know how hard it is to quit smoking,” he says. With vaping, “we’re really dealing with much of the same problem.”
“Early on there were some reports vaping was less addictive,” he says. “But that’s still something that can be debated.”