New App and Recommendations from the American Academy of Pediatrics!

The American Academy of Pediatrics recommends that pediatricians consider off label Nicotine Replacement Therapy (NRT) for youth with moderate or severe evidence of nicotine dependence and a clear desire to quit. To date, research has found more modest effectiveness of NRT in youth compared to adults, and no serious harm from using NRT in adolescents under 18 years of age. Additional research is underway. 

To assist providers who treat adolescents, the AAP has developed the Youth Tobacco Progressive Web App (PWA). Find it at Tobacco Cessation | AAP The app guides providers through these steps of care:

1.     Ask/screen for tobacco product use

2.     Counsel/determine quitting interest

3.     Treat

To take the first step of treatment, use a validated screening tool to determine the level of tobacco dependence, like the one in the app. 

The app includes scales such as the HONC (hooked on nicotine checklist) that are tailored to vaping. The screening questions assess for loss of autonomy over e-cigarette use, indicating that nicotine addiction has begun. You’ll find NRT product and dosing recommendations in the app for youth who are found to have moderate or severe tobacco dependence. Estimated dosing needs for combination NRT (long-acting patch plus shorter acting gum or lozenge) serve as a starting point for your patient. Resources for behavioral support/counseling are available through the app, including texting, quitlines, and online. 

For the greatest success, encourage youth to participate in a form of behavioral counseling throughout their quit attempt! Massachusetts offers My Life, My Quit for youth ages 13-17 with free phone coaching and options for live texting as well (mylifemyquit.com) Follow up early with your young patients as nonadherence and relapse are common. For example, following up 2 weeks after a patient’s quit date can create a touch point for assessing progress, adjusting treatment as needed, and providing additional intervention for relapse. Though quitting is hard, help is available!

The AAP also provides training videos that you can find at their E-cigarettes and Vaping Toolkit page. They include:

Promoting Confidentiality During an Adolescent Clinical Visit

Counseling About E-cigarettes When a Patient is Ready to Quit

Counseling About E-cigarettes When a Patient is Reluctant to Quit

Screening and Prevention of E-cigarette Use

Nicotrol Inhaler Discontinued:

Manufacturing of Nicotrol, the FDA-approved nicotine inhaler sold in the U.S., was discontinued in September 2023 because an essential resin used in producing the mouthpiece is no longer available. Another inhaler, which goes by the trade name Nicorette, is not FDA-approved but is equivalent to Nicotrol. Unfortunately, Nicorette also uses the resin. Some patients have been purchasing the Nicorette inhaler online without a prescription, such as through Kea Health (Delaware) and Johnson & Johnson and McNeil in Canada, however this supply also will soon be depleted.

The other four nicotine replacement therapy medications that are available in the U.S.--patch, gum, lozenge, and nasal spray--remain available. Like the nicotine inhaler, nicotine from the gum and lozenge is absorbed through the lining of the mouth and therefore these three products have a similar timeline for onset of action. 

Welcome Spring!

Encourage patients to use outdoor time to do activities that promote wellness and calm while quitting:

Gardening/starting some seeds, setting up hummingbird feeders, doing deep breathing exercises, walking, picnicking in the park, riding a bike, taking pictures of nature, and many more. Encourage patients to brainstorm their own healthy and effective behavioral strategies to help them stay tobacco free!  

Our brochure, "Take the First Step Toward a Nicotine-Free Life," offers tips and resources for your patients. It can be offered at no cost from the MA Health Promotion Clearinghouse.

 A full description of Quitline services can be found here.