HIGH POINT — At 14, Luka Kinard was vaping the equivalent of 80 cigarettes a day.
The High Point teenager fed his addiction at home and at school, using common e-cigarette brands such as Juul to breathe in nicotine suspended with other chemicals in a vapor.
He eventually experienced cold sweats, persistent chest pains and, in September, a grand mal seizure.
His mother, Kelly Kinard, couldn't make him stop and wasn't willing to let it continue. So she came up with an unusual solution: booking a spot for her son in a teenage addiction treatment program in California and convincing the family insurance to pay for it.
That trip to rehab turned out to be a transforming experience.
Kinard went back to his old self, in one sense. But he also began a new path: speaking out about his experiences, in settings across North Carolina, in other states and in Washington, D.C. The Centers for Disease Control and Prevention has asked him to take part next month in a meeting of a federal interagency committee on smoking and health.
Government and health leaders are alarmed by the popularity among teenagers of Juul and other similar devices built to heat concentrated nicotine salts. The explosion in use of this newer type of vaping device and liquid has been followed by an upturn in teen vaping rates. From 2017 to 2018, e-cigarette use by high school students increased by 78%, to nearly 1 in 5 students.
Kinard's use was extreme, but he's not the only teenager who has battled an intense addiction to vaping, or who has seen what may be symptoms of high levels of nicotine intake. Some teenagers are reporting throwing up after using, or being unable to focus at school, said Dr. Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Harvard Medical School.
With teenage vaping on the rise, and doctors raising concerns about its effect on teens, plenty of people have been interested to hear what Kinard and his mother have to say about their experiences.
"My main goal throughout all this is not to tell kids to go stop doing what they're doing," said Kinard, who is now 16 and a rising junior recently enrolled in an online college preparatory program. "Because I know at the end of the day, I can't make anybody do anything, you know. But I just want to raise awareness that there are a lot healthier ways to fit in, to cope, and just to be a teenager, and get rid of all your worries. The sense of relief from it is never going to last forever."
One drug, many forms
When Kinard finished middle school, he was an "A" student, he and his mother say.
"I was like a really nice kid, wanting to always go out and play sports, and go outside and be around people, always liked having people's company," he said.
He'd also always gravitated to having older friends. That summer, some of them introduced him to chewing tobacco.
It made him feel sick, he said, but he also liked the "head rush" feeling he got. He said he started to feel addicted, just from that one time. He had both a curiosity and an urge to do more.
Kinard used chewing tobacco for a while that summer, then progressed to cigarettes.
He'd smoke three or four a day, usually, sometimes up to a pack. He tried to quit, but couldn't make himself do it.
Cigarettes had other downsides too.
"I mean, you walk into a classroom, or you walk into a building or a house, you smell like cigarette smoke, you're gonna catch eyes," he said. "You are going to catch a lot of judgment."
He next turned to vaping.
With vaping, most of the barriers to his using were gone.
He could satisfy his cravings whenever he wanted. In class or at home, he felt he could hide it more easily.
At High Point Central, where he spent his freshman and sophomore years, he used to keep his vaping device up his sleeve, and put his head down on his desk to inhale, or go to the bathroom to vape. He'd exhale the vapor toward the ground or into the corner of a room, or simply hold it in.
He never got caught or in trouble, he said.
Lots of other people in his grade were also vaping, or were tolerant to vaping, so he didn't feel negatively judged, like with smoking, and he could more easily get vaping supplies than cigarettes from other students. It smelled better, and it tasted better. He did it more and more.
A rush to catch up
As teen vaping has spiked, public health and education leaders, as well as addiction treatment specialists, have had to learn and compile accurate information quickly as they try to understand the phenomenon and combat addiction and misinformation.
In March, at an e-cigarette info session for parents at Page High School in Greensboro, Guilford County Schools Substance Abuse Coordinator Kimberly Fields said she's glad for the growing attention.
"This vaping thing is happening, it's kind of taken over," she said. "And I'm actually glad that it's a topic that's in the media because it was a topic that wasn't for a while, that we kind of didn't know about. And it just kind of exploded in our faces."
