In Harm's Way: Health Risks of Teen Vaping

0:00:13 William Moyers
Hello, everyone! Welcome to Let's Talk, our podcast series produced and delivered to you by Hazelden Betty Ford. I'm your host, William C. Moyers, thanks for joining us for this important conversation. About what parents need to know when it comes to vaping, nicotine, and their children. Welcome, Dr. Polley!

0:00:39 Dr. Sara Polley
Yeah, thanks for having me! [smiles]

0:00:40 William Moyers
Thanks for being here today. Let's just get right to it. What is vaping?

0:00:45 Dr. Sara Polley
Yes. So vaping—I'm so happy we're having this conversation because I think those of us in the field have been trying to raise red flags saying, 'Something is happening here, this is a really big deal!' But vaping is the use of what's called an electronic delivery device. Where it's like a device and some of them come pre-filled and look sort of like a cigarette. 

0:01:04 William Moyers
Or like a pen, right? [holds up pen to demonstrate]

0:01:05 Dr. Sara Polley
Yeah or like a pen, or like a little square, like a little metal square. Some of them have these pods that have like juice in them, what they would call juice, that you can pop in and out. That have different contents of nicotine within the juice--

0:01:17 William Moyers
Mmm.

0:01:17 Dr. Sara Polley
And then you basically, the device heats up and vaporizes the juice that has the nicotine in it. And then you inhale the vapor. And so, when people are vaping, they're essentially doing an analog to smoking where they're putting something up to their mouth and then they're delivering themselves nicotine into their lungs.

0:01:33 William Moyers
And nicotine is a drug.

0:01:35 Dr. Sara Polley
That's right. Nicotine is the addictive drug in tobacco cigarettes, in chew that people use, yes, it's nicotine is the drug. 

0:01:43 William Moyers
Is vaping safer than that stick of tobacco that's burning at one end?

0:01:50 Dr. Sara Polley
That's an interesting question because the reason vaping or electronic delivery devices were invented was to try to get tobacco smokers to ease off of use of tobacco cigarettes, because tobacco cigarettes are so toxic—

0:02:03 William Moyers
Mmm-hmm.

0:02:04 Dr. Sara Polley
And cause so many issues that I think many of us know about. And so it was almost like a harm reduction strategy to say like—

0:02:08 William Moyers
Mmm-hmm.

0:02:09 Dr. Sara Polley
Look, like, tobacco is so bad for you, can we get you to do this electronic delivery device? The problem is that it's new and we don't have long-term studies. And so, I just always remember back to the beginning of tobacco, right? Where people would say, 'This is great! There's no health problems associated with it!' And then, twenty, thirty years later, we were like, 'Oh, no, people are getting cancer, this is not good.' And the worry is that the same thing will happen with vaping or electronic delivery devices. Because it's not just nicotine or water that's going to your lung, it's all kinds of other chemicals as well.

0:02:38 William Moyers
And there's a reason why you're sitting on this set as our Medical Director of our Youth Continuum, and I'm asking you about vaping because it is prevalent particularly with young people. 

0:02:48 Dr. Sara Polley
Yes. And that's why we've been raising red flags. Is it's an anomaly when I have a young person come in that is not addicted to nicotine. I would say more than 90 percent of my patients have a dependence on nicotine.

0:03:01 William Moyers
90 percent?!

0:03:01 Dr. Sara Polley
Yes, it's like I said it's an anomaly if I have somebody who hasn't been regularly using nicotine. To the point that they're having withdrawal and they're physically dependent on it.

0:03:11 William Moyers
And so how do you balance the treatment that they may be coming in for for an opioid use disorder or alcoholism with their dependence on nicotine?

0:03:19 Dr. Sara Polley
Yeah. So the approach we take at the Youth Continuum, our youth facility, is a tobacco- or nicotine-free facility.

0:03:24 William Moyers
Completely?

0:03:24 Dr. Sara Polley
Yes. And so we—our patients are not allowed to use nicotine and we consider nicotine to be a substance of abuse. And we help people to get off of nicotine. Just as we help them get off of other substances. And so, we use nicotine replacement products and other types of medication in addition to therapy and behavioral support—

0:03:41 William Moyers
Mmm-hmm.

0:03:41 Dr. Sara Polley
To really help them to understand that nicotine is a substance just like other substances. 

