Vaping nicotine rather than smoking the drug is widely promoted as a safe way to wean off cigarettes, but the popular practice is exposing a new generation to risky substance use. Listen in as host William C. Moyers talks with youth addiction and recovery expert Joseph Lee, MD, about the difference between vaping and smoking, types of vaping devices used for nicotine and other drugs, and the harmful health effects of vaping—especially for teens. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:14 William Moyers Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on issues related to substance use. Issues that matter to us, and issues that matter to you, including prevention, research, addiction, treatment and recovery from substance use disorders. I'm your host William Moyers and joining us today is Dr. Joe Lee. Joe, welcome. 0:00:39 Dr. Joe Lee Thanks for having me again. 0:00:40 W William Moyers Thanks for being here again. Our topic today is one that you know a lot about called vaping. Specifically, what's the harm in vaping? And, if you would please Joe for our audience, describe a little bit of what is vaping. 0:00:52 Dr. Joe Lee Well vaping just means turning some liquid or a dry thing into a vapor basically, a mist, that then you can inhale. And so, it's become popular in different arenas mainly with nicotine. But also with marijuana some. And there are lots of other chemicals that you can technically vaporize and so there's technology that's used to turn things into a kind of mist. And there's a lot of science behind that. But that in general is called vaping. So it's a catch-all phrase where lots of different kinds of chemicals are basically turned into a mist and inhaled. 0:01:32 William Moyers You're the Medical Director of our Youth Continuum for the Hazelden Betty Ford Foundation. And so, much of your focus obviously is on youth. Are you seeing a lot of youth vaping? 0:01:42 Dr. Joe Lee Yeah I don't wanna use the word epidemic lightly. But, let's just say that for decades, prior to us talking about marijuana legalization or anything else, we had done a great job as a community reducing the amount of tobacco use by youth and adults in the country. And tobacco use in the country had been dwindling for the past two or three decades. And I think it's safe to say that this vaping culture and the economics behind vaping has completely eradicated those gains. And you're seeing many people take to vaping 'cause they see it as a safer alternative. It was initially marketed to people who are heavier smokers so that they could get off tobacco products, and it was believed to be less carcinogenic. And certainly the—some of the chemicals are less carcinogenic or toxic to us, but what's actually happened is you know more than a cottage industry, a booming industry where they actually cater to younger and younger people who then get addicted to nicotine products via vaping. 0:02:42 William Moyers So, it's oriented primarily towards a young consumer? 0:02:47 Dr. Joe Lee Yeah, all of the playbook is very much like the nicotine industry. Tobacco industry what they used to do was they wanted people getting addicted early. 'Cause then they knew that they would die in their fifties due to heart disease and all other complications from cigarette use that we know now. And so, you gotta get the customers on early. And you gotta make the product as addictive as possible. So they put a lot of science and effort into that. So it's always been a play where you cater to a younger audience 'cause then you know that the addiction will create a habit that earns you a profit for a very long time. 0:03:20 William Moyers Why is vaping relevant to our population? 0:03:24 Dr. Joe Lee Well young people like it because of some assumed safety. That it's maybe better than tobacco products. And I think that's somewhat misleading 'cause nicotine by itself can be toxic just as a chemical. And the addiction is still just as real whether there are carcinogens attached or not. Long-term studies aren't established on exactly how safe vaping is. And so young people like the false assumption that maybe it's safer than using tobacco products. And they also like the discreet aspect. Because it doesn't smell as much and so if they wanna be discreet about their use, they can be. And I think they also like the technological aspects of it. Some of the flavors that you can get for nicotine products that you can use in e-cigs and vape pens are attractive to people. So you've heard of Juul and other companies. And they've kind of rightly owned that in their advertising they've basically targeted young people. And they're trying to reverse that but if you're trying to make a profit in the vaping industry, I don't see how you can't really try to ensnare more young people. I think that's really their business model. And I think that they should be more transparent about it. Because a lot of young people are getting hooked on nicotine products this way. 0:04:30 William Moyers And what about as you eluded to earlier the vaping of other substances? Primarily I'm thinking about marijuana. How does that work? 0:04:39 Dr. Joe Lee Well, it's complicated but you don't have to vape just a liquid. You can vape a dry good or a solid or a wax. So, there's lots of different things that can be put in a vaping apparatus. And so the vaping technology has evolved quite a bit. There are even some things where you can vape more than one kind of thing. You know so like marijuana and nicotine. Or some people go online and figure out how to rig their vape pens so that they can vape both marijuana and nicotine. It's not a super popular thing to do they just usually carry around two different kinds of technology generally if they wanna do that. But marijuana