In the last month, the Centers for Disease Control and Prevention has warned the public of severe lung-damage and pneumonia-like symptoms linked to vaping. At least seven vaping-related deaths have been reported, with hundreds more people requiring hospitalization— The New England Journal of Medicine, not known for hyperbole, proclaimed “there is clearly an epidemic that begs for an urgent response.”
Thus far, though, investigators haven’t uncovered what’s making people sick. Some patients vaped THC, while others vaped only nicotine, and still others were using a combination of the two, making it harder to pinpoint a culprit. In the absence of a definitive cause, doctors are strongly encouraging people not to vape—which is good advice even absent the risk of life-threatening lung damage.
If you vape regularly, you’re almost definitely addicted to nicotine. It’s worth understanding that whether you vape or smoke tobacco, the underlying chemical effect is the same. Every time you take a hit of a vape or a cig, you’re bringing nicotine into your bloodstream. Nicotine makes you feel good—which is why people keep smoking, even when they intellectually know it’s doing them harm. “Nicotine is as addictive as cocaine and heroin. It has the same effect on the brain and changes the brain,” said Deborah Buckles, program director of the Tobacco Treatment Program at the Indiana University Melvin and Bren Simon Cancer Center.
That means vaping—often marketed as a way to quit smoking, though the Food and Drug Administration has never approved them for that—produces the same addiction as cigarettes do, centered around deliberately getting a hit. And quitting means going through withdrawal: Symptoms include anxiety, irritability, cravings, over-eating, and the like. So: If you want to quit vaping without turning to cigarettes, as many people are doing—how do you actually get off nicotine altogether? (Because, just for the record: Quitting “cold turkey”—abruptly stopping with no support, whether physical or psychological—is generally a terrible approach, according to experts. One study showed that a mere three to five percent of smokers succeeded at quitting cold turkey.)
Ask for help and find counseling.
Kicking any addiction can make you feel like you’re at war with yourself. But experts recommend asking for help. “The most effective means of tobacco treatment is medication combined with counseling,” said Buckles. That’s because you’re not just trying to reverse physiological changes—rewiring your brain, in a sense—but also unraveling a whole host of everyday psychological habits. That might mean turning a smoke break into a walk break, for example.
Quitting can mean changing your current social milieu, at least temporarily. “If your friends are smoking or using Juul, how are we going to address that pressure, when you try to quit?” said Lena Matthias Gray, a tobacco treatment specialist with the University of Michigan’s MHealth Tobacco Consultation Service. You don’t want to drop your friends along with your habit, and a counselor can help you navigate that change. They can also guide you through other psychological issues around addiction.
Gray encourages quitters to reach out to counselors, either locally or on the web at SmokeFree.gov. There you can also find apps aimed to help you quit, and SmokefreeTXT, a text-based service for anyone looking to ditch nicotine.
With the help of a doctor, look into nicotine replacement therapy.
In conjunction with counseling, there are a number of FDA-approved methods for quitting smoking. Getting nicotine by means other than smoking (or vaping) is called nicotine replacement therapy, or NRT, which are also approved by the FDA. The most familiar methods of NRT are nicotine gums, lozenges, and patches—all of which are available over the counter, without a prescription. (Nicotine inhalers and nasal sprays, however, do require a prescription.). Pushan Jani, assistant professor of pulmonary and sleep medicine at McGovern Medical School at UTHealth in Houston, explains that these products work on the same basic idea: Providing users with increasingly smaller doses of nicotine to control withdrawal symptoms while weaning them off the drug.
Some people dismiss NRT as just trading one delivery system for another—isn’t it just a different way of being addicted? But the delivery system matters: Without the noxious smoke of traditional cigarettes or the wildly unregulated chemicals of vapes, you’re actually getting a less harmful supply of nicotine. You also don’t get the same rush as a cigarette or vape; it’s a more gradual dose, designed to not trigger the brain’s addictive feelings of being rewarded.
NRT has been around for a long time, with decades of research proving its safety and efficacy. That said, there can be side-effects, including dizziness, nausea, hiccups, racing heartbeat, and others. Nicotine gum may irritate your jaw or leave a bad aftertaste; lozenges may provoke coughing; and patches can cause skin irritation. Nicotine overdose is a rare side effect (you should be receiving less nicotine than vaping), but if you start having a fast heartbeat, dizziness, cold sweats, or nausea, see a doctor. And, of course, if you’re pregnant, you’ll want to look at other options. All of these minor and well-known side effects pale next to the uncertainty around vaping, where people are suffering permanent lung damage due to causes currently unknown.
If you and a doctor determine they're right for you, look into prescription drugs to cut out nicotine entirely.
Prescription smoking cessation drugs, on the other hand, are options that don’t include nicotine, but can address its effects. Varenicline (sold under the brand name Chantix), Jani explained, is a nicotinic receptor partial agonist. That’s a concise way of saying it bonds to the same neuro receptors as nicotine, so if a nicotine addict uses a nicotine product while taking the medicationthe hit doesn’t have nearly the same rewarding effect. Without that reward—the rush of the puff—it’s easier to quit. “The most effective and safest medication on the market today is Varenicline,” said Buckles. (It, too, can have side effects, including nausea, sleep problems, constipation, gas, and vomiting.)
The antidepressant Bupropion (sold as Wellbutrin) is also FDA-approved for quitting. Like varenicline, it contains no nicotine, but its mood-elevating effects may help blunt some of the side-effects of nicotine withdrawal, such as irritability and, yes, depression. Dulling those symptoms can make it easier to stick with quitting. (Bupropion’s potential side effects probably sound familiar by now: nausea, dizziness, constipation, insomnia, and others.)
Stick to what works for you, which is also most likely to be supported by research.
All the experts we talked to emphasized looking for FDA approval. Other methods, such as hypnosis or acupuncture, may work, but as Gray points out, they’re not as supported by research. “Someone might get relief from that,” she said, “but it’s not going to harm them.”
Change your perspective about vaping—and once you've quit, keep it that way.
While there are options for people who want to quit, Jani pointed to a bigger problem—what he calls a cultural problem. After decades of health officials successfully (and rightfully) demonizing cigarettes, vaping arrived with little regulatory oversight and an implied promise as a safer alternative. Vaping kind of made smoking cool again, and from a public health perspective, that’s a problem. “We need to change the perspective to remind people these are harmful products,” Jani said.
“The best thing is to never start using nicotine or any tobacco products,” said Buckles. Because they are harmful, and once you’re in? “Addiction to nicotine can happen in as little as a few puffs over a few days/weeks,” Buckles said—it’s hard to get out. “There is no ‘magic pill,’” she said. “The easiest way to quit is with medication and assistance from someone trained in addiction.”
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This article originally appeared on VICE US.