How Do We Handle Weed and Vaping While Raising Adopted, Foster, and Relative Kids?

Are you educated and informed on the issues around weed and vaping, including THC, nicotine, and the signs of addiction? Listen to this interview with Dr. Krishna White. She is an attending physician at the Children's Hospital of Philadelphia, with board certifications in Pediatrics, Adolescent Medicine, and Addiction Medicine. 

In this episode, we discuss:

• Can you explain why kids who’ve experienced trauma, prenatal substance exposure, or who are neurodivergent may be at greater risk for turning to substances like marijuana or vaping?
• How are kids typically using marijuana today? (edibles, vaping THC, traditional smoking, oils)
• Are kids generally aware of what they’re consuming, especially when it comes to the potency of today’s marijuana?
• What are some of the short-term effects of marijuana use in adolescents?
• What long-term impacts are you seeing in your clinical practice, especially for kids whose brains are still developing?
• Now let’s move to vaping – what it is, why it’s so popular, and what we need to know about how kids are using it. 
• Can you break down what vaping is and what substances kids may be inhaling?
• Why is vaping so appealing to tweens and teens, even those who’ve never used another substance?
• What are some of the immediate health concerns tied to vaping in young people?
• And long-term—what are you most worried about when it comes to kids who are vaping regularly?
• What strategies can adoptive, foster, or kinship caregivers use to help buffer or “substance-proof” their kids?
• How early should conversations about marijuana and vaping begin?
• For kids who already have a higher vulnerability, what are some protective factors or environments that help reduce their risk?
• What are some signs that a child might be using marijuana or vaping—even if they’re trying to hide it?
• If a child has already started using, how can caregivers respond in a way that’s both firm and supportive?
• When does occasional experimentation cross the line into something that needs professional help?
• What are nicotine pouches – why are they appealing and what are the short or long term impacts we should know about?
• What would you say to a caregiver who’s feeling overwhelmed or ashamed that this is part of their child’s story?
• If you could offer just one piece of advice to a caregiver trying to navigate this with their teen, what would it be?

Resources:

• Prenatal Exposure, Part 2: Parenting Tweens and Teens
• Are Kids Exposed Prenatally More Likely to Abuse Alcohol & Drugs?
• Preventing Teen Substance Abuse - Center for Parent and Teen Communic

Chapters

• 0:00 What long-term impacts are you seeing in your clinical practice, especially for kids whose brains are still developing?
• 2:40 Can you explain why kids who’ve experienced trauma, prenatal substance exposure, or who are neurodivergent may be at greater risk for turning to substances like marijuana or vaping?
• 3:45 How are kids typically using marijuana today?
• 4:35 Are kids generally aware of what they’re consuming, especially when it comes to the potency of today’s marijuana?
• 6:36 What are some of the short-term effects of marijuana use in adolescents?
• 8:15 What long-term impacts are you seeing in your clinical practice, especially for kids whose brains are still developing?
• 10:44 Now let’s move to vaping – what it is, why it’s so popular, and what we need to know about how kids are using it.
• 15:56 What are some of the immediate health concerns tied to vaping in young people?
• 16:45 And long-term—what are you most worried about when it comes to kids who are vaping regularly?
• 20:44 What strategies can adoptive, foster, or kinship caregivers use to help buffer or “substance-proof” their kids?
• 26:16 How early should conversations about marijuana and vaping begin?
• 29:34 For kids who already have a higher vulnerability, what are some protective factors or environments that help reduce their risk?
• 32:21 What are nicotine pouches – why are they appealing and what are the short or long term impacts we should know about?
• 36:18 What are some signs that a child might be using marijuana or vaping—even if they’re trying to hide it?
• 39:00 If a child has already started using, how can caregivers respond in a way that’s both firm and supportive?
• 45:38 When does occasional experimentation cross the line into something that needs professional help?
• 48:36 What would you say to a caregiver who’s feeling overwhelmed or ashamed that this is part of their child’s story?
• 51:07 If you could offer just one piece of advice to a caregiver trying to navigate this with their teen, what would it be?

Transcript

Please pardon any errors, this is an automated transcript.

Hello and welcome to Creating a Family. Talk about adoption, foster care and kinship
care. This podcast is a production of Creating a Family dot org and my name is
Tracy Whitney. I am your new host to both of the Creating a Family podcasts and
I'm delighted to be here today. We're going to be talking about a topic that I
don't know enough about both as a parent as an educator and I'm excited to speak
with Dr. Krishna White. She is an attending physician in the Craig Dalsimer Division
of Adolescent Medicine at the Children's Hospital of Philadelphia. She's a professor
of pediatrics in the Perlman School of Medicine at the University of Pennsylvania.