concentrates can be vaped, people have known that for a long time so this isn't new. There's a thing called an atomizer which is just a fancy way of saying that's the thing that turns it into mist. And you can do it by heating it, you can do it by convection, which is a different kind of heating—you can do it lots of different ways. But the danger is that you know it's appealing to young people. And the people are using high-potency chemicals. Getting addicted very quickly. And if you look at the tobacco data, if your child is using or teenager is using tobacco products, it's kind of a harbinger for the future that a lot of bad things are gonna happen. And I'm not talking about gateway drug stuff even. Dropouts from school, school attendance, mental health issues, it's been a correlative but very powerful correlation that young people who use nicotine products are just in more trouble and at higher risk when they grow up. 0:06:05 William Moyers Why though, Joe? 0:06:07 Dr. Joe Lee It has to do with the population. It's probably that they're a high-risk population to start with. And so, when you look at any substance—and I've said this on your show before—but, if you look at alcohol for example and that's the safest one to start with—you know 30 percent of Americans don't drink at all. 30 percent of Americans drink once a week. And 20 percent of the population consumes 80 percent of the alcohol in the country. 10 percent of the population consumes 50 percent of all the alcohol in the entire country. And that kind of consumption distribution is similar in marijuana, nicotine, lottery tickets, video games, so anything that you can consider a vice. Things that people get carried away with, the distribution pattern of consumption is not a bell curve. And so then imagine if you're a capitalist. And you're the Juul company or you're selling an e-pen. Who are you going to make a profit off of? You're gonna make a profit of off the people who are not recreational users but tend to use too much of your product. Those are high-risk people. And that's why those people get targeted. And that's why those people use a lot. 0:07:06 William Moyers What's your counsel to parents? I know you see it as our youth facility in Plymouth, Minnesota, I hear about it from parents as well and I'm a parent of a young person who has experimented with vaping. And fortunately has moved beyond that. But what are the messages that you would have for how parents can confront maybe is too strong a word for it, but engage their young daughter or young son in the conversation around vaping? 0:07:33 Dr. Joe Lee I think parents need to have a wisdom about what they're trying to do and not just be reactive. And so if they have honest conversations and have a good relationships, kids are usually honest about vaping. I will tell you there is a cottage industry now and I've used that term before, but there is a real cottage industry of young people who cannot legally vape. But they will actually buy cartridges, vaping cartridges and pens, from older kids who can get it legally. [chuckles] So it has spawned this little industry for young people who were you know maybe selling marijuana or Xanax or other things and so actually I see a lot of young people now making quite a bit of profit on this nicotine stuff. [Moyers laughs] But going back to the parenting part, I think parents should be up front about it. But they also need to recognize what's happening in the big picture and not get caught up in the nicotine. When a young person goes to nicotine, alcohol, marijuana, or anything else that is potentially addictive quickly at a young age, they're raising their hand and saying I'm a high-risk person. That's what they're telling you. So, while there's importance in talking about the substance itself, it's probably more important to recognize where your child is really heading. What that behavior says about your child's trajectory. What the correlations are. And the correlations aren't good at all. 0:08:40 William Moyers Should parents be in a punishment mode when they discover that their child is vaping? 0:08:47 Dr. Joe Lee Probably not. And, but I say this broadly 'cause if you have a great relationship, and your child trusts you, you know as parents I lose my cool every day I got a two-year-old and a seven-year-old they get the best of me every day. [grinning] So I try every day to be a better parent, right? So and I think we're all in that boat. So this isn't like if you get mad at your child 'cause you discover they're sneaking in Juuls or something that its gonna be the end of the world. But it really is contingent upon your relationship. But as a broad arching tactic, going really aggressively just puts it all under ground. And I'm not gonna tell you the truth anyway. And that's probably not the kind of relationship you want. 0:09:21 William Moyers What do you see among our youth population? Do they come in the door with a nicotine dependence, specifically vaping being an issue? 0:09:30 Dr. Joe Lee Yeah, we see a lot. It in fact it's become a huge problem because the potency is pretty strong. And there's a huge science in what kind of atomizer you use, how many milligrams are in the nicotine or in the cartridge, the PH balance of the vapor or the smoke that you inhale. There's a huge science to it. So it's not all apples to apples. But let's just say that they're getting high, high quantities of nicotine and they're getting addicted at a very young age. And they're very blind to the toll that its gonna take on them later in life. And so, a message that seems to really work for young people is showing them the truth. That from a capitalistic standpoint, they're suckers. They're that ten to twenty percent that are being preyed upon. They don't know it, but they're the ones that are gonna give all their money, harm their health, for decades on end to feed an industry. And that's what turned the tide with the tobacco thing. Is that when kids started to realize that, that there was this industry that really didn't care about them, was making all this profit at their expense, they started to connect the dots and we started to see a decrease in loss. This is the exact same playbook, but it's disguised with other banter and jargon. And young people I talk to can get to the truth and once they see it that way, they're more likely to stop using, 'cause they don't wanna be anybody's pawn. 0:10:45 William Moyers How do we treat nicotine dependence among our young population at our facilities? 