This article first appeared in Forum, The Edge Malaysia Weekly on September 9, 2019 - September 15, 2019
As the vaping epidemic grows in Malaysia, health risks associated with nicotine have risen dangerously. “Adolescents do not think they will get addicted to nicotine, but when they do want to stop, they find [that] it is very difficult,” according to Yale School of Medicine neuroscientist Marina Picciotto.
Young people are vaping in record numbers in many parts of the world. Despite various research reports highlighting its dangers and marketing tactics to hook teenagers and young adults, the number of vape users continue to climb. And while it is possible to buy e-liquid or pod refills without nicotine, it is much harder to find them.
Many observers, including policymakers, overlook or underestimate the role of nicotine — a key ingredient in the vapours inhaled. Most teenagers do not realise that nicotine is highly addictive. Studies have shown that young people who vape are more likely to shift to cigarettes, which can cause a broad range of diseases.
The Ministry of Health Malaysia recently estimated that 90% of e-liquids in the country are laced with nicotine. But an industry lobbyist has claimed “wilful confusion” at the ministry in delaying action against vaping despite existing laws empowering them to act.
Why nicotine is so addictive to youth
Nicotine is harmful to one’s health at any stage in life, but is especially dangerous before the brain is fully developed, around the age of 25. Studies show that nicotine can physically change the teenage brain.
Adolescents believe they will not get addicted to nicotine but find it very difficult to stop as “the adolescent brain is more sensitive to rewards”, says Picciotto, who has studied nicotine addiction for decades.
The mesolimbic dopamine “reward” system is one of the more primitive parts of the brain that developed to positively reinforce behaviour needed to survive, such as eating. As the mechanism is engrained in the brain, it is very hard to resist.
When a teenager inhales vapour with nicotine, the drug is quickly absorbed through the blood vessels lining the lungs, reaching the brain in about 10 seconds. There, nicotine particles fit “well” into receptors on nerve cells (neurons) throughout the brain.
“Nicotine, alcohol, heroin or any drug of abuse works by hijacking the brain’s reward system,” says Yale addiction neurobiologist Nii Addy. The reward system was never meant for drugs but evolved, enabling nicotine to bio-chemically interact with natural neurotransmitters that activate the muscles in our body.
Once nicotine binds to the receptor, it signals the brain to release dopamine — a well-known neurotransmitter that generates a “feel-good” feeling. Dopamine is part of the brain’s feedback system signalling that “whatever just happened felt good”, training the brain to repeat the action.
Unlike other drugs such as alcohol, nicotine quickly leaves the body once it is broken down by the liver. And once it is gone, the brain craves nicotine again. Craving, due to the drug that causes the dopamine rush, makes it difficult for addicted youth to quit nicotine.
Recent research, including human brain imaging studies, shows that “environmental cues, especially those associated with drug use, can change dopamine concentrations in the brain”. Simply seeing someone vape,or visiting a school toilet where teenagers vape during the school day can unleash intense cravings, making it difficult not to relapse.
Physical changes caused by nicotine
Nicotine also causes physical changes to the brain, some temporary while others could have long-lasting effects. Research on cigarette smoking has long shown that acetylcholine receptors in the brain increase with continuous exposure to nicotine, intensifying cravings. But the receptors decrease after the brain is no longer exposed to nicotine, implying that such changes are reversible.
Animal studies also show nicotine adversely affecting brain functions, relating to focus, memory and learning, which may be long-lasting. According to Yale’s Picciotto, nicotine can increase connections among cells in the cerebral cortex region in animals’ developing brain, which would cause cognitive function and attention problems. This may also be true for human brains.
Comparing the pros and cons of vaping versus smoking is complicated. Unlike regular combustible cigarettes, e-cigarettes probably do not produce 7,000 chemicals, some of which can cause cancer.
However, aerosol from vape devices contains lead and volatile organic compounds, some of which are linked to cancer, while long-term health effects from vaping are still unresearched.
Importantly, e-cigarettes have not been approved by the US Food and Drug Administration as smoking-cessation devices. But according to the US Centers for Disease Control and Prevention, e-cigarettes may be better for adult smokers if they completely replace smoking.
The “pod mod” is a newer, popular vape device outcompeting many other e-cigarettes. The nicotine in these pods is 2 to 10 times more concentrated than most “free-base” nicotine in other e-liquids. A single pod from one vape manufacturer contains 0.7ml of nicotine, about the same as 20 regular cigarettes.
Despite its highly addictive nature, people can successfully quit nicotine, particularly with personalised approaches under the guidance of suitably trained physicians. For young people, early intervention could significantly improve the quality of their lives.
Professor Wan Manan Muda was professor of nutrition and public health at Universiti Sains Malaysia, Kelantan. Jomo Kwame Sundaram was an economics professor and United Nations official. To learn more, visit yalemedicine.org Also see Institute for Public Health, Malaysia. 2016. Tobacco & e-cigarette survey among Malaysian adolescents 2016.
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