She's board certified in pediatrics, adolescent medicine, and addiction medicine. And
in 2019, she joined the Division of Adolescent Medicine at CHOP in order to start a
substance use clinic. She's currently the medical director of Adolescent Specialized
Treatment and Recovery Team and the outpatient medical director for the division. Wow,
you've got a full plate. After many years of clinical practice and advocacy, she
became board certified in addiction medicine in 2020. She is also the proud wife,
mother of a teen daughter and stepmother of three young adults. So she's got lots
of life experience, plus medical experience and education and training. And so we're
thrilled to have you here today. Welcome, Dr. White. - Thank you so much for having
me. I'm very excited to talk to creating family today. - Thank you. We are gonna
just kind of couch this in terms of an intro that will help families kind of get
where we're going. So many of us in the adoptive foster and kinship community,
kinship meaning families who are raising family members, are raising kids who've been
exposed to trauma, who've been exposed to neglect, abuse, prenatal substance exposure
from when their birth mother was pregnant. And many of these kids therefore process
the world differently than say a typical child who's not had those experiences.
These factors can increase their vulnerability to risky behaviors such as substance
abuse. So Dr. White, we would love for you to guide us today through a conversation
that will educate parents and caregivers about marijuana and vaping and how they show
up in the lives of our kids, what we should be watching for, and most importantly,
how we as parents and caregivers can support and protect and guide our kids through
the challenges that they will face in adolescence. So let's get started kind of with
a baseline definition or working definition of why kids in our community of adoption,
foster care, kinship or relative caregiving, who've experienced these hard life stories
before coming to our homes, why are they maybe more at greater risk for turning to
substances like marijuana or vaping? - So, you know, that's a very good question and
it's a complicated question and it's a mixture of biology and social factors. So
one, we know that a lot of kids that are in kinship and foster care are there
because their parent has, one or more parents has a substance use problem. And so
that means that they've had maybe early exposure to substances. It also means that
they might be genetically more predisposed to substance use disorder because we know
there are genes that put you at higher risk of addiction. It's not just a social
failing or a problem with will. We know that it's a neurochemical chronic relapsing
brain illness that starts in adolescence. - So how are kids using these substances
today? Specifically, how are kids accessing or using, we'll start with marijuana.
How are they getting ahold of it and how are they consuming it? - So it's changed
from when a lot of us were younger. Now a lot of times people are vaping it in
addition to smoking. They're also using edibles. So it's available in multiple
different forms. And some of those forms don't have the smells that you remember
growing up in childhood with it. They don't have an odor. If you have an edible,
it can look like just regular food and candy. And so some kids are using, they
don't know that the products have these, THC or cannabis in it. And then some
people, it decreases the barrier to use it if you can't get caught from a smell.
- So you mentioned that they may not always be aware that they're consuming something
with THC in it. Are they aware of the differences in potency from say when we were
adolescents and adolescents today? Are they aware of that difference in potency and
how different is marijuana today? - So, you know,
I'm a 90s kid. And so I always tell my patients, this is not your 90s weed. It's
not from the earth, all the things that we heard growing up. A lot of this is
there are chemicals, you know, it's not from the earth, it's concentrated. It's a
lot more potent. You know, marijuana in the 60s was like had 3 % THC in the 96%.
Some of these products have 50, 60, 90 % THC content. So it's a lot more potent
than the products that were available decades ago. So it's more accessible in that
it's in a lot more vehicles of delivery, and now it's more potent to boot.
Exactly. Okay.
I'm sorry to interrupt this intriguing conversation. I hope you feel like you're
learning as much as I'm learning as we're listening to Dr. White. I wanted to let
you know about a learning opportunity that comes from our library of 15 free courses
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They're You can see the full library of courses that we've put together that will
strengthen your family and help you with things like talking to your kids about weed
and how to navigate those conversations. Thanks so much and have a great day.
So what are some of the short -term effects want to use in adolescence that you can
help us understand? Sure, that has changed as well. And so I'm so glad that you're
asking me the questions of parents can be aware. Again, we may remember the munchies
and being hungry and red eyes, right? Those are the things that remember right now,
we're actually seeing appetites going down and weight loss. We may remember it was
used to treat cancer and AIDS patients because of vomiting. Now we're seeing the
potent products are causing vomiting so bad that people are admitted to the hospital
because they can't stop it and the typical vomiting medications don't work. So those
are some of the short -term things that we're seeing, weight loss, vomiting, belly
pain. We've also seen increased admissions for psychosis or altered mental status
because we know that, again, these high -protein C products and marijuana in general,
even at lower potencies, can make you more likely to have a psychotic episode,
particularly if you have a genetic predisposition to do so. - So psychotic episode,
can you unpack that just a little bit for us? - Sure, where people are just acting
strange. You know, they may be aggressive, they may be confused, anxious,
irritable. And so any of those change in behavior and change in quiet,
withdrawn, depressed, crying, any of those things that we're seeing could be a sign
of a marijuana or cannabis use. So those are all the short -term impacts that we
might see in our homes or in our interactions with kids in our care. What are then
some of the long -term impacts that you're seeing from marijuana use with its easier
accessibility and its higher potency. - So a lot of this we're still learning. And
so we know that there's more likely to have psychotic disorders like schizophrenia.
