While the Parliament has been holding back for almost a year the amendment to the Tobacco Law, which would ban nicotine pouches, the use of this product among first-year high school students has increased 2019-fold since 10.
About a fifth of fifteen- and sixteen-year-olds used electronic cigarettes in the past year, which, like snus pouches, are also banned in many European Union countries, as are tobacco cartridges for tobacco heating devices.
The "forgotten" law in the Parliament envisages, among other things, a ban on flavors in tobacco and nicotine products and nicotine (snus) pouches, as well as the establishment of better regulation...
Pediatric neurologists and pulmonologists warn of the devastating effects of nicotine and tobacco on the development and health of the brain and lungs of children and young people, while the Parents Association reports that the use of these products is widespread and normalized even among elementary school students.
"Every parent who has a child in the final grades of elementary school or at the beginning of high school, if they talk to them, can understand the scale of the problem. Children freely buy these products in stores, at newsstands, online... For years, we have been asking in vain for tobacco and nicotine pouches to be banned by law and for their import to stop," the Parents' Association told "Vijesti".
Adolescents quickly develop addiction
neuropediatrician, dr Nelica Ivanovic Radovic, points out that snus, a moist, ground tobacco product for oral use, contains at least 28 carcinogens and poses enormous health risks. On the other hand, flavored nicotine pouches have concentrations ranging from two to 20 mg per pouch, and this variability in dosage poses an additional risk because users can unknowingly ingest large amounts of nicotine.
She explains that new tobacco-free nicotine products may be attractive to adolescents because of the possibility of hiding use from parents and other authorities, the similarity to favorite food products (e.g., chewing gum), and the availability of appealing fruit and candy flavors. Their promotion, she says, uses marketing approaches that appeal to young people, and digital marketing campaigns imply minimal harm from using these products.
"Nicotine is addictive and harmful to health, especially for the developing body, including the brain. Nicotine exposure during adolescence can negatively affect adolescent brain development and increase the risk of nicotine addiction and problems with attention, memory, learning, and impulse control, which has been documented in numerous clinical and population studies," emphasizes Ivanović Radović.
She explains that the brain develops until approximately the age of 25, with particularly intense developmental processes during adolescence.
The doctor points out that adolescence is a developmental period characterized by increased experimentation with substance use, including nicotine and alcohol.
“While the adolescent brain is particularly susceptible to the rewarding and reinforcing properties of drugs, smoking in adolescence poses a unique set of health risks. Nicotine is a psychoactive substance and acts as an agonist of nicotinic acetylcholine receptors (nAChRs) in the central nervous system. These receptors are widely distributed in the brain and play a key role in neurotransmission. When nicotine binds to these receptors, it leads to the release of various neurotransmitters, including dopamine, noradrenaline, serotonin, and GABA,” the doctor emphasizes.
He explains that activation of nicotine receptors leads to the release of dopamine, which creates a feeling of pleasure and encourages the habit of use, and this mechanism is the basis for the development of addiction.
Ivanović Radović says that in adolescents, these receptors are particularly numerous in areas responsible for learning and memory (hippocampus), attention (prefrontal cortex), mood regulation (limbic system), reward and motivation (dopamine system). Adolescents, he warns, can develop signs of addiction after a relatively short period of use, even with lower doses of nicotine. This, he emphasizes, is a consequence of the immaturity of the prefrontal cortex, which otherwise regulates impulse control and decision-making.
Nicotine causes permanent changes in brain function
Dr. Ivanović Radović also warns that nicotine itself can have neurotoxic effects, especially in higher doses, and acute toxicity can lead to headaches, nausea, dizziness, and in extreme cases, convulsions.
On the other hand, chronic exposure can lead to altered neurotransmitter levels and disrupted homeostasis (balance) in the brain.
The doctor points out that chronic nicotine use leads to the development of tolerance, when the same dose of nicotine no longer produces the same, desired effect, and the development of withdrawal syndrome, when nicotine is no longer available, which leads to pronounced mood disorders, the development of symptoms of depression, anxiety, irritability and anhedonia, or the inability to feel pleasure, and maintaining a "normal" state requires continuous use of nicotine.
"These changes are particularly pronounced in certain parts of the brain, the most important of which are the nucleus accumbens, which is the reward center, the prefrontal cortex, which is responsible for executive functions and decision-making, and the ventral tegmental area, which is the source of dopamine neurons... It is clear that any attempt to stop using nicotine is difficult and that gradual reduction or pharmacological assistance is required. We must keep in mind that the relapse rate is high and that long-term abstinence is key to full recovery," says the doctor.
She says research shows that regular nicotine use during adolescence can lead to impaired concentration and attention, working memory, slowed information processing, and difficulty making complex decisions.
