Page 6 - WCMS2Q22

President’s Message
By John A. Hopper, MD, DFASAM, FAAAP, FACP
Little (Vape) Shop oMf Horrors
y earliest memory of experiencing fear is of watching Roger Corman’s black and white B-movie cult classic, Little Shop of Horrors. It
was the late 1960’s; I was about 4 years old. My grandpar- ents didn’t have many rules when I was visiting. I saw and loved all the classic horror flicks: “Frankenstein”, “The Wolfman”, “Dracula”, “The Mummy”, “The Blob,” and even the campy “Creature from the Black Lagoon” but the original “Little Shop” conveyed a level of threat- ening darkness that I was not ready for. If you’ve never seen it in the original (not one of the later, more popular versions), It begins as a love story in which the nerdy florist’s assistant, Seymour, loves his plant Audrey, Jr., who it turns out is carnivorous. As Audrey grows, her appetite becomes insatiable (“feed me, FEED ME”) and Seymour begins killing people to satisfy Audrey’s constant hunger. The story haunted me for years.
As a physician, I am haunted in the same way by an article that appeared in the September 4, 2014, issue of The New England Journal of Medicine. In this paper, Eric and Denise Kandel describe “A Molecular Basis for
Nicotine as a Gateway Drug.” They brilliantly map out the molecular mechanisms that underpin nicotine addiction, including the effects on chromatin, the transcription of genes, and the priming effect of nicotine on future use of cocaine by “adolescent” rats. Written at a time when e-cigarettes use was steadily increasing, this paper got me thinking about tobacco and nicotine on a new, and dark, level. The implication of the article is that nicotine use among adolescents could lead to much greater stimulant (specifically cocaine) use and addiction in the future. Epidemiology shows that most individuals with cocaine dependence were nicotine dependent first and that cocaine dependence is much lower among never smokers relative to former smokers.
Since that time, the news has become bleaker. On May 30, 2022, the online edition of Pediatrics published a paper by John Pierce and colleagues at University of California San Diego reporting that 1 million youths in the United States, ages 14 to 17 years, became new daily tobacco users in 2017. By 2019, more than 75% of these young persons were vaping e-cigarettes daily. The authors show the parallel between the rise in youth vaping and the 40% growth of JUUL products in 2019. The tremendous and hard-fought efforts to reduce tobacco smoking by teens have been more than erased in just a few years. Current regular cigarette use by high schoolers is at an all-time low of 6% but regular nicotine vaping is at nearly 33%. Before 2014 I would have rationalized that nicotine is a relatively safe molecule and better to vape it than smoke tobacco. Once again, however, even the some of the most knowledgeable members of society have been duped by the merchants of death. We are now seeing the downstream effects including rising rates of emergency department visits for stimulant related problems and a dramatic increase in overdoses related to stimulants.
It gets worse. House Bills 6108 and 6109 were recently passed by the House. While these bills raise the age for tobacco sales, they fail to include a meaningful enforce- ment mechanism to ensure retailers comply, putting federal substance abuse funding at risk. In addition, the House bills are tie-barred to Senate legislation (Senate Bills 576, 577 and 720) that allows tobacco products to be
6 Washtenaw County Medical Society BULLETIN SPRING 2022