In some people, not all that use marijuana. And the question is gonna be, since
we're seeing more of the psychosis at younger age, are they gonna have more people,
they're gonna have those long -term, more permanent psychotic disorder diagnosis like
schizophrenia. We also know with marijuana addiction. You know,
I think kids when they're using, they might be using to cope with something and
using to get high, deal with stress. But most people aren't trying to use a
substance to become addicted to it and have to use it in order to function. And so
we know that earlier that teens use a product, any product, the more likely they
are to develop addiction. And so we can expect to have addiction rates that would
be another long -term outcome. But again, this generation unfortunately is gonna tell
us what happens when you have long -term exposure to high THC products because that's
not something that's happened in prior generations. - So you mentioned the risk for
addiction. I'm assuming then that maybe some of the chemicals and the additives that
are in today's more potent weed have some addictive properties to them,
in addition to maybe the genetic biological component, the substance itself has more
risk for addictive behaviors. Yeah, the higher potency makes it more addictive.
There's also a lot of other chemicals interacting in these eight products. So we
know that there's heavy metals like lead and 10 cadmium that are in some of these
products. we know that carcinogens or cancer causing agents are in these products.
And then flavors and other kind of chemicals that normally aren't things that you
ingest. And so again, we know that these substances can cause problems down the
line. And we're gonna be monitoring to see what happens with youth that are using
these for decades. Like, we found out with decades of cigarette use, what type of
cancers and other things come from that. - So we're kind of using what we learned
from the whole nicotine and cigarette experience to help us track forward what we
might be looking at down the pike for marijuana experience. - Exactly. - Oy.
Well, let's move into vaping a little bit. What is vaping? Why is it so popular?
What do parents need to know? What do caregivers need to be looking for? Let's kind
of start there. Break down for us what vaping is and what are the most common
things that kids are using in their vapes? Sure. I mean, first I want to start
with the good news is that kids don't smoke cigarettes anymore. So we've done a
really good job at the public health messaging, the laws to decrease access, changing
culture norms that you don't really, I can't remember the last time someone told me
they spoke to cigarette in my clinic. And I said to young adults, unfortunately,
even though a lot of the vaping products were made to get people off of cigarettes,
for youth, it's often the first time they're exposed to any nicotine product where
adults, they might be going from a cigarette to a vape. And so because it was
originally unregulated. There weren't public health messages against it. If you ask a
kid if they smoke, they'll say no. And then if you see, we have to ask if they
vape and they'll say yes. And they don't even consider it. They don't even consider
it smoking. Got you. They don't consider it smoking. They don't consider it the same
thing. And so we've had to change our language. But vaping is the older term e
-cigarettes. So it's electronic devices that combust nicotine into a vapor.
Again, there's no smell with it. Sometimes they have flavors, which are very
attractive. Some of the packaging looks like everyday objects. There were versions of
it that looked like USB drives. They can be small, you plug them in to charge
them. And parents may not be aware that that's what the child is using. - So are
most of the kids using nicotine in their vapes or THC or a combination or something
else entirely? - I think most are nicotine, but about 3 % of the nicotine users also
vape THC, which is the chemical that's in cannabis or weed or marijuana. And so a
lot of times we see both. Some kids may not know if you're getting a vape from
your friend. People aren't asking, is this nicotine? Is it THC? They're just taking
a vape. And so I've had patients who they've come in and they had an episode, they
didn't realize they thought it was a nicotine vape and then they had a bad reaction
and realized there was THC in the vape. What if they may not know what it's using,
particularly how people begin? Parents are using their friends vape. - Well,
and we're seeing an increase in adults using vaping products also. So the modeling
of what to use and where to use it, they may not be discussing it at home, but
they're seeing their parents do it, or their caregivers do it, yeah. - Yeah, it's
very important to model what we want our kids to use. And again, for parents,
sometimes they are using that to get over their cigarette addiction. But you have to
be careful, you know, if you're using any type of recreational marijuana or medicinal
marijuana or vaping, that your kids do not have access to it, that you're able to
quit yourself, which I hope you're able to quit yourself. - Right. Yeah, so why is
it so appealing to tweens and teens that have never had exposure or use of any
other substance? What kind of makes it intriguing to them? - So I think it's the
novelty. Teens, brains are wired to try new things. That's why they can learn
Spanish and algebra, things that I could right now with my with my not team brain
and that's why they can join the military and you know be in the athletic
competitions and do all kinds of wonderful things they're wired to seek new
experiences and try something new and this is truly new the exposure is also there
you know almost universally even down to some elementary and middle schools you'll
see use actually in school not only in the bathroom in the classroom because teacher
can turn their head and you can hit your vape a couple times and be done with it.
Some of my teacher friends have told me those experiences. I know principals that
have alerts on their phone that tell them when vaping is happening in the bathroom
and a principal showed me where the vape alert had went off 100 times that day in
the high school bathroom. And so I think just the exposure that people have to
vapes. It's new. It's being advertised and targeted towards them. That's why we're
doing those flavors. That's one of the reasons why teens are using. And, you know,
their parents are using, they're seeing them, and their friends are using. So it's
kind of just bombarded from all sides for our guests.