0:03:46 William Moyers
There has been some pushback in society about the use of vaping. What is the pushback? Where do we begin to get worried about it? What's been the red flags early on? 'Cause it's still a relatively new “technology” [uses air quotes] or delivery system. What are we seeing?

0:04:05 Dr. Sara Polley
Yeah, well I think—so the original purpose again to kinda be used for patients who are already addicted to tobacco cigarettes to try to reduce harm. 

0:04:14 William Moyers
Mmm-hmm.

0:04:15 Dr. Sara Polley
And I think the problem is, right, is that commercialization happened. People realized, they know that nicotine is an addictive substance, and the same thing that happened with tobacco cigarettes is playing out with vaping. Where it's, 'Let's advertise these as safe, let's advertise them as fun, let's get young people hooked when they're 12, 15, so that then they're lifelong addicts and continue to buy our product.' And so that, you know, and sadly I think we probably could have predicted that this would happen—

0:04:41 William Moyers
Yeah.

0:04:41 Dr. Sara Polley
Because it's what happens with all addictive substances--

0:04:43 William Moyers
Yes.

0:04:44 Dr. Sara Polley
Is people wanna make money. Off of our brains and our tendency to become addicted to things. And so, yeah, so there's been a lot of concern surrounding particular types of products. Flavoring in products.

0:04:54 William Moyers
Flavoring.

0:04:55 Dr. Sara Polley
You know, marketing that might be targeted more towards young people.

0:04:58 William Moyers
And, the other thing about vaping, from a parental perspective, is that it's harder to detect it—

0:05:05 Dr. Sara Polley
Yes.

0:05:06 William Moyers
Than if you walk into your son or daughter's room and there's a cloud of tobacco smoke.

0:05:11 Dr. Sara Polley
Yes, that's right. And so and it's very easy to hide the devices because they're so small. You know, in treatment that's actually why we have to have special protocols to try to—'cause kids will try to hide them and bring them into treatment because they're so addicted to nicotine—

0:05:23 William Moyers
Wow.

0:05:24 Dr. Sara Polley
That even though they know it's against the rules, they can't imagine that they wouldn't be able to use nicotine or vape while they're in treatment. So they try to sneak it in. And it's really easy to conceal because they're just these small devices. Some of them actually don't contain much metal at all, so they won't even set off a metal detector. [chuckles] 

0:05:40 William Moyers
Mmm.

0:05:41 Dr. Sara Polley
And you know, a lot of kids are bringing them to school and they'll use them in between classes. I have some kids who have even said they've been able to use them during class. And if there is any kind of residual vapor they just kind of blow it into their clothing. And they keep the device kind of in their backpack and they bend over like they're getting something from their backpack. And you know, schools are—I've talked with some people who are leaders of schools—and it's like they have so many other things that they're worried about—

0:06:04 William Moyers
Yes!

0:06:05 Dr. Sara Polley
That the idea that these kids might be using these vapes it's like they can't police that. And so, many kids come in and they're used to using their vape and getting nicotine, you know, very frequently throughout the day. Which is different than tobacco cigarettes, right?

0:06:16 William Moyers
Mmm-hmm.

0:06:17 Dr. Sara Polley
Like, again, you couldn't kind of smoke a tobacco cigarette in school as a 14-year-old and not have somebody know. 

0:06:20 William Moyers
Right. Right.

0:06:22 Dr. Sara Polley
And you need to go out for a break because you can't do it inside if you're an adult. And so, and that's not the case with vaping. 

0:06:27 William Moyers
Is there a way for parents to screen or otherwise pay attention to their child's behavior as it relates to vaping?

0:06:38 Dr. Sara Polley
Yeah. I think parents should ask early and often about their child's knowledge and what their perception is about vaping and about nicotine. You know, one of the questions you can easily start with is, 'So you do have any friends at school that vape, do you know what vaping is?'

0:06:53 William Moyers
Hmm.

0:06:54 Dr. Sara Polley
And just kinda get a sense of your child's knowledge about it.

0:06:56 William Moyers
Mmm-hmm. Mmm-hmm.

0:06:57 Dr. Sara Polley
Generally, the rule of thumb is that if your child has friends who vape it's really only a matter of time before they start to vape themselves. And so, it's important again to educate yourself as a parent about what vaping is, about really the risks associated with nicotine use in young people, which there are plenty. And to try to educate your child about that. And have a dialogue with them. And again, kinda set limits and say, you know, 'It's against the rules in our family for you to use nicotine or for you to vape, and this would be the consequence if I found out that you were doing that.'

