The Health Hazards Facing Teen ‘Triple Users’


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About 17 percent of high school students in a new study were “triple users” of marijuana, cigarettes, and e-cigarettes. Dmitry Ageev/EyeEm/Getty Images
  • Researchers report that nearly 17 percent of high school students in a new study were “triple users” of marijuana, cigarettes, and e-cigarettes.
  • They say those “triple users” face higher risks to both their physical health and mental health.
  • Experts add that it’s more difficult for “triple users” to quit smoking and vaping.

In sports, being a triple threat likely means you’re a great player who’s dangerous to the other team. But when it comes to inhaling certain substances, a triple threat means danger to the user.

A new study reports that a sizable group of adolescents are using e-cigarettes, cigarettes, and marijuana at the same time.

Researchers say those younger people are at greater psychosocial and health risk than exclusive users of cannabis, tobacco, or e-cigarettes.

The study cross-classified use of e-cigarettes, combustible cigarettes, and marijuana among high school students in the United States who participated in the 2019 Youth Risk Behavior Survey.

The largest segment of the participants, about 44 percent, were those who never used any of the three substances.

The next largest group was the triple users at nearly 17 percent. E-cigarette plus marijuana users were next (nearly 16 percent), followed by exclusive e-cigarette users (13 percent).

The triple user group was typically elevated above the other groups when it came to the risk level for psychosocial variables.

The study findings included suggestions for further research on the social and health implications of e-cigarettes. It also indicated a need for more research on prevention approaches for double and triple users.

The researchers said the additional research is crucial, because the addictive effects of these habits put people at greater risk for adverse health consequences.

Other experts agree.

“I think there are two aspects of the study worth highlighting and that do tell us something new,” Aaron Weiner, PhD, a clinical psychologist, addiction counselor, and the president-elect of the Society of Addiction Psychology, told Healthline.

“First, this is one of the first studies that has reported that the non-user group is under 50 percent of the total sample,” Weiner noted.

“Until now, it was safe to say that more teens were not using smoked or aerosol-based drugs than those who are. I think there’s a clear line that can be drawn here between the rise of vaping, both for nicotine and for the THC/marijuana, and this increase in teen users over the 50 percent mark,” he said.

Weiner said he’d like to see more details about the users’ ages and frequency of use.

“Secondly, in terms of triple users, the concept makes intuitive sense,” Weiner added. “We know nicotine and THC have negative emotional consequences on teens, so it stands to reason that teens who are using all three substances and delivery methods are likely using more drugs in general, putting them in a higher risk category than a teen using fewer drugs or no drugs at all.”

“The research on how nicotine and THC harm the developing mind is extensive, and the less exposure that adolescents and teens have to the substances, the better,” he concluded.

Brian Wind, PhD, is the chief clinical officer at JourneyPure, a national chain of recovery centers. Wind told Healthline that combining the three makes it much harder to quit.

“Studies have highlighted that the three uses combined can greatly reduce the motivation to quit, poorer outcomes when it comes to attempts to quit, increased risk for mental health disorders, and poor memory functions,” Wind said.

“The long-term effects can be compounded with a bigger negative impact on brain development and coordination, and a greater reliance on nicotine and tobacco,” he added. “It can also heighten the risk of psychiatric illnesses and risky behavior to a greater extent compared to adolescents who exclusively use e-cigarettes or marijuana, which can have negative physical and social consequences.”

Dr. Jordan Tishler, the president of InhaleMD and an instructor at Harvard Medical School in Massachusetts, told Healthline that parents must be prepared to deal with the problem.

“They need to address the risks when their kids are middle schoolers, or even earlier,” Tishler said. “They need to become educated on those risks and be able to have frank, unbiased, non-judgmental conversations with their kids. Kids are good hypocrisy detectors, so the discussion needs to be honest.”

“The data from this study arms parents with information they can use to have this discussion with their kids and help keep them safe,” he added.



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