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What are some of the immediate health concerns that we need to know about regarding
vaping and young people? So I think the one of the things I see most immediately
with vaping is again the addiction. It's so much easier to get addicted to something
the more you can use it and because you don't have those barriers of smells and
that you can use it almost anywhere. You can use it during the school day. You can
use it at home in your bedroom. I'm seeing addiction earlier ages or after earlier
use because of the frequency of use and how the nicotine changes the brain. We're
also seeing people come in with chronic coughs, decreased athletic performances. You're
not able to run as fast when you've been vaping. And again, nicotine is an appetite
suppressant. So it decreases your appetite. So we've seen weight loss associated with
that as well. So long term, what are you most worried about when it comes to kids
who are vaping? What should we as parents and caregivers be worried about the long
term? I think long term, all of the long term things that we were worried about
with cigarettes and tobacco products, we have to worry about with vaping as well.
The cancers, the lung disease, all of those things. There's no evidence that we're
going to see less of that in the vape form. First, the cigar or cigarette forms
that we're using before. And I think, again, the addiction and the problems that
that has, this is more like a medium term fact. Kids are getting kicked out of
school. They're getting help for using these products in school. Well, - Interrupted
education in high school is a huge impact. - Yeah, a lot of schools have zero
tolerance policies and I understand that they want the schools to be safe, but these
products are universal and you have a child that gets caught and then all of a
sudden they're expelled from their home school, they have to go to another school or
online school. So I think those effects and those outcomes are one of the things
that we have to worry about and how it affects their educational attainment. And we
would love for schools to kind of have some alternative pathways that get people
into treatment and education, as opposed to expelling them for this behavior.
Yeah, and when you're talking about a population of kids who are already at risk
for learning impacts, learning challenges, cognitive delays or other developmental
delays, from natal exposure, et cetera. Having your education interrupted,
coupled with the potential long -term impacts of vaping and what it does to your
lungs and the rest of your body, that's a pretty big ball of wax for parents to
kind of be holding space for. I'd like to talk a little bit about something that
you mentioned earlier, when we are concerned about the long -term effects, they should
be the same as what we are looking at for the cigarette factor. Can you hone in
just a little bit more on what some of those effects would be? I've heard a lot
of families talking about some of the, one of my friends called it sticky lungs
from vaping, and I'd love to hear a little bit more about that, kind of the real
specific long -term impact that that might be. Sure. A few years ago,
there was kind of an outbreak of the evoli, which is evaping associated lung injury.
And even though we're not seeing as many cases as we saw in 2019, 2020, when that
came out, we're still seeing cases of a lung injury and damage. Sometimes our people
are coming into the hospital needing treatment with steroids and oxygen due to lung
damage, and that's when they're young. So that's one of the effects of it. We know
that smoking can put you at risk for asthma attacks and forcing the asthma for
chronic obstructive pulmonary disease when you get older and a variety of different
types of cancers that are increased with the carcinogens that are in cigarettes and
some of those carcinogens are in the vape products as well. - So that lung injury
could follow them for a lifetime then is what I'm hearing you. It can and some
rare extreme cases. It's been bad enough for people needed lung transplants.
Fortunately, we don't see that often, but it is, you know, I have some athletes
where they notice it affects their performance. And then we're in the back to school
like trial start next week season. We want to be optimized in your performance. And
it can affect that as well. I also worry about, you know, people, particularly those
youth in foster care and kinship care, turning to substances to cope with problems,
that they're losing the opportunity to learn alternative coping skills with life
pressures that they are gonna, that they unfortunately have more of than the rest of
us.
- That's a good one. (laughs) Yeah, I appreciate that. So let's move right into how
that impacts our community. We are a community of parents and caregivers who care
very much about building alternate coping strategies for our kids, giving them
healthier ways to deal with discomfort of the internal state,
whether it be fear or anxiety or a trauma wound or something like that.
Let's start the conversation with a few strategies that adoptive foster or kinship
caregivers can start to implement in their homes that would help buffer
risk. One, I think you have to know the risk. So know the fact that, you know,
that if they've had trauma, and they're in care, we know that youth in care may
use substances at or more than youth that are not in care. If they have a genetic
risk factor, because they have a parent that has used substances, knowing that and
knowing how to talk about that and how maybe they may not be the one that wants
to try it because there might be hooked where there are other friends that don't
have that family history may not get hooked at a young age. I think it's also
important to, you know, have communication where you can talk about your stressors,
talk about what's going on in school and your relationships as a caregiver with your
teen, and having that communication is also important. And then all the other things,
activities, supervision, connection to the community, to sports, to school,
community service, any of those things are important and teaching the coping skills.
So having like a physical coping skill that you can do and then also like an
emotional or spiritual ones are very important. - That's great. I love it when you
said prevention in pediatrics is such a key. It's true when we can catch them
really young and help them develop new and different habits.
I think another thing that I would add to that is when you are raising a child
who has come to you from another situation, whether it's out of the foster system
or an international adoption or even raising your grandchild when there's been an
inability to live at home any longer. One of the things that's probably super
important to Remember is helping the child or the young person, tweens and teens,
understand the context of where they came from. If you have information that you
can, in age appropriate ways, share with them about their biological family's history
of use or abuse of substances and help them understand that those coping mechanisms
were not healthy and you're ready and willing and able to teach them new coping
mechanisms but also helping them understand again in an age -appropriate way what the
internal tendency towards addiction or abuse might be.
