When her son was a high school freshman, Kristin Beauparlant noticed a change.
The hockey player began getting short of breath more easily on the ice. Beauparlant could hear her son's coughing and wheezing from the stands. But it was his demeanor that scared hermost. Cade Beauparlant's anxiety and mood swings worsened, his outbursts so sudden and so explosive that his mother said she came to fear him.
It took more than three years — and help from a renowned pediatrician — to understand what was going on: Her son was addicted to nicotine, delivered by a Juul, a sleek e-cigarette that looks like a USB drive.
As e-cigarettes have skyrocketed in popularity among teenagers in the past two years, pediatricians report seeing teens who behave less like tobacco users and more like patients with substance-abuse disorders.
Some young people have resorted to stealing from their parents or selling e-cigarette paraphernalia to support their habits, addiction treatment specialists said. And even though many teens assume e-cigarettes are safe, some turn up with signs of nicotine toxicity, a condition previously seen in young children who accidentally ingested nicotine gum.
Others are reporting respiratory problems. After more than three years of vaping daily, Beauparlant was diagnosed with restrictive lung disease. His mother said she is working with an attorney to flle a class-action lawsuit against Juul that would force it to set up treatment centers.
"We were thinking about vapes just like we thought about cigarettes. Over time we realized, 'No, no, this is something really different,' " said Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Boston Children's Hospital.
She and other doctors said they think they are witnessing for the flrst time the damage that repeated exposure to high levels of nicotine wreaks on young bodies.
Anecdotal evidence from leading addiction specialists in Boston and New York and from families grappling with adolescent e-cigarette addiction points to previously unseen consequences of use among teens. Several families have sued Juul, accusing it of causing nicotine addiction in their children and describing extreme addiction symptoms.
Doctors said they think the behaviors of teens addicted to e-cigarettes could be linked to their design: Many products, including Juul, allow users to ingest far more nicotine than they would with traditional cigarettes. Concerns over teen use prompted San Francisco to become the flrst major city to ban e-cigarette sales.
"With the Juuls, kids are able to get a much higher dose of nicotine — and dose matters," Levy said. "These kids have behaviors that we often see in patients who have opioid or marijuana addiction, but we didn't typically see with kids who developed addiction to traditional tobacco cigarettes."
A House subcommittee has accused Juul Labs of targeting children and teens, including at schools. Company offlcials said the effort stopped last fall and actually was designed to educate youths about the dangers of nicotine addiction.
Juul has defended the design of its products, saying they were engineered with adult smokers in mind. The company says its own clinical trials show that nicotine is absorbed more slowly through use of its e-cigarette than through cigarettes.
But doctors say teens consume e-cigarettes at far faster rates than they do traditional cigarettes, with some consuming a pod or more a day — equivalent to the amount of nicotine in a pack of cigarettes. E-cigarette vapor does not burn the throat as much as cigarette smoke does, and that makes it easier for consumers to use e-cigarettes more frequently.
In 2018, more than 37% of 12th graders reported vaping at least once in the past 12 months, according to flndings released by the National Institute on Drug Abuse, even though many were too young to legally purchase the products. A year earlier, the flgure was about 28%.
Experts say that teen brains are particularly vulnerable to addiction because they are still developing and that it is easier for teens to fall victim to addictive products because they have less impulse control.
They worry that the chemical will shape the brains of teens, priming their "reward pathways" and making them more vulnerable to other kinds of substance abuse. They worry, too, that many pediatricians lack the expertise and treatments to help young people who cannot quit.
And there are few treatment options for teens addicted to nicotine. While adult smokers seeking to quit have beneflted from nicotine patches and the drug varenicline, better known as Chantix, there is scant evidence that those treatments work for young people, said Jonathan Winickoff, a pediatrician and researcher at Massachusetts General Hospital who treated Cade Beauparlant.
"We have millions of kids now, millions of adolescents who are using mostly Juul — and in some cases other devices — who are unable to quit," Winickoff said. "It's something we don't have the infrastructure to deal with."