
Addicted to vaped nicotine, teenagers have no clear path to quitting - ductionist
https://www.nytimes.com/2018/12/18/health/vaping-nicotine-teenagers.html
======
Raidion
As someone who has never smoked, but juuls occasionally, I would like to see
some studies on the health effects on nicotine alone. Much of the anti smoking
literature focuses on the health effects of inhaling burning plant matter
along with nicotine. How different is a straight nicotine addiction from that
of a coffee addiction? A heavy coffee drinker is chemically dependent on the
caffeine, but there isn't any cultural or even health pressure to quit coffee
(unless some heart/BP issues). You even see articles that say that coffee has
health benefits.

I go through great lengths to insure that I don't become dependent on either,
though I enjoy both. Caffeine really does reduce fatigue, and nicotine 'dials
you in' when you're focusing. Wish I knew what the chemicals themselves were
doing to me without the complications from the delivery systems.

~~~
elektor
Here is a new study that looked at urine samples from only smokers, only e-cig
users, dual smokers, and never smokers:

[https://jamanetwork.com/journals/jamanetworkopen/fullarticle...](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718096?widget=personalizedcontent&previousarticle=0)

If you look at Figure 1, the e-cig users and never smokers are pretty similar.

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adrianN
How many of the teenagers that vape today would have used cigarettes fifteen
years ago? If you asked my class whether they know someone who regularly
smokes because "they have to" everybody would have raised their hands. I think
about a third smoked at least occasionally, at parties and such.

I'm not convinced that vaping is a bigger problem or that it's harder to quit
vaping than smoking. How is reducing the frequency of vaping, or choosing
liquids with lower nicotine content, not possible with vaping, but reducing
the number of cigarettes you smoke per day is?

~~~
bredren
The article specifically calls out the problem of unit measurement when vaping
due to varying amounts of nicotine.

The devices themselves have varying liquid capacity and vaporizing volume
settings--you can't easily track how many pulls until the device is empty.

Battery limitations also confuse the amount "left" in the device.

Cigarette units are simpler, in part because there aren't that many brands,
and even if you roll your own, you probably have a pretty good idea of how
much tobacco you're putting in the cigarettes.

But especially with boxes of cigarettes, you can easily count them down and
keep track knowing each starts with 20.

I'd also suggest that cigarette use is far more difficult to hide than
vaporizer use. Cigarettes smell terrible compared to most vape clouds. The
smell and risk of iscovery could be important elements of cigarettes that
might make them easier for teenagers to quit.

Finally, vaping comes in just about every flavor imaginable. Much more diverse
in taste offering than cigarettes with the same high. It is really a much more
refined narcotic delivery than cigarettes and so it aught to be harder for
anyone to quit.

~~~
adrianN
I don't vape, but I imagine that the user has a relatively good idea how much
they inhale and how much liquid they use per day (or week). It's not like they
switch devices, settings, and liquids all the time.

~~~
barry-cotter
Some people do but they’re even less of a concern because they’re vape nerds.
They know perfectly well how much they’re consuming. It’s hard to avoid
knowing it when you have to buy new cartridges or bottles of fluid when you
run out.

~~~
ce4
Exactly. it compares pretty well, number of packs vs number of eg. of 10ml
bottles. Or number of refills, battery switches, recharges needed.

Also: most vapes have a trigger counter.

------
jdnier
I remember an interesting summary posted on HN back in 2013 about nicotine and
tobacco. This was before vaping became popular, but the case he made was that
nicotine is actually not very addictive on it own, but seems to reinforce
addiction in the presence of other compounds found in tobacco (e.g., MAOIs).
Lots of primary sources given.

So what else is in vaping liquid?

"Nicotine as a useful stimulant" (gwern.net)

[https://news.ycombinator.com/item?id=6457772](https://news.ycombinator.com/item?id=6457772)

~~~
nicotine_temp
Positive comments about nicotine in the LessWrong community were a major
reason why I started vaping. I found the addiction to be less serious than
commonly claimed, but I also found the beneficial effects to be small. I
couldn't say with confidence that it's better than caffeine, and caffeine is
more socially acceptable. I don't suppose I'd be shadowbanned for telling
people my experience of caffeine.