Certainly we cannot determine that in any sort of percentage or you know great
degree of certainty, but it is something that we can talk to our kids about and
help them understand that their context may be different than their peers. So in a
group of five friends, three of them may have grown up in a very typical family.
And two of them may have had, you know, impacts from the foster system or impacts
from, you know, connection to adoption. And so their, their context will be different
than their peers and helping them understand that in in kind of those very
straightforward conversations is a big buffer. I think if we can try and remember to
do it without instilling fear, that's, you know, one of the challenges that adoptive
and foster families face is how to share this information about the child's true
story, full story, without instilling fear. Exactly. And I think, you know,
your to talk about context is really important. Their perception might be that this
is normalized and everybody is doing it. We know that the vast majority of middle
and high schools are not using substances. And study last year, 6 % of kids were
using e -cigarettes and 1 % for 8%, we haven't talked about the nicotine pouches as
another form. - I'd love to talk about that too. - Yeah, we'll talk about you know,
1 .8 % were using the nicotine pouches. That means there's a vast majority of kids
that are not using these substances. So like normalizing the fact that no use is
actually what most teens are doing, and that these substances are being targeted so
that people can make money off of their misfortune of trying these substances in
addiction. Some of those things can be helpful in talking to youth.
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- How early should we start these conversations? - I know that that's a good
question. It's interesting, they recommend asking what we in medicine would call
screening for alcohol use as early as nine. We really wanna start asking about it
and having the conversations before they're first exposed. I would say probably most
practices is around that 11, 12 visit that your provider will start talking to you
alone and asking if you've had use and then if you're not having use,
you know, doing a little bit of education about that. If you've had some early
exposure, maybe you had, you know, you had a drink at a party, we'll talk about
that in the visit. So I definitely, you know, anywhere in the older child,
middle school age is a good time to start having those and it should be ongoing
conversations. I like to have a conversations with my kids. When you see something
on TV or social media, it's a good time to talk about, oh man, what happened? I
don't know if you see the eagles in the back, we went to the eagles parade. And
yeah, go birds, right? And then you can, we were at the parade and there was a
lot of marijuana in the air. So it was a beautiful moment to talk about the first
parade. grade, the first one, a teachable moment to talk about, you know, marijuana
use. And so taking those teachable moments and having it to be just part of your
routine conversation as opposed to let me sit down and have a talk with you is a
way to address it. Yeah. And I would put a plug in that the first time your child
talks about it with an adult should not be in the pediatrician office the very
first time, try and get to it before the pediatricians start talking to your kids
about it. You are your goal as a parent and a caregiver is to build that trusting,
safe, secure relationship with any child in your home. And so talking about these
hard topics goes to building that trusting, lasting relationship. So get the
conversations started again, use media like Dr. White recommended use books that they
may be reading for school use songs you hear when you're you know driving around
together just start the conversation it is awkward it's uncomfortable I have six
children I've had to do this multiple times have these awkward uncomfortable
conversations but it's worth it if you then have a kid that comes that comes to
you and says, "Hey, I was at a party and so -and -so was using pot and I'm not
sure what to do about it. I'm not sure how you feel about it." It gives you that
opportunity to talk to your kids and have really honest conversations. I will be the
first to admit, my kids were kind of laughing at me when I told them that I was
doing this interview. I'll be the first to admit that I did not, coming into
today's conversation, know nearly enough about weed and vaping and hopefully we'll get
a chance to talk about the nicotine pouches. I've just not had enough exposure or
experience with those conversations and I'm recognizing now is I'm learning more about
it that that's kind of a gap in my parenting that I can't go back and fix it now
but I still have two living at home that I can talk about it with. So for some
of our kids who have these higher vulnerabilities, like we talked about at the top
of the show, what are some additional protective factors or environmental things that
we can put in place that will maybe help reduce their risk? - So I think,
you know, it's important to know that when you're more vulnerable to have that early
identification and intervention. And So if you were to notice a vape,
we don't want people to overreact and punish them and do a lot of yelling and
screening, but taking the opportunity to have that conversation. Hey, I noticed this
in your bag or the teacher called me. You know, this is really concerning. Can we
can we talk about this? Do you feel like you're addicted? The kids will tell you,
you know, people come in to my clinic and they will tell me, you know what, I,
you know, last year I was doing in a couple of times. Now the last month, I have
to do it every single day or I get a headache or I get anxious. And so having
those conversations so you can get a sense of where they are on the spectrum is
important. But also putting those, those positive things, positive activities, positive
ways of coping and getting those new experiences is going to be important. And I
think we have the awkward conversations, let them teach you like they love to teach
just you haven't heard about that. Let me tell you and they'll pull up and so like
let them teach you what products are using, what brands are out there. It changes
all the time and just know you're going to get some eye rolls, but the eyes are
rolling. That means they heard you. A lot of parents think that they're not
listening. They are listening to us. They do hear what we say. And that's what
makes the eyes roll.