E-cigarettes, also known as vapes, are battery-operated devices that create a mist of various elements and chemicals, typically including nicotine, that a user then inhales.
They come in a wide variety of shapes and sizes, some of which parents may mistake for school supplies, Fields said. She said that although there are some non-nicotine vaping liquids, they make up a very small part of the market. And some of those have even been found to contain small amounts of the drug, she said.
For a long time, the devices had the reputation of something used more by adults than by teenagers. Now, youth are more likely than adults to use e-cigarettes, the CDC said. They are the most commonly used tobacco product among high school students.
Some start with other tobacco products, like Kinard did, but some teenagers also get their first nicotine from vaping. Some teen nicotine users just vape. Some just use traditional tobacco products. Some do both.
About 2 in 5 high school student tobacco users use more than one tobacco product, according to the CDC.
"Once you become addicted, you use the nicotine you can get," said Levy, the Harvard addiction treatment program manager.
The CDC said the aerosol inhaled from e-cigarettes generally contains fewer toxic chemicals than regular cigarette smoke. While that means they are less harmful than cigarettes, by the CDC's calculation, they're not harmless. Traditional cigarette smoking kills about half of long-term smokers and causes 1 in 5 deaths in the United States, according to the CDC.
And the agency points out that e-cigarette mist can contain, "harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents."
Vaping is new enough that there's a lot scientists don't know about long-term effects.
Kinard gravitated toward a particular type of e-cigarette liquid: nicotine salt. Within a month or two of starting to use them, he said he was up to four "pods" of concentrated liquid a day, with each pod containing as much nicotine as a pack of traditional cigarettes. It felt more addictive, he said.
The first, and most common of the devices built around nicotine salt is the Juul. Mass-market vapes have been around in the United States for about a decade or so, but Juul first debuted in 2015. Now more brands, like Suorin and Phix, also make e-cigarettes built specifically for nicotine salts.
When heated, the nicotine-salt solution creates an inhalable mist that can hold more nicotine per volume without the normal increase in throat irritation, according to a variety of vaping hobby publications. So devices made specifically for nicotine salts are often smaller and easier to conceal than a big vape that's built to hold a lot of liquid.
Traditional "freebase" vaping liquid delivers a slower, smaller nicotine dose than cigarettes. Nicotine salt liquid appears to deliver a bigger punch, with a quicker spike, getting closer to the experience of a cigarette user, Fields said. That's been a selling point for Juul.
Levy suspects some teenagers are figuring out ways to inhale from these devices that are allowing them to absorb far more nicotine than what a cigarette user would get.
Her evidence is anecdotal from her program, which treats addiction to a wide variety of drugs.
Until recently, she only had one instance she remembers of a teenager seeking treatment for solely a cigarette addiction. Nicotine-only users just weren't seeking their help. Within the last year, however, some families have been showing up with teenagers addicted to just Juul . She's been quoted in national news pieces, and that's brought further influxes.
"When these Juuls first came out, I think, like the rest of the world, we thought the impact would be similar to cigarettes, without the smoke," she said. "We've started to understand that some kids are getting much, much higher doses from this."
Levy said some of the teenagers talk about using inhalation "tricks" to get more nicotine into their systems. They report feeling buzzed and dizzy, like they stood up too quickly, and also talk about having stomach pains and sometimes throwing up. She said someone else told her separately that at parties at that person's college, it's more commonly assumed that a partygoer who is throwing up is "nic sick" than that they drank too much.
Some teenagers she works with also say they are struggling to focus or sit still. They stress these are not symptoms they had before they began vaping. And they see themselves as having a problem.
"They are telling us they are not doing well in school, they are feeling off," Levy said. "Their whole school years were disrupted by this behavior."
A turn for the worse
Looking back, Kinard believes his increased nicotine use from vaping and the cravings that went with it led to changes in his moods and habits. He began holing up in his room more often, and becoming more irritable. His grades started dropping around second semester of freshman year.
"That was when I was like: 'This is a problem,'" he said. "But I just didn't really want to admit it to people."