------
beizhia
These kind of articles always seem odd to me. I've used an e-cig to stop
smoking. Worked myself down from 21mg juice to 3mg, step by step. Now I really
only use it when I'm out drinking, to prevent myself from wanting a cigarette
(old habits do die hard, after all)

The e-cig helped, but the real motivator is that I wanted to run and play
soccer more effectively. Vaping was just a tool that kept me away from
cigarettes.

~~~
ce4
And one very nice side effect of vapes that I noticed to be crucial for
weaning off more easily:

Vaped nicotine feels way less addicting. I think its got something to do with
other "active agents" and additives missing compared to cigarettes.

Edit: For example, studies have shown cigarette smoke to inhibit MAO in the
brain due to some agent besides nicotine, which vaping very probably doesnt.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC19495/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC19495/)

~~~
seanmcdirmid
This, but for the same reason I found vaping not very useful in stopping my
cigarette habit (I missed more than just the nicotine). I’ve heard some of the
salts in newer vapes have solved that problem, but who knows what those do.

~~~
ce4
I'm off of both now and even can have a single cigarette every now and then
without having a relapse. Glad to have never tried those salts.

------
robinduckett
Except "reduce the intake of nicotine, with some self discipline".

In the UK, a lot of vape liquid is sold with no nicotine. You state your
preferred level of nicotine, and someone behind the desk tells you how much
nicotine to purchase to get that level of nicotine in the vape.

You can vape as is, with no nicotine, but what's the point unless you're
quitting?

~~~
bad_user
I’ve been a smoker and I can tell you, reducing the nicotine doesn’t work. And
there is no such thing as “self discipline” that can help, unless you’re
talking about quitting all smoking.

A tiny amount of nicotine is enough to maintain or reactivate your physical
addiction. This is why the phrase “once a smoker always a smoker”, because for
people like me it doesn’t matter that we haven’t smoked in 4 years, a single
cigarette will bring back that addiction with a vengeance.

A minority of people supposedly have an easier time quitting. Hence the joke:
Quitting is easy, I did it dozens of times already.

Nicotine is one of the most addictive substances. AFAIK it ranks higher than
drugs like cocaine.

The best strategy is quitting cold turkey, but the withdrawal symptoms can be
severe. For people that failed that, there is some medication available that
can interfere with the brain receptors to reduce the cravings.

~~~
pseudalopex
I know several people who quit smoking by switching to vaping and reducing the
nicotine concentration. All of them had tried to quit before. At least one of
them had tried medication. It does work for some people.

------
warmblanket
I smoked for ten years and recently switched to vaping. I don't believe it is
necessarily healthier or less addictive, but I do think it might be easier on
the lungs and vocal cords (I sing), even though not vaping or smoking at all
is clearly the best option.

So, I have tried patches before, and I got relentlessly addicted to them. I
wore them for something like two years. I have ADHD and take stimulant
medication for it, and stimulants are pretty famous for causing tobacco users
to smoke a lot more.

After I got used to the e-cigarettes/vaping, I don't want to go back. I
decline offers from friends for real cigarettes when out drinking at
bars/etc., and I have had a pack of cigarettes in my house for about 6 weeks
now without smoking a single one. The taste and smell just isn't good anymore
now that I'm off the "analogs".

It's hard to know how much nicotine I'm ingesting, though. Smoking real
cigarettes now gives me a strong nicotine buzz that I don't get from vaping,
like that infamous light-headed feeling beginner smokers get. I suspect this
is due to vaping delivery being less efficient and more gradually throughout
the day, but you would think it would be easier to compare, say, a JUUL to a
standard cigarette.

The other problem I've had with my JUUL is leaking. The last few pods I have
vaped, have all leaked considerable amounts of liquid - sometimes on my lips,
sometimes on the sides of the pod and into the chamber. I'm not sure if this
is an issue with my device or QC. I clean the device regularly with a Q-Tip.
Obviously, leaked liquid is not ingested or vaped, so that's lost nicotine and
can't be counted. The same applies to any liquid left in a JUUL pod when it is
thrown away. I've started throwing away pods before they are completely empty,
because its not working as well. Air bubbles are also a problem and lead to
poor performance.

Just my experience, I'm sure I'll get harassed for this since I'm discussing
vape usage, but addictions are addictions, and not everyone wants to quit.

~~~
tigershark
If it goes into your lips is not wasted nicotine, on the contrary you are
overdosing on it. Nicotine is absorbed by the skin as far as I remember.

~~~
ac29
>Nicotine is absorbed by the skin as far as I remember.

Yep, of course it is, otherwise nicotine patches wouldn't work. It's also
absorbed through mucous membranes in the mouth (see dip, chew, snus, etc).

------
danieltillett
As a parent with young teenagers this really worries me. Vaping looks to be a
lot more effective way of delivering high doses of nicotine than cigarettes.
Do we want a generation of kids addicted to vaping because we thought it
harmless?

