By Matthew Perrone

The Associated Press

WASHINGTON — The nation’s top health authorities agree: Teen vaping is an epidemic that now affects some 3.6 million underage users of Juul and other e-cigarettes. But no one seems to know the best way to help teenagers who may be addicted to nicotine.

E-cigarettes are now the top high-risk substance used by teenagers, according to the latest U.S. figures, which show that Juul and similar products have quickly outpaced cigarettes, alcohol, marijuana and other substances that have been tracked over more than four decades.

In recent months, government officials have rolled out a series of proposals aimed at keeping the products away from youngsters, including tightening sales in convenience stores and online. But there’s been little discussion of how to treat nicotine addiction in children as young as 11 years old. While some adolescents should be able to quit unaided, experts say many will be hampered by withdrawal symptoms, including anxiety, irritability, difficulty concentrating and loss of appetite.

Physicians who treat young people now face a series of dilemmas: The anti-­smoking therapies on the market — such as nicotine patches and gums — are not approved for children, due to lack of testing or ineffective results. And young people view the habit as far less risky, which poses another hurdle to quitting.

The harshness of cigarette smoke often limits how much teenagers inhale, sometimes discouraging them from picking up the habit altogether. That deterrent doesn’t exist with e-cigarette vapor, which is typically much smoother, according to experts.

Kicking any addiction requires discipline, patience and a willingness to follow a treatment plan — something that doesn’t come easily to many young people, experts said.

“Teenagers have their own ideas of what might work for them, and they’re going to do what they do,” said Susanne Tanski, a tobacco prevention expert with the American Academy of Pediatrics. “But we desperately need studies to figure out what’s going to work with this population.”

Since debuting in the U.S. in 2007, e-cigarettes and other vaping devices have grown into a $6.6 billion business. Driving the recent surge in underage use are small, easy-to-conceal devices like Juul, which vaporizes a high-nicotine solution sold in flavors such as creme, mango and cucumber. Despite industry worries of a crackdown on flavors, the FDA has taken no steps to ban the array of candy and fruit varieties that companies use to differentiate their offerings.

E-cigarettes have become a scourge in U.S. schools, with students often vaping in the bathroom or between classes. One in 5 five high schoolers reported vaping in the last month, according to 2018 federal survey figures.

Juul and other brands are pitched to adult smokers as a way to quit smoking, but there’s been little research on that claim or their long-term health effects, particularly in young people. Nicotine can affect learning, memory and attention in the teenage brain, but there’s virtually no research on how e-cigarette vapor affects lungs, which do not fully mature until the 20s.

Tanski and other experts will meet Friday at the Food and Drug Administration to discuss the potential role for pharmaceutical therapies and non-prescription medications such as nicotine gums and patches.

Regulators acknowledge they are starting from square one: The FDA “is not aware of any research examining either drug or behavioral interventions” to help e-cigarette users quit, the agency noted in its announcement.

The FDA will also hear from researchers, vaping executives, parents and teenagers.

“We want to make sure our voices are heard and that — most importantly — our kids’ voices are heard,” said Meredith Berkman, who plans to speak at the meeting with her 10th-grade son. Berkman said she first realized her son and his friends were “Juuling” last year when she heard them repeatedly opening and closing his bedroom window.

“Unless the flavors are off the market, kids are going to continue to be seduced by these highly addictive nicotine-delivery systems like Juul,” Berkman said.

Quitting smoking is notoriously difficult, even for adults with access to various aids and programs. More than 55 percent of adult smokers try to quit each year, yet only about 7 percent succeed, according to government figures.

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