Expressing curiosity is one of those buffers that we can put in place with our
kids, not just curiosity about issues around weed and vaping,
but general curiosity about their life and what they're interested in,
why they're interested in it, what draws them to it, kind of engaging in that "I
wonder" or that observation language. If you develop that habit when they're very,
very young, then it's easier for them to feel as if you're a safe place to be
able to talk about it later. And talking about things later often means like a
friend of mine said the other day, the bigger the kid, the bigger the problem,
bigger the kid, the bigger the issue. And not that the kid is the problem, but the
issues that they're facing are more complex and tangled. And so setting that stage
of curiosity and wonder and observation earlier and younger with kids who have these
increased risk factors or increased vulnerabilities is a great shift on our part.
So I wanna move into, I'd like to go ahead and talk now about the nicotine
pouches. We didn't have it on our original agenda to talk about, but it certainly
fits well into this topic. So if you want to just share a little bit about what
they are, again, what's appealing about them to young people and what are some of
the risks that we need to be aware of? So these are newer products that are out
there where it's nicotine and like again, flavors, cause that's the theme, flavored
couches. And you know, this has the advantage of it's not you don't have to smoke
or vape it so it's like you know think about chewable tobacco and this is kind of
a newer version of that. Again it's being marketed as a smoking cessation product
for adults but for kids there are flavors their availability and you know local
convenient stores makes it an entryway into nicotine and there's different brands that
come in different pouches that you can just kind of put in your cheek and kind of
suck and absorb and get nicotine that way. And so again, it's just another product
to keep up with that we have to educate folks that we have to ask about. So now,
you know, I used to ask, do you smoke or you drink? And now it's like in the
past year, have you tried any tobacco product? That could be a cigarette, a vape, a
pouch, you know, the list is longer and longer of different things that we have to
vows hook, you know, like all the different, there's so many different forms of
tobacco. It is a lot to keep up with. It is a lot to keep up with the parent
and as a doctor.
And I learned, you know, for my patients every day of different versions. And again,
they love to be the expert to tell me about something I did know.
Regarding the pouches, Is there an age limit? Are they supposed to be checking age
ID when they're sold in stores? - They're supposed to be, but we know that kids can
get access in a variety of different ways. And then people can also buy things
online. There's another way that substances are getting into our homes without having
to go to the typical store with a fake ID. - Right. So a lot of kids are using
them not for smoking cessation. what are the benefits that the kids feel when
they're using a product like a vape? Like what are the physical kind of the
dopamine hits that they're getting from doing this? - Yeah, they feel a buzz. They
feel decrease in anxiety, a lot of folks. And then once your body becomes dependent
on the chemicals, if you don't take them, you feel anxious, you can't sleep, you
need them of being able to sleep or to be able to not feel anxious. But a lot of
times it's just the initial buzz and high feeling. - And that's true of marijuana,
of vaping, and of the pouches. - Correct. - Because they all have similar substances
within them. - Yep, that affected those brain chemicals and give you those big
endorphin boosts.
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much, and let's go back to the show.
What are some of the signs that parents and caregivers can be alert to? We talked
about them a little bit at the top of the show, but in general, for we vaping
pouches, any of those things, what are some of the signs that we should be kind of
ticking off in our brain to help us know whether or not a child is engaging or
trying to hide it or whatever? - Sure, I'll start with the more serious ones first.
And this is a good time, you know, as you're going on those family vacations,
right? And you're gonna be somewhere for a week and you notice your kids a little
bit more irritable, they're anxious, sleeping, they're going out, you know, away from
the rest of the family, that can be a sign that they're addicted to a substance
and that they're in withdrawal. And they may not even know that they're in
withdrawal until they are away from it up to their time. Obviously, if the school
is calling you about use at school, that's another sign that they may have developed
a serious problem. And then, you know, if you're seeing puffs of air, little puffs
of smoke in the house or smelling strange flavor smells, again, it's not as strong
and pregnant as as cigarettes and cigars and those things were, but they do have
some smells associated with as well. And then they may, again, if they're not using
in front of you, maybe leaving, going to the bathroom, going outside to use,
and those could be signs. But it's one of the things to think about with weight
loss. There's so many different things that can cause weight loss, eating disorders,
but we're seeing a lot of patients where it's the substance use is causing the
weight loss because they just don't have appetite. They don't feel like eating when
they're taking high doses of THC or nicotine. So some of the more immediate symptoms
that we might be seeing would include that anxiety or irritability.
Are there any physical symptoms besides the puffs of smoke? Are there physical
symptoms that we might see kind of in the short term or the immediate? Maybe
increasing cough could be some of the things and then you might see where their
endurance is not the same with sports. They're more winded for THC or the cannabis
related. It may make them more interest to use. You may have more stomach aches,
vomiting. Those could be some of the signs that you see with that use. - Okay,
great. That's kind of a review of what we've already discussed then. - And then
changing your grades as well. So - Well, your grades are not, you know, doing well
in school. - Yeah, so changes in school performance or engagement,
but also some sleep changes would probably be included in that. Okay, so when a
parent or caregiver suspects or confirms use or abuse, how do we hold the line with
our kids that comes as supportive. I want to come alongside of you. I want to help
you conquer this. I want to help you kind of kick this, but firm in a way that
says, you know, this is not what our family stands for. This is not who we are
kind of a thing. Yeah, I think you want to give that clear message of your family
expectations and that absence is normative for kids. It's what the majority of kids
are doing and that's what you want for them. I think that should be clear. I think
that can be a challenging situation if the parents themselves are using substances,
because they're seeing you and I've had patients say as soon as their parent leaves
the room, well, they didn't tell you, my dad smokes weed and my mom smokes
cigarettes, so why did they bring me in to see you? Because I'm the only thing. So
you definitely have to think about your own use as well and be a model and treat
that so that you can be a model for your kids. - So consistency of action and
message, integrity, holding the line in a supportive way that,
you know, kind of says it's you and me against this substance, not you versus me.
