I applaud both the recent media coverage and action by local government officials and schools on vaping. As the medical director of Day One, a nonprofit dedicated to improving the health of Maine by providing substance use, mental health and wellness services to youth and families, I recognize the importance of helping families understand that e-cigarettes have not been proven as a safe alternative to smoking. The recent deaths associated with vaping are tragic and possibly avoidable. There is, however, a broader problem affecting our youth who use e-cigarettes.

After a hard fought decline in smoking among young people, we are seeing a rapid rise in e-cigarette use. This is thought to be due to added flavors, less cost, misconception of safety and less obvious use (odor and smoke). As a novelty, many kids are trying it that might not have tried smoking; it can be a “cool” thing to do. In reality, doses of nicotine may be higher in e-cigarettes than traditional tobacco products. Some say the dangerous impurities found in traditional cigarettes are not present in e-cigarettes, however, as the recent deaths suggest, contaminants in e-cigarettes may actually be more dangerous. They can include cancer causing chemicals, heavy metals, other organic chemicals that are harmful to the user and others exposed to the vapor. And there have been no long-term studies done that address the safety of e-cigarettes. To add to the problem, e-cigarettes are also increasingly used as a vehicle for inhalation of controlled substances.

We know our brains and other parts of our nervous system do not fully mature until the mid-20s. Chemicals, such as nicotine, opioids, stimulants and sedatives, can affect a maturing brain in ways more profound and irreversible than a fully matured brain. In our substance use recovery work this fact is central to urgent and relentless attention to any hazardous compound our youths may use. As we all know, habits formed as an adult are difficult to abandon. Imagine such habits may be more quickly hard-wired in a youth’s brain and the increased difficulty of change. Then think of the lifelong effects.

In my practice of family medicine I am fortunate to see young people (some that I delivered!) and feel grateful for their honesty and ability to share experiences with me. In the last two weeks I saw two 7th graders and an 8th grader. All three were very knowledgeable about vaping and had school acquaintances that were actively using e-cigarettes. One patient had tried it ‘but didn’t like it’ (thankfully). If there is such awareness, and use, by patients in my small practice, one can imagine the penetration in the broader society.

In my work, I have also consulted with clinicians who are seeing a corresponding increase in the use of e-cigarettes. As the agency on the front lines of treating adolescent substance use, Day One and its clinicians are in a unique setting to help teens understand the reality that nicotine is an addictive substance and e-cigarettes in particular deliver a powerful dose. As they do with other drugs, clinicians can help teens recognize the negative impact of nicotine. Youth can be assisted in pinpointing the reasons they may have begun to use it in the first place, and address the underlying causes to help them learn healthy decision-making skills.

I reaffirm the media’s efforts to provide pertinent information about e-cigarettes and wonder how we can secure the necessary support to keep this practice out of the hands, and minds, of our children. Let’s speak up against e-cigarette use in youth, just as we have against traditional cigarette smoking and use of controlled substances. Adolescence is enough of a challenge without handicapping by untoward neurological and physiological dangers.

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