Doctors rarely pursue counseling or prescription medicine as treatment options for young patients addicted to nicotine, according to a Boston Children’s Hospital study.
Authors of the peer-reviewed study, which included 80,000 young people with nicotine addiction in 11 states, said the study points to a missed opportunity. The release comes at a time when communities around the country are grappling with how to handle the recent surge in youth nicotine use largely driven by vaping – including places like Bayfield, where the town board is considering stricter smoking policies. Doctors work to give patients the resources they need, but they might be able to do better in some areas, said Krista Ault, medical director for Mercy Family Medicine.
“We have treatments that are proven to work for older people and are very likely to work for young people as well,” said Nicholas Chadi, a pediatrician at Boston Children’s Hospital and first author on the paper, in a news release. “Not using these treatments is a missed opportunity.”
The study, published in the peer-review journal JAMA Pediatrics, surveyed Medicaid data for people, ages 10 to 22, who were diagnosed with nicotine use disorder in 2014 and 2015. It was written by seven authors from six medical institutions and funded by the National Institute of Health, the National Institute on Drug Abuse and Thrasher Research Foundation.
In the study, 4% of patients received counseling. Doctors prescribed medication to 1.2%, and one in 1,000 patients received prescriptions and counseling – which would double or triple their chances of quitting, according to a news release about the study.
The study focused on adolescents with nicotine use disorder, regardless of what tool the person used to smoke. However, the increase in e-cigarette use among adolescents has spurred national concern.
For high schoolers, 4.5% used e-cigarettes in 2013 compared to 13.4% in 2014, according to a nationally representative survey by the Centers for Disease Control and Prevention. In 2018, Federal Drug Administration Commissioner Scott Gottlieb said youth e-cigarette use was an “epidemic.”
Many e-cigarette products contain nicotine. For example, all Juul pods, a type of e-cigarette that dominates the vaping market, contain nicotine.
Although it is the combustion in traditional cigarettes that can be fatal, nicotine use among youths can impact brain development during adolescence, and a preliminary 2014-2015 study showed that e-cigarette use was a predictor of future cigarette smoking.
In Colorado, 27% of middle and high school students used e-cigarettes in 2017 compared to 7% who used cigarettes, according to the Healthy Kids Colorado Survey. Young people are vaping nicotine at twice the national average, and Colorado has seen six cases of vaping-related lung illness since Sept. 18, according to news releases from the Colorado Department of Public Health and Environment.
“I definitely have seen an uptick in vaping ... both adults and kids,” Ault said.
Ault said that nicotine replacement is an option for teens, as the study indicates. However, there isn’t enough research to support prescribing many oral medications to young adults.
At Mercy, if someone is interested in quitting, Ault gives brief counseling on the spot.
She helps her patients look at what other habits might trigger their smoking, like drinking or stress. Mercy also offers up to six sessions of counseling. People can also contact the Colorado Quitline, which offers some free nicotine-replacement materials and counseling resources.
In Colorado, young people are vaping nicotine at twice the national average, according to a July news release from the Colorado Department of Public Health and Environment.
“The scary thing for kids is the younger you start vaping, the more likely you are to end up with an addiction issue – just because the younger they are, the less able their brains are to handle it,” said Ault, who is also a family practice physician.
Doctors depend on accurate reporting from patients, but they can face challenges getting it.
Doctors have limited access to young patients because they come to the doctor’s office less often – typically once a year. They might not relay their smoking habits accurately, or they might not want to talk about smoking in front of a parent.
Still, medical providers could do more, especially while talking with patients during the screening process, Ault said.
“It kind of speaks to the fact that sometimes maybe we’re not screening them as effectively as we could,” she said. “It’s how do you figure out that they’re smoking in the first place? Then, how do you do targeted interventions?”
With accurate reporting, better screening by doctors and patients who are ready and willing to pursue treatment, medical professionals can help determine the right treatment for people struggling with smoking.
“That’s half the battle,” Ault said. “They have to be interested in having that conversation.”