- Exactly. And you don't want to be too punitive. You don't want to, you know, make
it so that people are scared to tell you, "I know some parents will run and get
home drug testing and put them on the ground." That's not something we really
recommend that parents do. If there's concerns going to a professional so they can
get assessed and you can start with your primary care provider as a first person to
reach out to is one of the first steps. And then you also want to remember that
there's still your lovable kid that they were before you knew about their use and
that you recognize that and that you know that that that doesn't mean that you
don't love them that because you're disappointed in the behavior that they've done.
Yeah. Yeah, it's pretty important for kids in care, right? We already had lost
connections with their family that this doesn't mean that you're going to put them
out the house, you know, call the agency, but you do want to make sure they get
help and you have rules that you can't do this in this house. Right. I saw
something the other day that said bad decisions does not equal bad kids. Yes.
And it's so important that we help our kids recognize when you make a mistake, when
you fail, when you don't hit the mark of what we as a family hold true,
you got to give them a path back. And when we remain open, when we remain
accessible in that way. It's giving them that path back. It's giving them that
second chance and being humble about it and acknowledging all the ways that you've
also missed the mark and not held the family values to priority.
That humility, I think, makes you more accessible as a parent. That's a hard one
for me, I will admit, because I don't really love airing my mistakes 'cause I'm
usually beating myself up about them. That's a common thing. - It is important to
think about how you might've contributed to their self -sustaining even inadvertently.
Like maybe they were super stressed out about that SAT that you put them in class
and you're super focused on. And so acknowledging that, "Oh, I understand this is a
hard time for you "and then you might have went to that." How can I take some of
the load off? Maybe we don't have to take five AP classes this year or do you
know they have to get a job and work in school. Maybe there's some ways that we
can make it so that you have time to hang out with your friends and go do some
fun activities and don't feel like the only break you get in life is when you're
able to smoke a vape. And that brings up a really good point for families that are
welcoming new foster children or you know an aunt or an uncle that's welcoming a
new relative child into your home, many times those children will come with,
I say children, young adults, youth will come with these habits already forming.
And you weren't there to set a good context, set preventative buffer strategies in
place, but you still gotta deal with what's in front of you and the child that's
in front of you. Number one is still a child, even though they're, you know, 15,
they're still a child. It's still a child's brain that's still developing in there.
And tiptoeing into that gently and lovingly, making yourself warm and welcome to
start and not trying to tackle all the bad habits first right off the gate,
you know, right out the gate, establishing that trust and establishing that
relationship first, giving firm boundaries that say, I know you came to this house
with this habit already entrenched, and if you feel the need to do it, you'll have
to do it outside. When you're here in the house, please don't do it. There's other
children. There's other people that don't want to be impacted by it. And if you are
open to it, I would love to help you find other healthy ways to cope. And just
kind of setting that slow roll towards healthier expectations instead of jumping on
it all at once. - Yeah, you did a perfect description of what we call harm
reduction, which is we're not gonna quit right now. Can we decrease the use? Can we
use it in a more appropriate way? - Right. - And in a safer way so that we're
exposing other people in the house until you get to the point where you're able to
completely quit. And I think what you described is a perfect way of messaging with
youth that already have exposure and there's help out there. There are even programs
online that you can sign up for text to quit. Well, they will text and give
support. They're quit lines. Most of the quit lines you have to be 18 to call a
quit line, but there are quit lines now. There are quit lines that are available as
well for those youth that are 18. There's medications that are also available to
help with nicotine withdrawal. The same ones are available for adults are available
for for teens as well with prescription. - And that's another thing that's so
important and could be included in one of those buffering techniques that you offer
your kids is letting them know, I'm not just available here to help you. There's a
whole community of professionals that are willing to come alongside of us and help
us help you through this and to overcome it and to find healthier coping strategies.
'Cause Everybody needs coping strategies. - Absolutely. - We all need them. But we
want our kids to have the best opportunities and the best resources available for
healthy coping strategies. So that's great. Sometimes experimentation can cross a line
rather quickly for kids that have increased vulnerabilities or increased risk factors,
excuse me. What do we need to know about what that line is and where do we go
when it's time to, because they've crossed that line and we need to get them some
help. - Yeah, when you start having consequences, I think that's when you've crossed
the line. Again, grades changing, getting in trouble at school, getting admitted to
the hospital for medical complications of your use. All those are red flags that
we've crossed the line and we need to seek help. And for any other is the patient
is using or your child is using in addition to that a lot of youth may start
with, you know, a nicotine and cannabis and alcohol, but there are other substances
that people are using as well. So making sure they have a full assessment of what's
going on. We also know that people that use those substances, maybe they're not
using them yet, but they're going to be the kids that are more likely to try some
of those other substance like opiates and fentanyl and benzos later, methamphetamine,
things like that. So getting that early identification and getting help and there's
professional help available in a variety of different ways early is really the key.