His parents weren't oblivious to his nicotine use.
Early on, they confronted him every time he came home smelling like tobacco, Kelly Kinard said.
"When he started vaping, I wasn't all that concerned, because like everyone else in the country, I had heard that vaping is a healthier alternative to smoking," she said. "And I thought we could use it to wean him off the nicotine."
Later, she said, she figured out that he was addicted to Juul. She kept finding evidence of it in his room, and discovered he'd been deceiving them to get money to buy more.
"Once we found out he was spending money that we gave him on nicotine products, we stopped giving him money to go out," she said. "That's when he started selling his belongings."
Kinard sometimes got vaping supplies from other students, but he also often shopped at stores.
"I look older," he said, explaining he had success getting them at smaller convenience stores and gas stations.
For a few months last summer, Kinard was on a prescription for Wellbutrin, an anti-depressant and smoking cessation aid, but Kelly Kinard said she soon realized her son lacked the will and maturity to quit. It wasn't working.
"We'd been battling his Juul addiction for months," Kelly Kinard said. "And you know not only were we sending him to a counselor, we were also doing family counseling ... and you know, a lot of punishment.
"We tried bribing. We tried everything. And it became clear that the addiction was out of his control. And then last fall, he had a grand mal seizure after Juuling."
Marina Picciotto, a Yale psychiatry professor and nicotine expert, said she doesn't find it at all surprising that someone vaping the equivalent of 80 cigarettes a day would have symptoms including chest pains, cold sweats, irritability and a seizure.
But she also said most nicotine addicts don't consume it at those levels.
"I think it's very rare and a huge outlier," she said, for people to vape four pods per day, like Luka Kinard did. However, Kinard said he knows some other teenagers who did or do vape that much.
With cigarette smokers, Picciotto said, there are some unusual cases of people who smoke four packs a day, but those are typically situations where the person has developed a very high nicotine tolerance over many years.
She theorized that since nicotine takes longer to get to the brain in vaping than in cigarettes, that could contribute to someone who is vaping continuing to take in nicotine past what they need to satisfy their cravings. It would be like a person continuing to eat because they don't realize they are full.
Being young, she said, could be another contributing factor.
"The teenage brain may not get the stop signals," she said. "The adolescent brain is not very good at stopping. When you feel something is good, you just keep after it."
Seeking a solution
Kinard's seizure in September forced his family's crisis to a head.
After a trip to the ER, his mother said, they followed up with a pediatrician, neurologist and cardiologist.
"Some of them had never even heard of Juuling," she said. "Which was frustrating ... So I started doing internet research."
Based on her research, Kelly Kinard became convinced that her then-15-year-old son's nicotine use needed to be treated like any other substance abuse problem. When she explained to the insurance company about his symptoms, behavior and seizure, the company agreed.
Her search for an adolescent-only treatment center that would best fit his needs led her to the facility in California.
But Kinard did not take his parents' ultimatum that he go to rehab well. It was right around Halloween and he had just bought new vapes that he was eager to use.
"I was mad," he said. "I was really mad."
"That's an understatement," Kelly Kinard said and laughed. "He didn't go willingly."
She and Luka's father told him rehab would be only eight days, when they knew it would be at least 30. She said she also threatened to call the cops and have them drive him to the airport to get him to go.
In rehab, all the other teenagers there had used nicotine, but none were there just for that like Kinard was. They'd added on other drugs, and other addictions.
Kinard said his nicotine use led him to experiment with alcohol and marijuana, but those hadn't taken over his life the way the nicotine did.
In rehab, there was no choice but to go 100% cold turkey. No drugs, and no way to get them, and no cell phones.
And there was no way out, save participating in the activities, doing the work, and coming to grips with what it meant to live drug-free. He also had to learn to use other methods to deal with feelings and problems. He craved nicotine, but there was just nothing to do about it, other than tell the counselors how he felt.
"You kind of have to sit with it," he said. "Just learn to sit in your own skin, or accept it."
A new direction
Kinard came home to a "pretty interesting" Christmas. Interesting in a good way. The most satisfying he'd had in a long time. Not like rehab.
