Researchers say providers have largely failed to use the tools that exist to help young people quit smoking despite the growing prevalence in vaping that's led to the first increases in youth tobacco use in decades.
A study published Monday in JAMA Pediatrics of more than 81,000 young people with nicotine use disorder found just 4% had received counseling to encourage them to stop using tobacco products, while only 1.2% were prescribed medications to help them quit.
Just 1 in 1,000 patients had received both counseling and treatment, a combination experts say can lead to a three-fold increase in quitting among adults.
"Such low treatment rates during a developmental period when adolescents and young adults are at increased risk of developing lifelong nicotine addiction likely represent a missed opportunity to address nicotine use disorders in this population," the study concluded.
The study examined data of more than 3 million Medicaid patients ages 10 to 22 across 11 states who were diagnosed with having nicotine use disorder between January 2014 and June 2015.
It found youth who were older and those with concurring mental health and substance use disorders had a higher probability of receiving medication.
"This may represent an under-appreciation among clinicians of the implications of nicotine use disorder in adolescents and young adults otherwise perceived as healthy and an opportunity to increase treatment rates in this group," the study found.
Study co-author Dr. Scott Hadland, a pediatrician and addiction specialist at Boston Medical Center, said he is seeing signs of an increasing number of young people having what he called "true" nicotine addiction, including those who have undergone physical withdrawal symptoms.
While he felt tobacco-cessation tools such as medications might be a way of addressing that increase, he acknowledged there was little data to show whether tobacco-cessation medications were effective treatments for youth, or what effect the use of such drugs could have on adolescents.
He said such lingering questions probably made doctors more hesitant to prescribe those medications in young patients.
"That's a really critical gap," Hadland said. "We need to understand more and more whether these medications are useful and in what ways are they useful."
Rates of tobacco cigarette smoking have been steadily falling for the past 30 years, but the explosion in the use of electronic cigarettes among young people in recent years has led to a reversal in that trend.
Preliminary data from the Centers for Disease Control and Prevention found more than a quarter of high school students had used e-cigarettes in the past 30 days in 2019.
A February CDC report found 27% of high school students and 7% of middle school students in 2018 were current users of a tobacco product, marking the first significant uptick in tobacco use in at least the past five years.
Researchers recommended providers ask their patients whether they or family members smoke or use e-cigarettes, advise them on the dangers of the products, and encourage them to stop.
Guidelines from the American Academy of Pediatrics recommend physicians offer medication to those young people addicted to nicotine to help them quit or explore other options such as nicotine replacement therapy.
The call for healthcare providers to address youth nicotine use comes as the country faces an outbreak of lung illnesses related to vaping.
More than 530 cases have been reported as of Sept. 19, according to the CDC, which have resulted in eight deaths.