0:07:25 William Moyers
And I know we're focusing on vaping and nicotine, but, the reality is that when we talk about vaping, we have to talk about it in the context of how it can be used to ingest other substances. 

0:07:39 Dr. Sara Polley
Yeah.

0:07:40 William Moyers
Can you talk a little bit about that?

0:07:41 Dr. Sara Polley
Yeah. And so that's particularly where some of the dangerous part comes in. Is that, you know, people who make illicit substances realized, 'Oh, we could use these electronic delivery devices and try to make a separate pod that contains other types of chemicals or addictive things'—

0:07:55 William Moyers
Mmm.

0:07:56 Dr. Sara Polley
So that the person could swap out the nicotine pod and put in a pod that has other types of drugs or substances. And so, it's really common now for people to be able to get cannabis or marijuana in a pod that can like flip into an electronic delivery device that's typically used for nicotine. And so, you'll hear sometimes in the news about these kinds of outbreaks of, you know, acute lung injury—

0:08:18 William Moyers
Yes. Yes.

0:08:18 Dr. Sara Polley
Where young people are being hospitalized and we had that happen in Minnesota a couple of years ago. And the reason for that was that there were illicitly-made pods with marijuana that people were putting into their electronic delivery devices. And those pods contained chemicals that they wouldn't normally contain in the nicotine version. Which were then toxic to the lung and actually caused really significant lung damage. To the point that when I was doing outpatient work, I had some patients that required a lung transplant. [Moyers gasps] Secondary to the fact that they had used one of these illicit pods that then damaged their lungs beyond the point that they could be repaired.

0:08:51 William Moyers
So the myth that vaping is safer than tobacco is a myth because it might be safer in the context of the burning gases that are burning through the tobacco, but you just pointed it out—they're deadly dangerous.

0:09:08 Dr. Sara Polley
Yeah. Well and we know that if someone's vaping nicotine that their barrier to buy an illicit pod and to vape something else goes down.

0:09:16 William Moyers
Yes.

0:09:17 Dr. Sara Polley
And so, that you know vaping nicotine is a risk factor for the use of other substances, or a risk factor for the use of obtaining one of these illicit pods.

0:09:25 William Moyers
What's your counsel to parents who do find evidence that their child is vaping? How should the parent have the conversation?

0:09:38 Dr. Sara Polley
Yeah.

0:09:38 William Moyers
About what happens next.

0:09:40 Dr. Sara Polley
Yeah. Well, I think one of the most important pieces is to try to remain calm. [Moyers chuckles softly] These situations are really hard. And cause a lot of feelings for parents. And so, you know, but you're—it's gonna be really hard to make progress and join with your child if you're getting aggressive or reactive or kind of reactionary. You know I think it's important to take the items. Again, that seems so obvious but I've met parents that are like, 'Well we didn't take the vape, we let them keep it and we just said we didn't like that they were using it.'

0:10:08 William Moyers
Mmm.

0:10:09 Dr. Sara Polley
And it's like, no, take the vape from them, you know—

0:10:09 William Moyers
Yeah.

0:10:10 Dr. Sara Polley
Talk to them about consequences for engaging in that behavior. You know, a hard part is that I think young people underestimate how addictive nicotine is. And the young brain is actually more sensitive to becoming dependent on nicotine more quickly than an adult brain is.

0:10:24 William Moyers
Mmm.

0:10:25 Dr. Sara Polley
And so, there's some research that indicates that even after one to two days of kind of you know using it intermittently throughout the day, the brain is already dependent and will crave nicotine. And so, a lot of kids, when you take the vape away, will then experience symptoms of nicotine withdrawal. And so those can be treated using nicotine replacement in similar ways to what we do with adults. Or they can be treated kind of with comfort measures—

0:10:48 William Moyers
Huh.

0:10:49 Dr. Sara Polley
Education, kind of saying, 'Yes it's going to be harder for you to sleep, you're not gonna have an appetite, you're gonna be cranky, but that's because you're withdrawing from nicotine and it will pass.'

0:10:58 William Moyers
If parents get to the point where their child is dependent on substances, whatever that substance is, and they also are vaping—

0:11:07 Dr. Sara Polley
Mmm-hmm.

0:11:07 William Moyers
Is it realistic for the parents to look for a treatment program that is going to address all those issues at one time? Or is it okay for the treatment facility to deal with the alcohol misuse or the addiction to opiates?