0:10:50 Dr. Joe Lee Well, addiction is very Pavlovian. So it's like the food and the bell and the dog. And so the probably with you know the experiment goes you ring the bell, the dog salivates, you know 'cause he's expecting food. The problem with nicotine addiction is it's everywhere. So everything's the bell. You're in the car, you're out of the car, you talk to your girlfriend, you talk to your boyfriend, you get on Instagram, you get off Instagram, you eat dinner, you wake up in the morning. And everybody wakes up in withdrawal. When you wake up, you're physiologically in withdrawal. So, it's a serious, serious addiction. And so you treat it like any other addiction. You can use medications to help with some cravings. You can use some alternatives. There are adults who are heavy smokers and they will anecdotally tell you that they've found some relief using e-cigs— 0:11:33 William Moyers Yes. Yes. [nodding] 0:11:33 Dr. Joe Lee Or vape pens, to get off of cigarettes. But larger research shows that it doesn't work any better than other products we have for nicotine cessation now. 0:11:40 William Moyers Oh, interesting. Okay. 0:11:41 Dr. Joe Lee And then what they don't tell you is while there's that subset where they really make money are the young people who wanna smoke the cherry flavor [laughs] or vape the cherry flavor and that they're gonna have that customer on the hook for three decades. 0:11:53 William Moyers What is our policy in terms of the use of tobacco products on our youth campus? 0:12:00 Dr. Joe Lee Well we know that people who use tobacco products just have worse outcomes in recovery. 0:12:03 William Moyers Huh. [nods] 0:12:03 Dr. Joe Lee And so we don't use—we don't allow tobacco use and we don't allow nicotine use on our campus for that reason. We also respect the fact that some of them don't wanna quit at the time. And so we try to do what we can to help them with cravings. And we try to engage them long-term on it. And so it's an ongoing dialogue, it's not about do you allow it or not, it's really about arming that individual with the right information and trying to cater to their values. And when they look at it and say, you know, I've done things where I'll actually pull up a compound interest calculator. Online. Figure out how much they're spending on nicotine products a week. Multiply it, do a compound thing for like twenty years. They're shocked at how much money and opportunity they're giving away to these companies. 0:12:46 William Moyers [laughs] Sure. Huh. 0:12:47 Dr. Joe Lee And when you look at it that way they start to think differently. About their choices. 'Cause it's their really their choice to stop spawning an industry like that. And if they see themselves as being pawns in this they have a better shot at saying you know what I really don't wanna give my money to those people. 0:13:02 William Moyers Is there any good news out there today as it relates to the trends around vaping or the trends around substance use in general with the young people? I know parents feel overwhelmed in so many ways that whether it's technology or the debate about the legalization or actually the legalization of marijuana or vaping, that they're just getting it from all quadrants now. 0:13:21 Dr. Joe Lee For lower risk kids, the global data there's some good news in that use is going down. Across the board. With the exception of nicotine products and maybe marijuana. But use is going down. Not a tremendous amount. But we're making an impact. It means that some of the things we're doing works. It means that young people read the news, they pay attention to things. And so, for lower risk kids maybe even some moderate risk kids, I think we're making an impact. I think the higher risk kids are getting lots of confusing messages. They're the ones that I think parade the kind of false health messages about e-cigs or marijuana or other drugs. You know they used to have health benefits of alcohol, back in the news, and that's been largely debunked but the only people that used to come to my office saying wine was good for you were the people that drank too much. [both laugh] Nobody else really cared. So we have the same dilemma with high-risk youth. But for other youth I think we are making a bit of an impact. 0:14:15 William Moyers That's a good note to end our conversation on today. Dr. Joe Lee, thank you for taking the time to share your experience, strength, and hope with our listeners and our viewers today. It's never easy but being a parent in today's generation sure is worth it as long as the parent can hang in there and continue that communication. And we wanna thank you for lending your expertise to us today. 0:14:37 Dr. Joe Lee Thank you. 0:14:38 William Moyers On behalf of all of us at the Hazelden Betty Ford Foundation, I'm your host William Moyers. Thank you for joining us again and make sure you tune in for another edition of Let's Talk, a series of podcasts on the issues that matter to our community today. Thank you.