Psychologist Suchitra Krishnan-Sarin weighs in on vaping

By Catherine Robertson Souter
November 4th, 2019
Suchitra Krishnan-Sarin, Ph.D, professor of psychiatry at the Yale University School of Medicine

Suchitra Krishnan-Sarin, Ph.D, professor of psychiatry at the Yale University School of Medicine

E-cigarettes were originally introduced as a tool to help cigarette smokers quit. It was probably a sign of things to come, though, when retailers set up booths in shopping malls to reach clients. Flash forward 13 years from when the products were introduced to the United States, to where the market for e-cigarettes has seen unparalleled growth, a new nickname, “vaping,” and devices that no longer resemble the cigarette of yore.

With greater awareness around teens using the products in schools and a recent spate of as-yet-unexplained lung-related illness and deaths, vaping has been more in the news in the past year or two. But, since some of the more popular products have only been on the market for a few years, the long-term issues remain somewhat unknown.

New England Psychologist’s Catherine Robertson Souter recently spoke with Suchitra Krishnan-Sarin, Ph.D, professor of psychiatry at the Yale University School of Medicine, about the issues with vaping and what psychologists should know.

Krishnan-Sarin serves as a member of the Federal Drug Administration’s Tobacco Product Scientific Advisory Committee and is a co-leader of the Yale Tobacco Centers of Regulatory Science, which is using a multidisciplinary approach to understand the role of flavors in tobacco and nicotine addiction.

What happened in the past three to five years to bring about such a big issue?

I think this problem is related to the extreme innovativeness of the devices and their appeal to youth. The products have changed over the years since they were first on the market. The first product looked like a cigarette and it contained the same amount of nicotine as a cigarette. In 2015, products like Juul started coming on market and they have seen a huge market surge since then.

The other big thing which I think has contributed is social media presence. That is the way many learned about the products along with learning how to adapt the liquids to do vape tricks and smoke tricks. These are all over YouTube and similar sites.

What are people not aware of when it comes to e-cigarettes and vaping?

Due to a lack of science, people don’t fully understand the potential long-term risks of nicotine exposure or marijuana exposure, especially to the adolescent brain. There is a lot of science in this area and the literature tells us that the adolescent brain is extremely sensitive to the effects of nicotine.

Are they, at least, healthier than cigarettes?

The carcinogenic effects of cigarettes are related to other compounds in them so the carcinogenic potential of e-cigarettes may be shown to be less because they do not contain these other compounds. But there are still constituents in e-cigarettes that cause inflammation and we don’t know where they will lead down the road.

These products came on the market in such a huge way and they took over the marketplace so quickly and as scientists, everyone is trying to keep up.

Many of these chemicals are considered safe in edible products but when you inhale them directly into your lungs there is more direct absorption into the blood stream. There is a lot of concern that constant exposure to these chemicals might have long-term effects but science has not reached the stage where we can clearly outline these effects.

What do you make of the vaping illnesses and deaths that have recently occurred?

The incidents of injuries and deaths that are being reported and are being related to vaping are based on self-reports from the individuals. But the only way to look at this is to obtain the products and see what the ingredients are.

Can’t we tell by looking at packaging?

The issue is that these products are so freely available on the market and also, they are being hacked by a lot of people who are not using the products as the manufacturer meant them to be used.

People are adding things into the liquids. For example, take the Juul. I? t only sells nicotine pods but there are lot of Juul-compatible pods being sold by other companies that can be filled with whatever you want and can be used how you like.

People are using them to produce huge vape clouds, etc. What we don’t know is what are they exposed to when they manipulate the content of the liquid to perform these tricks.

Why are teens drawn to them?

There are many aspects of these products that are appealing to youths including all the flavors. The devices themselves are very innovative and also very discreet. Some of the newer devices can be really small, like a usb device. They are easy to hide and the e-liquids can be adjusted to not produce much vapor. Kids can use them in school because it doesn’t produce huge clouds of smoke or smell.

So, what’s the point of smoking if you can’t see the cloud? That’s the fun part of smoking, isn’t it?

Well, that is cigarette smoking behavior – but most of the kids who vape are not former cigarette smokers and don’t have that cigarette smoking behavior. But the question is, what are the motivations for doing it? Understanding these behaviors is what we are working on. Is blowing clouds of smoke important for enjoying vaping? I don’t know; it remains to be seen.

Should psychologists talk about vaping with their adolescent clients?

I would say that it is important not to come from a punitive perspective but instead come from an angle of trying to make them understand what the potential long-term effects could be. Explain that they are producing changes to their body and brain they may not be that happy with in the long-term.

There are signs that point to changes in memory and cognition that have been noticed in cigarette smoking youth in past. Genetic studies show exposure to nicotine can produce epigenetic changes, changes to your genes relating to asthma and depression.

We have not shown these long-term impacts with e-cigarettes yet but there are signs that they will be similar to those with cigarette smoking.

What types of treatment work for e-cigarette addiction?

I don’t think the prevention and cessation programs for this product will be any different from any other product whether it is cigarettes, alcohol, opioids. But we will need to understand the behavioral cues that motivate people to use and how can we help them to stay away from those cues. So, that is a piece of science we really need.

There is also a pharmacological aspect depending on how much of the nicotine you have exposed yourself to. It is possible some may need nicotine replacement therapy to help them quit the behaviors.

What do you think of Massachusetts banning sales of the vaping products?

People forget about the nicotine addiction. If you are in a situation where the market is flooded by these devices and now these people are addicted to nicotine and you take the flavored products away, what will happen to these people?

If you take it away without putting into place programs to help these people, I worry they will turn to using cigarettes. That is a huge concern about jumping from the frying pan into the fire.

How do we move forward?

There are a lot of smokers who will tell you they quit because of these cigarettes so there might be potential benefits for these products but the lack of education for the public and the appealing flavors and devices and things like that has led to increased youth usage.

We need to find a way to regulate these compounds and make them only available to adults to be used when they want help to quit smoking cigarettes.

Education is going to be key.

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