~~~
sigsergv
> Vaping looks to be a lot more effective way of delivering high doses of
> nicotine than cigarettes

That's not true, from my personal experience cigarettes are MUCH more
powerful.

Also I don't understand why everyone so obsessed about nicotine as a main
active agent. It looks relatively harmless when comparing with smoke, carbon
monoxide, tar in cigarettes and strange substances in e-cigarette vapor (not
including nicotine).

~~~
hn-reporter1911
[https://en.wikipedia.org/wiki/Nicotine](https://en.wikipedia.org/wiki/Nicotine)

Nicotine is one of the most addictive substances known. Cigarettes may indeed
be more powerful, but people are obsessed with nicotine because it’s addictive
qualities are so well known.

~~~
sigsergv
Dependence on nicotine is mostly psychological/social. Nicotine patches could
prevent physical one but people still need to perform smoking “ritual” again
and again.

What I want to say: we should not fight nicotine, we should fight
smoking/vaping.

------
mrkurt
"Addicted to caffeine, teenagers have no clear path to quitting".

"Addicted to fortnight, kids have no clear path to quitting".

"Addicted to social media, millennials have no clear path to mental health".

We've spent 100 years creating companies that grow because addiction works.
It's gonna take a concerted, societal effort to disconnect addiction and
incentives.

~~~
dgut
Addiction is the result of underlying mental health issues though, not a
direct cause of companies selling addictive products... Teens have it rough,
at least they imagine.

Edit: Not sure why the downvotes. There is a trend of putting the blame for N
things on external factors, e.g "he is in debt because of all those credit
card advertisements". For Americans, it might seem like corporations are the
cause of many such ills, but there are societies where e.g aggressive
advertisements which are common in the US are non-existent, and people still
get in debt, eat badly or drink too many sugary drinks.

~~~
TaylorAlexander
I think it’s a genuinely difficult experience to be a teenager. Caught between
worlds, not quite an adult but no longer a child. I wouldn’t want to
invalidate that experience.

~~~
dgut
It's the process of leaving childhood, "the only utopia" as Hayao Miyazaki
once said and entering adulthood which usually implies having
responsibility/taking care of others.

------
013a
> The survey also found that many students believe they are vaping “just
> flavoring.” In fact, just about all brands include nicotine, and Juul has
> particularly high levels of it.

Wow. What?

Minor point, but nearly every flavor of eliquid I've ever seen comes in a 0mg
variant. Granted, none of the gas station pod systems have that.

More importantly: there is no way in hell you are vaping a Juul and just think
its flavored vapor. I have not once seen someone take a hit on a Juul for the
first time and not have a small coughing fit. Unless you inherited an
impossibly massive genetic nicotine tolerance, the first few times you hit a
Juul you're basically going to fly. I've seen one person puke. Having a small
brown-out for a second would not be unheard of. Its very strong. Its made for
adult smokers who have been smoking for years and want to quit. Its not even
that tasty compared to the other less strong brands; nicotine is straight up
disgusting, and only gets more disgusting as the concentration grows.

I don't believe for a second that kids were genuinely self-reporting that they
had no idea, unless they were actually vaping something more like 3mg/ml juice
from a normal vape. That, I could see. But a 50mg/ml Juul, absolutely not.
That's like saying you drank a shot of vodka and had no idea it wasn't water.

~~~
Raidion
I agree with you, but as a note, you'll cough just as hard if you hit a 0mg
nicotine vape for the first time. It's not the nicotine that makes you cough.

------
vbuwivbiu
simple - use cigarettes as an alternative while quitting

------
porlune
Bupropion (wellbutrin) was originally for depression, but can help people quit
smoking.

Note: the effects appear permanent, and you don't have to continue taking the
medication after the first round.

Edit: I'm curious why this was downvoted, I'm simply offering information that
I know has helped others in this very situation.

~~~
scurvy
I was going to suggest this, too. It helped me quit smoking. Unsure about the
effects on teenagers though.

No idea about the down votes; yours is a very reasonable suggestion.

------
xkfm
It's fairly easy to taper your nicotine usage (as well as make your own
juice), but I wouldn't expect teenagers to care that much, or use less
nicotine even if they were making their own.

I had a few incidents with caffeine/energy drinks, but they were arguably a
less harmful and definitely cheaper habit.