0:11:26 Dr. Sara Polley
Yeah. Well I think it's really important for parents to seek out a treatment that would not allow any substances for their child. I always find it so interesting that we've sort of decided that nicotine in the treatment world was okay, and you could smoke and go to treatment and it wasn't a big deal--

0:11:41 William Moyers
Mmm.

0:11:41 Dr. Sara Polley
And then we drew the line with cannabis. Like, 'No, but you can't use cannabis.' And a lot of young people nowadays will point out, like, 'Well that doesn't make any sense, 'cause the research about nicotine is that it also hurts my brain. So why have you arbitrarily decided?' And I think that can be confusing. And I think young people will look for those kinds of holes. [Moyers chuckles] And say, 'So this whole thing doesn't make any sense then because of this kind of discrepancy that I'm noticing.' And so I think just delivering the message that like, 'No, you're young, your brain is sensitive, there's really no amount of substance that's helpful for you, so no, we're not making an exception for nicotine.'

0:12:13 William Moyers
Dr. Polley, what is the impact of nicotine on the developing brain?

0:12:18 Dr. Sara Polley
Yeah. So there's been studies that have come out that kind of originated with tobacco use. And then there's been some more that have come out with the initiation of vaping and that use of nicotine.

0:12:26 William Moyers
Mmm-hmm.

0:12:27 Dr. Sara Polley
But really, nicotine impacts the brain of a young person differently than the brain of an adult. It kinda slows down the development of the prefrontal cortex, which is that front part of the brain that helps with decision-making, impulse control, and planning.

0:12:38 William Moyers
Mmm-hmm.

0:12:41 Dr. Sara Polley
And so, it in some ways creates what looks like ADHD in young people. Because it's sort of preventing their prefrontal cortex from doing the job that it needs to do. And we've found that actually those differences can persist past the time where the person stops using nicotine—

0:12:56 William Moyers
Oh?

0:12:56 Dr. Sara Polley
Or even if they cut down into adulthood. And so what I've wondered is if we're—what we will see now with this generation of individuals and young people whose brains are being nearly constantly exposed to nicotine from vaping if we'll see an increased rate of adult onset or adult ADHD—

0:13:15 William Moyers
Wow.

0:13:14 Dr. Sara Polley
Or if we'll see increasing, you know, addiction in adulthood now to other substances, if we'll see you know increases in impulsivity or anger management difficulty, all the kinds of things that you might see if you have impairment in the development of the prefrontal cortex. 

0:13:28 William Moyers
I know I think this occurred before you joined us about a year and a half ago, but we did—we meaning Hazelden Betty Ford—did ban the use of nicotine on our youth campus—

0:13:40 Dr. Sara Polley
Mmm-hmm.

0:13:41 William Moyers
And that was true for patients and for their parents—

0:13:44 Dr. Sara Polley
Yeah.

0:13:46 William Moyers
And for our employees. That was a good idea, yes?

0:13:49 Dr. Sara Polley
Yes! Oh, definitely. And I think there's movement in the field in general to really stop allowing nicotine in treatment programs. 

0:13:57 William Moyers
Mmm-hmm.

0:13:58 Dr. Sara Polley
Because we know that the outcomes are actually better. So they've done studies about how do people do when they leave treatment if they were allowed to use nicotine versus not allowed to use nicotine products. And people actually are more successful in their recovery and abstinence from other substances if they're not using nicotine.

0:14:13 William Moyers
And is that true both for youth and for adults?

0:14:16 Dr. Sara Polley
Yes, that's true for youth and adults.

0:14:18 William Moyers
So, I hate to go down this path, but do you feel strongly as a doctor and as a doctor who works in the field of addiction medicine, that nicotine should be voided at all treatment facilities?

0:14:34 Dr. Sara Polley
Yeah. I do support that. I mean again, I think there's kind of this weird inconsistency that we've decided that nicotine is okay, but, you know, cannabis is not okay. And I think that that leaves us open to, you know, a lot of patients kind of deciding that we don't know what we're talking about or kind of putting us to the side.

0:14:53 William Moyers
Mmm-hmm.

0:14:54 Dr. Sara Polley
Because it's a reasonable argument. Why is nicotine okay but cannabis is not okay? I mean, they're both harmful, they both impact your brain.

0:14:59 William Moyers
Mmm-hmm.

0:15:00 Dr. Sara Polley
But we have to have the line somewhere, right? 'Cause then caffeine comes into the picture too, right? [chuckles softly] 

0:15:03 William Moyers
Right.

