To Your Health With Dr. Jim Morrow: Episode 4, Vaping

**Dr. Jim Morrow, Morrow Family Medicine**

Dr. Morrow’s Show Notes on Vaping

If we are going to talk about vaping, we have to talk about: NICOTINE.
Why nicotine? What does it do to your brain?
Nicotine activates the circuitry that regulates feelings of pleasure, the so-called reward pathways. Research has shown that nicotine increases the levels of dopamine (a key brain chemical involved in mediating the desire to consume drugs) in the reward circuits of the brain.
Cigarettes also cause a marked decrease in the levels of monoamineoxidase (MAO), an enzyme responsible for breaking down dopamine, so…. more dopamine in the circulation.
The need to sustain the high dopamine levels results in the desire for repeated drug use.
Outward Signs of Nicotine Addiction
- an inability to stop using tobacco products
- withdrawal symptoms when nicotine use stops
- a desire to keep smoking even when health complications arise
- continued use of tobacco products even if it negatively impacts your life
Treatment for Nicotine Addiction
- Wellbutrin
- Chantix
- Support groups

What We Learned

In 1950, the tobacco companies came out with a huge ad, a statement to America, that they did not believe that cigarettes were any health threat at all. Their “Frank Statement to Cigarette Smokers” essentially stated that they felt tobacco was completely safe and caused no harm, stating that “for more than 300 years, tobacco has given solace, relaxation and enjoyment to mankind.”
In 1964, the Surgeon General, Luther Terry, submitted his report on the direct link between smoking and cancer. It concluded that smoking is a cause of lung cancer and laryngeal cancer in men, a probable cause of lung cancer in women, and the most important cause of chronic bronchitis.
In 1965, labeling changes occurred and today labels show graphic evidence of what cigarettes can do.
In 1967, advertisements for cigarettes had to start giving significant time to the dangers of smoking.
What is NOT a Treatment for Nicotine Addiction: VAPING!

If you’re puffing on something electronic – it’s vaping.
Might call it e-cig, vape, Juul (a brand name)
Bottom line is that it is an ENDS (electronic nicotine delivery system)
Vaping appears to increase young people’s risk of starting smoking
Young people who reported having used e-cigarettes were more than eight times as likely to start using conventional cigarettes
Problem may be exacerbated by the many flavors used to enhance the enjoyment of e-cigarette use
Adolescents and young adults are known to be very susceptible to flavorings
Vaping is exposing them to one of the most addictive chemicals known — nicotine
Studies show teens tend to underestimate their risk for getting addicted and overestimate their ability to quit once addicted

Types of e-Cigs

1st Gen: closely resembles a cigarette and is disposable
2^nd Gen: larger, pen shaped, rechargeable
3^rd Gen: do not look like combustible cigs at all, have large batteries, replaceable parts, these are called “mods”
Latest: Sleek, modular design like Juul (looks like a USB drive) and some others. These often have a much higher nicotine content than traditional cigs or earlier devices.

Nicotine Concentrations

Levels vary – some are nearly the same as traditional cigarettes
Mislabeling is a common problem
Nicotine delivery is affected by how the device is used by the consumer.
Juul delivers nicotine almost THREE TIMES FASTER than a typical cigarette.
- This increases the likelihood of addiction
- Often, (some say 37 % of the time) youth and young adult users are not even aware that the device has nicotine in it at all.

As Harmful as Typical Cigarettes?

While e-cigarettes contain some fewer toxins than combustible cigarettes, they are not free of toxins and still deliver harmful chemicals
There is an enormous variability within the product category and there is no typical e-cigarette
- different ingredients and different hardware, and deliver highly variable amounts of nicotine and potentially toxic chemicals

What People Think

Among adults,
- 31% think they are the same as cigs
- 4% think they are more harmful
- 29% don’t know
- 36% think they are less harmful

Usage Rates

In 2011, 1.5 percent of high school age students used e-cigs
In 2017 that number was up to 12 percent
In 2011, 0.6 percent of middle schoolers used them, and
In 2017, 3.5 percent used them
Among adults, in 2015, more than HALF of users also smoked cigarettes.
Among young adults, 40% also smoked cigarettes.

Patterns of Use

In 2017, studies showed that 12% of high school and 3.5% of middle school students has used e-cigs in the previous 30 days
2018 NASEM report concluded that, “there is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults”
60 percent of teens incorrectly reported e-cigarettes as being comprised of mostly flavoring.

Juul

Since 2016, Juul has surged in popularity – now with 68% of the e-cig share.
Many are unaware that the product always contains the addictive chemical nicotine
A single JUUL cartridge is roughly equal to a pack of cigarettes

Health Effects

Much is still unknown
E-cigs can deliver levels of nicotine similar to combustible cigarettes and this is causing concern about the potential risk for addiction
Exposure to nicotine among youth is particularly dangerous since it has been shown to have an effect on key brain receptors, making young people more susceptible to nicotine addiction
Effect of nicotine on developing brains may result in nicotine addiction and greater vulnerability to addiction to other drugs as well
Pregnant women who use nicotine are at a greater risk of stillbirth and preterm delivery.
At least 60 chemical compounds have been found in e-liquids, and more are present in the aerosol produced by e-cigarettes.
We don’t know what exposure to these flavors will do. Marketing has gotten out of hand with some being labeled “Thin Mint” or “Redi-Whip”, etc.
E-liquids can cause unknown problems
Explosions of devices can and do occur, although unlikely this is very dangerous.
Vaping is in its infancy. It is tobacco fifty years before the discovery that it caused lung cancer. What good could you possibly hope to derive from vaping?

Thinking about vaping? Think before you start! (Before you buy even that first device.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.