Much has been said about the need for more studies on new nicotine delivery systems such as e-cigarettes, vapor devices and other tobacco products. Although more information is always desirable, we already have numerous studies that demonstrate the deleterious effects of nicotine. Adolescents are particularly susceptible to the addictive power of nicotine as well as neurotoxic effects on the developing brain. Impaired cognitive function and changes in emotional behaviors have been seen and may persist later in life. Numerous studies have shown a relationship between nicotine use and increased risk of developing mental issues such as academic problems, antisocial behavior, depression, panic attacks, and increased use of other addictive substances.There are similar, more profound, finding with marijuana.

A recent CDC study published in Nicotine and Tobacco Research found that a quarter-million young people that had never smoked a cigarette previously used an e-cigarette in 2013. That number is triple what was found in 2011. More disturbing is that nearly half of these young e-cig users stated that they intended to smoke conventional cigarettes in the coming year. More than 70% of adolescents have tried some kind of cigarette. Despite these findings, “Big Tobacco” claims that they do not market to youth. Yeah, right.

A 2014 study published in Pediatrics found that “youth exposure to television e-cigarette advertisements, measured by target rating points, increased 256% from 2011 to 2013. Young adult exposure increased 321% over the same period. More than 76% of all youth e-cigarette advertising exposure occurred on cable networks and was driven primarily by an advertising campaign for 1 e-cigarette brand.” At last count, over 3/4 of these ads were for blu cigs (sic), a brand owned by Lorillard Tobacco Company. Lorillard is being acquired by Reynolds American for about $27 billion. Lorillard recently touted their 3.7% increase in Earnings Per Share (EPS) “as the Company continued to incrementally invest in its global blu electronic cigarette business.”

Although FDA banned certain flavors in cigarettes in 2009, other flavored tobacco products exist and are also presented in flavors designed to appeal to youngsters. Flavored little cigars are taxed at a lower rate than cigarettes and are often sold individually at under a dollar. Flavored tobacco for pipes and hookahs are also available. This price, coupled with alluring flavors such as chocolate, gummi bear, dreamsicle, every fruit imaginable, and others with names like Purple Thunder, Golden Honey, Caribbean Chill, and Mocha Taboo, fuel the fires of youthful addiction.

Nicotine solutions to recharge vapor devices, in concentrations from from 2mg/ml to 100mg/ml in various sizes, are readily available for as low as $85 per liter. A liter! This is another worrisome development, considering that, depending on route of administration, an adult lethal dose of nicotine is somewhere between 60mg and 300mg. Some simple math illustrates the danger of having such quantities of nicotine in unknowing or dastardly hands. On-line videos provide detailed instruction on how to use vapor devices for other drugs, including DEA Schedule I substances.
We are seeing ER visits due to nicotine ingestion by babies!

Pharmacists can and should have a significant impact on the young people in their communities. Visits to middle schools and high schools can highlight pharmacy as a career and promote healthy lifestyle choices regarding drugs, including nicotine, alcohol, and prescription controlled substances. Pharmacists are resources for drug information and explaining the adverse effects of nicotine on the adolescent brain is a role that should be a component of community practice.

Constant vigilance and continuing education are required for pharmacists to maintain their credibility regarding the cornucopia of new nicotine delivery systems. Electronic cigarettes, vapor devices, strips, orbs, and snus are all marketed as cleaner versions of tobacco products and some are even hailed as tools for smoking cessation. Pharmacists must be aware and knowledgeable of these products whether offered in their practice settings or not. It is likely that at least one out of five of our patients uses tobacco or tobacco-derived nicotine.