"I was like, 'Oh, wow. I'm not having to go ask to use the bathroom anymore,'" he said. "I don't have a roommate."
Kelly Kinard said at first she worried her son might use nicotine again. She was afraid to let him be around his friends, for fear that would make him want to vape.
But each drug test they gave him came back nicotine free and Kinard continued with counseling. As she noticed him becoming more honest with her and more committed to continuing not to vape, she realized she could allow her son to see friends and live life. Bit by bit, the family was able to build trust again.
"Recovery is a long process: just quitting isn't enough," she said. "You have to let the brain recover."
During the time Kinard had been in rehab, his mother had been talking to a reporter with The Wall Street Journal.
She'd contacted the reporter on a whim, with some thoughts on a previous story on vaping the reporter had written. As it turned out, the reporter was interested in talking to Kinard about her experiences with seeking rehab for her son.
When her son found out about the article, he felt that he should speak to the reporter too, she said.
After that Wall Street Journal article published, other people began to seek out the teen and his mother. He was interviewed by NBC News and featured on "Good Morning America."
Kelly Kinard said parents started calling her, asking for help dealing with their child's vaping addiction, or seeking advice on how to get their insurance company to pay for treatment.
She is now working with an organization called Parents Against Vaping E-cigarettes. PAVE has been referring parents who are struggling with their child's vaping addiction to talk to her. She knows of lots of families dealing with children with vaping addictions, but not many that have broken their addictions.
"I feel very fortunate to be on the other side of the problem right now," she said.
She and her son participated in a panel discussion on teenage vaping prevention at the Smoke Free South Carolina summit in late May. A month later, he spoke on a panel about quitting vaping in Washington, D.C., at an event sponsored by The Truth Initiative.
Shortly before the South Carolina summit, on May 15, Luka Kinard stood with N.C. Attorney General Josh Stein when Stein announced he was suing Juul over concerns about teenage users.
Stein is asking the courts to permanently keep Juul from selling flavors other than tobacco or menthol online to people in North Carolina. He is also seeking to have the courts prohibit Juul from sponsoring sports, entertainment or charity events held in North Carolina, putting up outdoor advertising within 1,000 feet of a school or playground, and other restrictions on sales and marketing.
On its website, Juul Labs Inc. said they "don't want anyone who doesn't smoke, or already use nicotine, to use Juul products.
"We certainly don't want youth using the product," the company said. "It is bad for public health, and it is bad for our mission."
The company said it stopped selling certain flavors in stores, enhanced online controls, dropped its Facebook and Instagram accounts, and made other changes as part of a 2018 action plan.
At this point, Juul holds nearly three-quarters of the e-cigarette market.
Kinard said he's not trying to tell any adult who is using vaping to quit cigarette smoking what to do, but he is convinced that what he sees as the harms of Juul and its competitors are outweighing any possible benefits across society as a whole.
"It's just where our values lie: are we going to have a future generation that’s addicted to nicotine?" he asked. "I think the best thing is to save the generation that’s at stake right now."
Even more than participating in panels or supporting Stein's lawsuit, Kinard is passionate about speaking to middle and high school students about his experiences. He enjoys public speaking and said he's building on skills he gained in middle school from Allen Jay Preparatory Academy and through Boy Scout national youth leadership training.
He's spoken on the topic at 10 schools in the state and has plans for more, not just in North Carolina, but also in South Carolina and even Montana.
Kinard said he knows the sense of guilt, shame, and loneliness that can come from dealing with an addiction. He hopes students who are dealing with these issues will feel less alone when he speaks to them. And he wants to help students understand there are better places to look for relief and pleasure.
"There’s sports, there’s music, there’s food even," he said. "Just things that you can get natural highs from that don’t harm you."
He has faced challenges with school, including catching up academically for the time he missed while in rehab. But he's excited about the work he's doing in sharing his story. And he sees a stark distinction between when his life revolved around vaping and how it is today.
"It was man versus the world for me," he said. "Whereas now I see so many positive things about the world. I'm just very happy to be here."