Merridith O’Leary: Addressing nicotine withdrawal during the vaping ban

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For the Gazette
Published: 10/15/2019 9:25:17 AM

Due to a substantial increase in cases of severe lung disease linked to the use of vape products in the country, on September 24, Massachusetts Governor Charlie Baker in support of Public Health Commissioner Monica Barhel declared a Public Health Emergency and put a pause of the sale of all vaping products. This action taken by the administration is parallel to actions taken as if there was E. coli or salmonella on romaine lettuce that was being sold and making people sick. However, unlike with a food recall where health side effects are not likely to occur, abrupt discontinued use of nicotine may result in withdrawal symptoms. Nicotine withdrawal is something that hasn’t been mentioned in media coverage about this current policy, yet it is an important reality for many people who stop using vaping products cold turkey.

The vape ban in Massachusetts has left many who use these products on a regular basis wondering what to do. Some have thought about transitioning to traditional cigarettes, others have mentioned that they will travel to another state to purchase their vapes and others are using this as an opportunity to quit smoking and vaping all together. While the science on what is causing the recent vaping crisis is still being reviewed, the evidence on the harmful effects of smoking traditional cigarettes is clear. Doctors and other medical experts consider nicotine replacement therapy one of the safest, effective and helpful tools smokers and vapers can use to quit.

Withdrawal from nicotine is a physiological process with very real effects and can take many attempts to successfully cease nicotine usage. When the body begins to withdraw from nicotine, someone may experience symptoms such as irritability/frustration and anger, anxiety, difficulty concentrating, weight fluctuations, restlessness/impatience, depression/dysphoria, headache, constipation and insomnia. Parents should be aware if their children begin to exhibit these symptoms, that they may have an addiction to nicotine that they were unaware of. These start within one-to-two days of quitting, are worst a week after ceasing usage and resolve within a month. Experiencing these negative symptoms is a large reason for relapse. Nicotine replacement therapy can help lessen the physical symptoms giving time to concentrate on triggers and psychological reasons by someone uses nicotine usage and space to try new strategies moving forward.

Although the average number of quit attempts before success is achieved is six to eight times, nicotine replacement therapy can double a smoker’s chances of quitting for good. Nicotine replacement therapy reduces withdrawal feelings by providing a small, controlled amount of nicotine but none of the other dangerous chemicals found in cigarettes or vape products. This small amount of nicotine helps satisfy craving for nicotine and reduces the urge to smoke.

Many nicotine replacement therapies are over the counter and are available at local pharmacies. Nicotine replacement therapy comes in a variety of forms that are used in different ways; the patch, gum, lozenge, inhaler and nasal spray. You can choose which forms you like best. Some nicotine replacement therapy products work better than others for some people. Some people might prefer certain nicotine replacement therapy products instead of others.

As a result of a public health emergency in response to the number of cases of severe lung disease associated with the use of e-cigarettes and marijuana vaping products in the Commonwealth, MassHealth is focused on ensuring its members have access to products to help them quit smoking or vaping, including nicotine replacement therapy products. MassHealth members do not need to pay anything out of pocket for products to help them quit smoking, including prescription medications and over the counter products like gum, patches and lozenges.

Since the ban on vaping products is scheduled to last until January 2020, this may be a good time for individuals who are trying to quit their dependence on nicotine to consider other less potentially harmful products that are readily available to help them to reduce their dependency on tobacco.

Below are some tips how to effectively use nicotine replacement therapy to help with success to quit.

■Patches provide a slow, steady release of nicotine to the bloodstream over a period of 16-24 hours. It takes about five hours to reach peak concentration in your blood.

■Many people report finding increased benefit in using both the patch and the gum together, by wearing a patch daily, and using gum when breakthrough cravings occur. This is safe.

■Some people report the nicotine patch causes sleep disturbances. It is okay to remove it before bed, and this generally helps with the sleep disruptions.

■If you are applying the patch first thing in the morning, be aware that morning cravings are the strongest. Keep the patch on your bedside table and apply first thing when you wake up. Since the patch takes time to build up in your blood, use in tandem with a piece of gum. Many report if they can get past this initial craving, the rest of the day progresses much easier.

■Patches come in multiple doses. Start with a dose equivalent to how much nicotine you consume daily, decrease the strength of the patch after one month, and then every two weeks after that.

14 mg patch: Smoking less than 10 cigarettes or ½ Juul pod per day.

21 mg patch: Smoking more than 10 cigarettes or ½ Juul pod per day.

■Like patches, nicotine gum also comes in multiple doses. This dose is calculated by how long you can go in the morning before consuming nicotine:

2 mg gum: If you can wait more than 30 minutes upon first waking up in the morning before you use nicotine.

4 mg gum: If you cannot wait more than 30 minutes upon first waking up before you first use nicotine.

■Many people use nicotine gum incorrectly. To get the greatest benefit: chew until a peppery taste emerges, and then “park” the gum in your cheek (this allows for nicotine absorption through mucous membranes in mouth). Slowly alternate between “chewing” and “parking” for 30 minutes.

■Acidic drinks such as coffee or tea will reduce effectiveness of gum, do not use them together.

Nicotine replacement therapy helps stem your body’s craving for nicotine, but it doesn’t address the psychological triggers for nicotine use. To improve your chances of quitting, try to identify what triggers your nicotine use: stress, boredom or certain social situations are often triggers. Keep a piece of paper with your vape device or cigarettes and make a quick note about how you’re feeling prior to using your device or lighting a cigarette, then at the end of the day or week look at the paper and identify common triggers. If you can avoid these, you may increase your chances of success.

Combining nicotine replacement therapy with other quit strategies can improve your chances of quitting and being successful in the long term. To give yourself the best chance for success, explore other quit methods that you can combine with medication. Think about developing a quit plan and calling or texting quit lines. For adults call 1-800-784-8669 or text “vape free mass” to 88709, and for teens text “start my quit” to 1-855-891-9989 or visit The Massachusetts Smokers’ Helpline is a free and confidential service for Massachusetts residents who want help to end their tobacco use. If you are looking to quit tobacco, you can now get help from a quit coach over the phone; or use online tools and resources; or a combination of these online features and telephone coaching.

Callers to the Helpline receive specialized coaching over the phone to help them quit smoking or using other tobacco products. Callers can also receive advice on medications, in-person coaching and how to find out if their insurance covers quit smoking services. If you have tried the quit line but have more questions, please reach out to Jenny Meyer, the City of Northampton Public Health Nurse at 413-587-1216.

Merridith O’Leary is the Public Health Director for the City of Northampton.

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