Extract from ABC News
Josh* reaches inside his pocket and is suddenly filled with a sense of panic.
He's left his vape at home.
The sudden dread he's feeling crystallises what he probably already knows, but has been unwilling to admit.
He is addicted.
Forgetting the vape creates the perfect opportunity for the young man, who has been vaping almost every day for the past seven years, to finally quit.
Resolved, he races to the nearest supermarket and buys nicotine chewing gum.
A month on, and he hasn't picked up a vape, marking the longest stretch since he first inhaled the vapour as a teenager.
"Vaping I would say is definitely more addictive [than smoking] because of the ease of access," he says.
"You can vape anywhere, so you can be lying in bed at night, and you can fall asleep with it in your mouth like a pacifier for a baby."
In recent years, there has been a significant rise in vapers under the age of 25 — and so too has the demand for services to help kick the habit.
Doctors brace for increase in youth seeking support
The rising popularity of vaping coupled with increasing government crackdowns on their use has doctors preparing for an increase in young people seeking help with nicotine addiction.
Hester Wilson, chair of the RACGP Addiction Special Interest Group, says while she doesn't believe doctors will be overwhelmed with cases, the profession is preparing for an increase.
"One of the concerns I have particularly for young people is — many of them will just stop [vaping] — but some of them will find they are really craving nicotine," she says.
"It would be a tragedy if they then move to smoking.
"We're really getting ready for the potential that there will be greater need."
New figures show a 13-year-old was the youngest of 1,225 Queenslanders who called the smoking cessation helpline Quitline, who had recently vaped over 17 months to December 2023.
Since Quitline first introduced questions about the use of the devices in August 2022, 5 per cent of callers who reported exclusively vaping were found to be younger than 18 years of age.
In some cases, children are even presenting with "significant symptoms of withdrawal", says Renee Bittoun, who has launched a dedicated vaping cessation clinic — believed to be Australia's first — at Ramsay Health Care in Sydney.
"We're talking as young as 12, 13, 14-year-olds are coming to this clinic, seeking help, wanting to stop doing it," says Professor Bittoun, who has worked in smoking cessation for 40 years.
"They have become anxious, distressed, upset, stressed."
Teens present with 'significant' withdrawal symptoms
In Australia, it is illegal to use a nicotine-containing vape without a prescription from a doctor or nurse practitioner.
The federal government recently announced a suite of reforms, aimed at reducing the prevalence of vaping particularly among young people, including banning the importation of single-use disposable vapes.
Further changes are expected to be brought in this year — including limiting flavours, reducing nicotine concentration, and requiring plain packaging.
People aged between 18 and 24 have recorded the highest increase in vaping rates, reaching nearly 20 per cent in 2023, according to data prepared for the federal health department last year.
Since opening the clinic about six months ago, of the dozen patients Professor Bittoun has seen, one of them — now a teenager – says they first started using the devices at the age of 10.
"What I've found so far, most astoundingly … the kids have significant symptoms of withdrawal, really severe symptoms," she says.
Researchers developing cessation methods
Nicola Rahman, a PhD candidate at Griffith University, has been studying what motivates people to vape — and to quit.
She has surveyed 500 current and former vapers, aged between 18 and 24 years, as part of an effort to develop a cessation program informed by the experience of people who have used the devices.
Nearly 60 per cent had tried to quit, and of those, the majority had tried using the cold turkey method, before many returned to vaping at the time of the study.
"This highlights to us the fact that there's a lack of specific support for vapers to help them quit," she says.
As part of the study, current and former vapers revealed the reasons they found it difficult to quit, with one key reason being the exposure to vaping they face when they socialise with friends.
"It's very socially acceptable still, it's still normalised, so there's a lack of stigma," Ms Rahman says.
"The nicotine addiction is definitely a key factor, it's too readily available, they can't even tell the amount of nicotine that they are vaping on a daily basis.
"Also, [it's] breaking that habit, there's nothing to reach for … a lot of users spoke about the fact that there was nothing to break that [hand-to-mouth] habit."
The study also asked vapers about whether they were smoking cigarettes.
Now developing her cessation program, Ms Rahman says it's also become apparent one in five of the participants were also smoking "so whilst they're trying to quit vaping, we have a dual smoking health issue happening as well".
Professor Bittoun also says more research is needed focusing on developing protocols for vaping cessation.
"You're getting 13 and 14-year-olds voluntarily coming to quit vaping because they're getting into trouble because they really don't want to do this anymore because it's costing them too much money," she says.
"[There is] a whole gamut of reasons, parental pressure sometimes, and parents don't know how to deal with this too because the kids are really pretty, pretty upset, pretty aggro, pretty distressed and probably anxious."
Doctors also preparing for rules around prescribing vapes
Dr Wilson says the Royal Australian College of General Practitioners has been updating its guidelines for doctors to both treat nicotine-vaping addiction and to prescribe therapeutic vapes.
"There is some uncertainty, which vapes will be available, which pharmacies will stock them, all of those logistic things that we need to know to feel comfortable and confident prescribing," she says.
"There is increasing evidence coming out worldwide that therapeutic nicotine vaping devices can be effective to stop smoking [cigarettes], so I think there is a place for them, but the trickiness is there's not a lot of evidence around vaping cessation.
"The long-term evidence of individual vaping and those people around them with passive inhalation vaping is not entirely clear yet.
"We are keen for people not to use them long term."
But there is evidence showing vaping can cause poisoning, seizures, burns and lung disease, according to Queensland Health.
In Josh's case, it was that feeling of panic – alongside concerns over the health impacts – that ultimately helped him kick the habit.
"I don't want to be one of those people on the packages of what it looks like when you've vaped for 40 years," he says.
"You've just got to stick with it when you get off it … Looking ahead I'm pretty confident."
*The ABC has changed Josh's name to protect his identity.
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