0:15:04 Dr. Sara Polley
It's like a lot of people misuse caffeine, and so, you know, we would then—and we do sort of talk about setting limits on no you can't just drink Red Bull energy drinks all day long—

0:15:12 William Moyers
Right. [Both chuckle]

0:15:13 Dr. Sara Polley
'Cause that's also gonna hurt your brain. But, you know, so yes, I do—I would support and I do think that I would like for the field to move in the direction of just not allowing nicotine in treating programs. 

0:15:23 William Moyers
Mmm-hmm. And we know that nicotine particularly smoking, we know it killed the co-founders of Alcoholics Anonymous, Bill Wilson and Dr. Bob Smith, they found recovery from their alcoholism, and they essentially smoked themselves to death.

0:15:39 Dr. Sara Polley
Yeah.

0:15:39 William Moyers
Because nicotine is an addictive drug that is difficult to get off of. 

0:15:44 Dr. Sara Polley
Yeah. Mmm-hmm.

0:15:45 William Moyers
Well how do people beat nicotine addiction?

0:15:50 Dr. Sara Polley
Yeah. The nicotine addiction is rough. I mean if anyone's never—like I grew up with parents that smoked and you know it's like I—it's horrible to try to quit smoking. I think people try so hard and it's just really hard. So again I think it's this kind of like multidisciplinary approach and they've shown that in research that really a combination of medications that can assist with smoking cessation in addition to behavioral interventions is really the way to go and will offer kind of the most success. And so, they talk about setting a quit date as being really important—

0:16:17 William Moyers
Ah.

0:16:18 Dr. Sara Polley
Planning ahead of the quit date as to what barriers you might have to being able to be successful and then really have a comprehensive plan for yourself, that offers behavioral support in addition to, you know, nicotine replacement options or some prescription medications we have available that have shown to help with smoking cessation.

0:16:34 William Moyers
Does insurance cover those prescriptions?

0:16:38 Dr. Sara Polley
Yes! Yes, thankfully yes. So I think insurance companies figured out, right, that it's more expensive for us to have smokers because of all the things that are gonna happen to them if they keep smoking. Than it is for us to pay for these options to help people stop smoking. So yes, even for young people now, actually, insurances are covering nicotine replacement—

0:16:55 William Moyers
Really!

0:16:55 Dr. Sara Polley
And other types of medications. Again, because they know that it saves them money if they do that now, versus allow the addiction to continue. 

0:17:02 William Moyers
And the last question before we go because I know there'll be people tuning in who see that we're promoting this as vaping and nicotine, but they may not be vaping but they're hooked on nicotine—what is your response, Dr. Polley, to the argument or to the case, that if somebody comes in with a dependence on alcohol and they're also dependent on nicotine, best that we address the alcohol addiction first—

0:17:28 Dr. Sara Polley
Yeah.

0:17:28 William Moyers
And let the nicotine addiction get addressed later on or after they leave treatment.

0:17:32 Dr. Sara Polley
Yeah. Well I don't know, it's an interesting idea. It almost makes me feel like we're underestimating people.

0:17:38 William Moyers
Aah.

0:17:39 Dr. Sara Polley
And, I don't—because it's like, why? Like do we have any evidence to suggest that they can't also—they can't focus on those two things at the same time? I don't know if we have that evidence. And I think it again it kinda sends this message that, you know, one thing is okay and another thing isn't okay, or one thing is worse than the other thing. And why—why do we send that message? Like I don't understand—to me it's like what's the relevance, why do we need to make that distinction?

0:18:02 William Moyers
Yes.

0:18:02 Dr. Sara Polley
I think people are very capable and if somebody could stop, I don't know why you couldn't stop smoking or using nicotine and alcohol at the same time.

0:18:10 William Moyers
Dr. Sara Polley, thank you for bringing your really intriguing and insightful expertise to our Let's Talk podcast today. Because I know there are a lot of parents, a lot of educators, and a lot of young people, who will benefit from what you have shared with us today. Dr. Sara Polley, thanks for being with us.

0:18:33 Dr. Sara Polley
Yeah. Mmm-hmm.

0:18:33 William Moyers
[turns to camera]
And thanks to all of you for tuning in for our Let's Talk podcast series. On behalf of our Executive Producer, Lisa Stangl, and the crew at Blue Moon Productions, I'm your host, William C. Moyers, we'll see ya again. [smiles]