So are there any specific types of programs or support resources out there that are
better suited for kids who come from a trauma background? So there is trauma
-informed, trauma -sensitive care that's available and when you're evaluating drug and
alcohol programs, that's one of the things you can ask is do they have experience
with that trauma -sensitive care? And I think it's also really important to have that
if they can have a relationship with the provider that they may be seeing before
they came to your house, going to that provider, someone that they have a
relationship with, so they feel comfortable talking to and coming out what the
specific treatment plan for them that can be helpful. Yeah if you've if you're a
foster parent or adoptive or pre -adoptive parent who's already you know put into
place therapeutic supports regular counseling or therapy having that person follow your
child through the process of any of these healing adventures yeah - Yeah,
it's very helpful to have that consistency of voice and consistency of care so that
the kids know I'm in your corner, I've got your back. I think it also helps to
have the kids here and see you as the parent or caregiver advocating for them to
those professionals. It's okay for the kids to hear and see you saying, no, I
actually think my child needs more or my child needs something different. This
doesn't feel like it's really hitting the mark. Letting the kids hear that can be
another buffer, another strategy that helps them feel seen and heard and that someone
is on their team long -term. - Exactly. - What would you say to a caregiver who is
feeling overwhelmed or ashamed that this has now become part of their child's story?
How do you kind of help the caregivers that you work with, kind of get over that
hump. - I think one know that, you know, this happens and this used to be addiction
and substance use was like a moral failing, right? You didn't have the willpower to
stay away and your parent didn't, you know, raise you up right. And that's why you
expose. We now know that this really has a lot of genetic and neurochemical basis
for this. And so, you know, and again, people aren't using substances with the
thought that it's going to change my brain chemistry. I'm going to have to use this
for the rest of my life. You're using this up this to feel better, to get high,
to relax. And then there's this kind of slippery soap where some people will develop
a problem. And I right knows that they're predisposed to develop a developing a
problem. So I think, you know, there's a lot of stigma with addiction. I think
we've gotten a little bit better with mental health and decreasing that stigma. We
still have some work to go with the stigma with kids and adults with substance use
disorders. But making sure that you talk to your fellow co -parents. A lot of people
are struggling with this. Any time I give a talk or I'm in a space and talk about
what I do, I'm on the train or something, then people disclose to me the family
member they had that had a substance So this is universal, it's an American problem
that's shared by everyone. And so nothing to be ashamed for, but you definitely want
to seek help for these youth. - Yeah, this issue of shame and stigma is a huge one
when you're bringing in a relative's child, say it's your grandchild and you're
feeling embarrassed and ashamed of the feelings of your child to be able to parent
their child and just kind of offering grace to everyone involved,
none of you planned for this, none of you wanted this, but this is where you are,
and so how can we move forward with getting everyone the help and the healthy
resources that they deserve and that they need and keeping the child that you're
caring for at the center of your conversations can help kind of push aside some of
that shame to push you through to getting to the right resources and support that
that child may need. It's a sticky wicket for many kinship caregiving families,
so I appreciate you clarifying it that way for us. If you could just offer,
as we're kind of wrapping up here, give me just like one piece of advice that you
would offer to parents or caregivers who are trying to educate themselves and
navigate through this, as you said, universal cultural phenomenon that we're facing as
a nation. - I think if there's one piece of advice, well, one I wanna thank you. I
used to run a foster care clinic and in my previous job, I've worked with a lot
of foster care families, particularly those of you who foster older children and
team. I know that is a tough job and you really appreciate what you do.
So one, I wanna thank all of you that are listening today and thanks to those of
you who foster and do kinship care for our adolescents and youth. If there's one
thing, I think you've already done it, right? You're providing a safe nurturing home
and having open communication. I think also going, you know, part of the process is
they're gonna be seen by healthcare providers, finding someone that you really trust
that's really good.
think about them. All of that is really important for teens as they develop into
young people. Well, I think that's a great way to wrap this up. Dr.
White, thank you so much for your time today. Thank you for bringing the wealth of
life experience as well as your medical and educational experience to the table today
to help us understand more about weed and vaping. And we through in nicotine
pouches, not even planning to, but I appreciate the willingness to go there. Thank
you so much for all that you do to serve the Philadelphia community of adolescents,
my family's patients at the CHOP practices, and we've enjoyed the benefits of such a
well -founded organization. But I know that families who are looking for more
information, they can start with their local children's hospital, correct? - Yes, they
can. - And adolescent medicine programs at your local children's hospital can be a
great place for you to start if you're looking for more information on how to
handle weed, vaping, and all the other substances out there that kids can get into.
Thanks so much for joining us today. If you liked what you heard, please drop us a
rating or a review. And we look forward to talking to you next week. Thank you.
- Thank you so much.