~~~
Implicated
What's an 'incident' with caffeine/energy drinks?

~~~
TylerE
It's actually not that hard to OD on caffeine. Doing a couple of strong
espressos in a row would do it for many people. Symptoms similar to a panic
attack.

[https://en.wikipedia.org/wiki/Caffeine#Overdose](https://en.wikipedia.org/wiki/Caffeine#Overdose)

Then you have stuff like this...
[https://www.thinkgeek.com/stuff/41/buzzaire.shtml](https://www.thinkgeek.com/stuff/41/buzzaire.shtml)

~~~
deadlydose
> Then you have stuff like this...
> [https://www.thinkgeek.com/stuff/41/buzzaire.shtml](https://www.thinkgeek.com/stuff/41/buzzaire.shtml)

Scroll to the bottom of the page or click 'Buy Now.'

------
Nasrudith
Serious question what did they do to help teenagers quit cigarettes in the
many decades past? Teenagers certainly were smoking well before the electronic
cigarette was invented and utterly flopped in the 1960s.

I don't see how a delivery mechanism is any different except perhaps poorly
designed regulation and not bringing down the wrath of god upon them
immediately for blatantly violating tobacco advertising laws - I remember far
too many radio commercials that weren't even trying to hide it - as 'a smoking
cessation commercial that spends 75% of the time talking about the
satisfaction and telling them they can use it anywhere'.

~~~
013a
Delivery mechanism really does matter. Vaping is much more accessible than
cigarettes; you can do it indoors with no risk of smelling like anything. You
can do it in bathrooms.

Also, if Nicotine is the only reason people are addicted to cigarettes, why
doesn't something like nicorette see just as much abuse? Delivery mechanism.
Cigarette/Vape users are mentally addicted just as much to the routine and
throat hit as they are to the chemical. I'd actually argue more-so.

~~~
barry-cotter
People have been smoking in bathrooms forever. If large portions of the
teenage population were still smoking the schools would explicitly or
implicitly give up on forbidding it. Trying to ban a behaviour a third of the
population engage in is a losing battle.

Look at France [https://thinkprogress.org/french-high-school-students-
encour...](https://thinkprogress.org/french-high-school-students-encouraged-
to-smoke-indoors-)

> In one of the strangest debates that’s resulted from the spate of shootings
> and bombings across Paris last November, French school administrators are
> weighing the dangers of teen smoking against the threat of potential
> terrorist attacks.

------
nicotine_temp
In my own experience, nicotine was not very addictive. As a non-smoker, I
started vaping 36mg/ml nicotine in unflavored propylene glycol. I used a high
concentration to minimize exposure to any unknown non-nicotine risks. I vaped
heavily for about 2 years before getting bored of it. I tapered the dose to
zero over two weeks and experienced only mild withdrawal symptoms. It's been
about four years since I quit and I've never felt the effects were
sufficiently interesting or enjoyable to start again.

------
NoPicklez
I remember when Vaping gained popularity, and I advocated it as a way for
addicted smokers to slowly reduce their nicotine intake, whilst still having
the physical sensation.

Now the issue is that you can constantly increase the strength of the nicotine
concentration in your own vape.

~~~
wybiral
You can also decrease the concentration. I smoked for years and eventually
switched to vaping for a few months while decreasing the quantity I was using.

The problem with cigarettes is that you have to buy 20 of them at a time and
they're all full-length which makes reducing your intake harder as an addict.

It seems like a dangerous gateway for non-smokers to get hooked but I do still
think it can help smokers taper off. I haven't smoked (or vaped) in two years
after tapering down my intake and quitting.

~~~
NoPicklez
Sorry, that's what I meant by advocating it as a way for addicted smokers to
reduce their nicotine intake. Through decreasing the quantity of Nicotine
added into the vape mixture.

I agree, think Vaping for existing smokers is a great idea. Still gives them
the psychological feeling of holding and breathing in vapor, but doesn't have
the harsh chemicals to go along with it, aside from the Nicotine for which you
control the dosage.

------
mattsfrey
Quitting is hard but it's doable. I smoked off and on for 10 years, the last 3
or so was just bumming cigs when out drunk but finally just gave it up
entirely when I was about to turn 30, have to reach a point where you decide
you're done.

------
Simulacra
Isn't this by design?

