The One Thing You Can’t Get In High School

Teen-age girls are smoking more, according to a new report by the surgeon general. Reading about this in the March 28 Chicago Tribune, Chatterbox tripped across the following:

In Rolling Meadows an anti-tobacco group unsuccessfully urged a high school in Arlington Heights to consider providing nicotine patches to students.

Chatterbox’s attempts to reach the anti-tobacco group and the high school principal were unavailing, so he doesn’t know why Vanguard Schoolvetoed the patch. (Perhaps he’ll have more on this tomorrow.) But he was able to find a Nov. 6 Tribune pieceby Oscar Avila examining the whole question of why, in an era when America’s high schools are enthusiastically passing out condoms and soda pop (egged on, in the latter instance, by Education Secretary Rod Paige) they generally refuse to give students nicotine patches and nicotine gum. Here’s Avila’s answer:

Some health officials warn nicotine replacement is risky until scientists know more. And they wonder how schools can justify giving students nicotine, a substance harmful and illegal for minors, even for a good reason.

But, as Avila points out, it isn’t the nicotine in a cigarette that’s going to kill you; it’s the tar. Nicotine is an addictive drug, but an addiction to nicotine isn’t particularly worrisome if it doesn’t occasion the consumption of other substances that cause cancer and heart disease. “There has been resistance because there has been resistance to providing nicotine in any form to teenagers,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, explained to Chatterbox in an e-mail. “It is probably an obsolete set of concerns that could be managed.”

By now you’re probably wondering whether there isn’t some legal obstacle to passing out Nicoderm in high schools. There is. To adults, nicotine patches and gum are sold over the counter, but the Food and Drug Administration requires teen-agers to get a doctor’s prescription. And most states aren’t keen on letting schools hand out prescription drugs to teen-agers. One state that does allow it is Oregon, and for several years high schools in Portland have been offering nicotine to kids who want to stop smoking. Chatterbox rang up Portland’s Grant High School and debriefed Colleen Engstrom, a registered nurse at the school clinic. Here’s how it works. Every student who comes into the clinic is asked whether he smokes, and, if so, how much and whether he wants some help quitting. (In addition, Engstrom says, somewhere between 20 to 40 kids a year come to the clinic specifically because they want to get help to quit smoking.) Those who desire assistance get a “tobacco evaluation,” which in most instances finds that the student is addicted to nicotine. Counseling ensues. “If they still don’t feel successful, and they’re still smoking, we discuss as part of the tobacco cessation program that we can give them nicotine patches or Nicorette gum,” Engstrom explained. A nurse practitioner writes a prescription, and the nicotine is delivered to the school clinic, where the student may take “a couple of days’ supply at a time.” Engstrom says about one in six kids who go the patch or gum route are able to quit, and that this success rate is only a bit less than what she’s observed in adults. She attributes the difference to teen-agers’ greater susceptibility to peer pressure.

Thus far, scientific studies haven’t been able to establish that nicotine patches and nicotine gum work on teen-agers. (The most thorough study, conducted by the University of Minnesota, has not yet been published.) But it’s interesting to note that even the Mayo Clinic’s Richard Hurt, whose studyon this question concluded that nicotine patch therapy “does not appear to be effective for treatment of adolescent smokers,” thinks that high schools should be giving them out anyway. “Even though we don’t have very much evidence that they do work on teen smoking,” he told Chatterbox, “there’s good pharmacological evidence that they should work.” Moreover, Hurt says, there’s no great reason to think that nicotine patches and gum are bad for you. “The least regulated nicotine delivery system [cigarettes] is the dirtiest and the worst,” Hurt noted, “and the most regulated [nicotine patches and gum] is the cleanest and the best.” During the Clinton administration, the surgeon general saidmore or less the same thing:

Because there is no evidence that bupropion SR or nicotine replacement is harmful for children and adolescents, clinicians may consider their use when tobacco dependence is obvious. However, because of the psychosocial and behavior aspects of smoking in adolescents, clinicians should be confident of the patient’s tobacco dependence and intention to quit before instituting pharmacotherapy.

To which Dr. Chatterbox can only add that the nicotine patch is surely better for a high-school sophomore than screwing and swigging Orange Crush.

Illustration by Robert Neubecker.