Children whose vaping has led to nicotine dependence should be given nicotine patches to help them quit vapes, say health officials in the United Kingdom.
A report from Public Health Wales (PHW) said that children in this position should receive “support not punishment.” The agency’s incident response group has been looking into a rise in vaping among children and young people in Wales.
According to the April report, “an increasing number of children are experiencing dependency at a level that makes it very difficult to get through the school day without vaping on school premises.”
“Nicotine replacement therapies, which are already offered to people aged over 12 who are smoking, is one tool that could help,” PHW consultant Chris Emmerson told the BBC, “… in tandem with other support mechanisms.”
The UK’s National Institute for Health and Care Excellence states that for children over the age of 12, NRT treatment should be limited to 12 weeks.
While vapes are much lower-risk alternatives to cigarettes and effective smoking cessation tools, NRT options such as patches don’t attract controversy like vapes, and are regarded as being at the lowest extreme of the nicotine product risk continuum.
“NRT could have a role during the school day, to discreetly prevent withdrawals.”
The PHW patch recommendation for children and teenagers raises questions about where authorities draw the line with youth harm reduction, and why. Tobacco harm reduction experts’ responses are mixed.
“NRT could have a role during the school day, to discreetly prevent withdrawals in a school environment where dependent vapers can’t vape,” Dr. Colin Mendelsohn, an Australian THR advocate, told Filter.
Nicotine dependence is more likely when nicotine is delivered more quickly, he said, and patches deliver nicotine more slowly than either cigarettes or vapes. “After switching from vaping to patches, it is easier to stop nicotine altogether.”
But Mendelsohn added that while the NRT approach may help some young people, “young people have never been keen to use NRT.”
British THR advocate Clive Bates, of Counterfactual Consulting, believes that a broad approach of applying smoking cessation therapies to minors who vape would be counterproductive, however, because it “plays into the ugly mess of confusion and ignorance of youth vaping.”
Fear of youth vaping, as Mendelsohn previously wrote for Filter, “greatly exceeds the objective threat it poses,” while “benefits are almost universally overlooked.” And that fear has consistently been used by policymakers around the world to restrict access to vapes for people who smoke.
“The danger of blundering in with vaping cessation advice combined with scare stories about vapes is that we might just end up with more smoking and more harm.”
Most adolescents who use vapes are simply experimenting, Bates told Filter, and for most, it’s a passing phase. “They aren’t going to become dependent and will probably quit fairly soon.”
Mendelsohn similarly cited a rate of somewhere between 3-8 percent of Australian youth with nicotine dependence, based on different surveys of self-reports and vaping frequency. And some of these youth either smoke, or did so previously.
Bates continued that vapes are likely displacing cigarettes for young people—and are therefore beneficial for youth who would otherwise smoke. As Mendelsohn and other experts have noted, common social, psychological or genetic factors seem to predispose youth to both vaping and smoking.
“The danger of tobacco control activists blundering in with vaping cessation advice combined with scare stories about vapes is that we might just end up with more smoking and more harm overall,” Bates said.
“Given that vapes are low-risk and cigarettes are high-risk, the net effect of youth vaping is likely to be strongly positive for public health,” he concluded. “The real challenge is to understand why there is a demand, to assess what would be happening in the absence of vapes, and to react proportionately—and preferably without doing more harm than good.”
Misguided or not, the widespread adoption of NRT for children, if it happened, would seemingly contradict years of bombastic statements from the World Health Organization and other health authorities about the dangers of nicotine to youth (even if NRT is on the WHO list of essential medicines).
“There is no evidence that nicotine damages the human adolescent brain,” as the WHO and others have claimed, Mendelsohn said. Research on generations of people who smoked cigarettes has demonstrated no such link. “Some vape to relax, to improve concentration or ADHD, or other benefits.”
“If we don’t address the cause, we are just playing whack-a-mole with the result of that cause.”
THR advocate Skip Murray, in the United States, told Filter that underlying causes of youth vaping (and other drug use) should be given more focus. “Are they trying to alleviate stress or depression?” she asked, adding that “not all of them are rebelling or experimenting.”
“If we don’t address the cause, we are just playing whack-a-mole with the result of that cause,” said Murray, who has written for Filter about the intersection of youth mental health and school vaping policies. “I find it deeply concerning we don’t have more conversations about what is going on with the lives of young people.”
Youth vaping or smoking may be indicators of issues such as ADHD or mental health concerns, she also pointed out.
Michelle, from Florida, started smoking at the age of 9, after listening to adults who said that cigarettes helped them “relax.” As a child with an undiagnosed anxiety issue, she was always being told to do just that. And the nicotine in cigarettes made it possible.
In 9th grade, “my grades improved when I could smoke before class,” she told Filter. “I finally had a way of feeling like I fit in with others in my class—I wasn’t the outcast from always being in trouble anymore.”
As an adult, Michelle received a diagnosis for her anxiety. “I researched what anxiety was, and found out how and why the nicotine in cigarettes was helping me—it all came together!”
Michelle then tried to quit smoking with NRT, but found it didn’t suit her. Her doctor recommended vaping instead, and it worked.
The Public Health Wales report also called for disposable vapes and flavor-names deemed to attract minors to be banned. This fits recent political hostility to vapes in the UK, previously known as one of the world’s most vape-friendly countries.
The impending Tobacco and Vapes Bill will bring restrictions on flavored vapes, which many people find critical to switching from cigarettes. A new vape tax, reducing the financial incentive to switch, was also announced in March. NRT for kids would suggest an openness to harm reduction in principle, just as access is being squeezed for those at much higher risk.
Photograph by RegBarc via Wikimedia Commons/Creative Commons 3.0