“…The use of nicotine sachets during childhood and adolescence can lead to increased anxiety and depressive symptoms, changes in response to stressful situations, and impaired social skills. Children and teenagers who use nicotine products often show deterioration in school performance, poorer learning outcomes, difficulty concentrating when solving tasks, and a higher likelihood of dropping out of school,” warns Ivanović Radović.
She also says that exposure to nicotine during this critical developmental period can lead to permanent changes in brain structure and function, impaired executive functions, increased risk of mental disorders in adulthood, and a greater likelihood of using other substances.
Scientific evidence, he argues, clearly shows that nicotine pouches (with or without tobacco) pose a significant threat to the brain health of children and teenagers.
He points out that research shows that recovery after stopping the use of these products is possible. After a few days and weeks without nicotine, the number of dopamine receptors begins to increase. After months of abstinence, receptor sensitivity returns. Long-term recovery occurs after years of not using nicotine and is reflected in a more complete recovery of the dopamine system.
"However, the degree of recovery depends on the duration of use, the age at which use began, and individual factors. It must be emphasized that this recovery is slower in people who started using nicotine in adolescence, because the changes occurred during a critical period of brain development...", the doctor points out.
Children's lungs are particularly sensitive
Pediatrician pulmonologist Dr. slađana Radulović warns that exposure to tobacco smoke has significantly more harmful effects on children than on adults. Children, he says, are particularly vulnerable due to their immature immune response, while adults are more affected by the consequences of long-term exposure.
"Nicotine easily crosses the placenta and already in the mother's womb shows harmful effects on fetal development and the development of the respiratory system. The concentration of nicotine in a newborn exposed to tobacco smoke is approximately the same as the concentration of nicotine in adult smokers. In children, nicotine affects the development of the respiratory system, leading to reduced lung function, increased hypersensitivity and inflammatory reactions in the airways. Children exposed to nicotine have more frequent episodes of coughing, wheezing and asthma attacks. Due to damage to the respiratory epithelium, respiratory infections, both viral and bacterial, are more common," explains Radulović.
The doctor says that lung development begins early, before the 28th day of conception, and occurs in four stages. The last one is around the 27th week of gestation, and only then can the lungs breathe independently, even though development is not complete.
"After birth, a multilocular and progressive increase in the size of the alveoli begins. A baby born at term has about half the number of alveoli of adults. The increase in the number of alveoli grows especially in the first 2-3 years of life and the complete number of alveoli develops by the age of 8-10. Boys have a greater number of alveoli than girls. After that, development continues in the direction of increasing the diameter and length of the airways and further remodeling of the alveoli. The final increase occurs during adolescence with a parallel increase in lung volumes that lasts longer in boys than in girls. In the first 10 years of life, the diameter of the chest also changes, and bone maturation lasts until the age of twenty," Radulović points out.
She says that smoking during pregnancy is a well-described cause of damage to small airway development with immediate or long-term consequences not only on airway development, but also on the development of airway hypersensitivity.
"Chemicals from tobacco smoke directly interfere with the normal development and maturation of cells in the respiratory organs, reduce the production of surfactant (a substance that keeps the alveoli open) and disrupt normal alveolar expansion and gas exchange, causing oxidative stress and inflammation in the airways. Abnormal muscle growth in the airways, constant inflammation, and impaired blood vessel development lead to thickening of the airway wall. Tobacco smoke in the early period of airway development can also affect gene expression, which can permanently affect airway growth and function," she emphasizes.
Dr. Radulović also warns that the use of electronic cigarettes, devices known as vapes, has increased sharply in the last 10-12 years, especially among non-smokers and adolescents.
"The main ingredient is propylene glycol and glycerol, which allow the nicotine to dissolve and are responsible for the creation of the mist. Propylene glycol dries out the mucous membrane in the respiratory tract and causes inflammation. Some experimental studies have reported increased cell death after exposure to these vapors, probably through the mechanism of increased oxidative stress. The immune system is activated and the inflammatory reaction leads to narrowing of the airways. The harmful effects are particularly pronounced in young people whose airways have not yet fully developed, affecting lung function, airway hypersensitivity, and increasing the risk of asthma and respiratory infections," the doctor emphasizes.
Lost years at the expense of generations
The executive director of the NGO Juventas, Ivana Vojvodić, recently assessed that more and more young people in Montenegro are smoking because there are no appropriate legal solutions.
She emphasized that it is necessary to accelerate the process in order to build a healthier Montenegro and make harmful tobacco and nicotine products less attractive, especially for children and young people.
She warned that three years have been lost since the Tobacco Law was supposed to be adopted in the Parliament, assessing that the responsibility lies with the MPs.
"In 2021, the government decided to ban flavors in tobacco and nicotine products, nicotine pouches, and to establish better regulation. And we, as a society, have caused enormous damage to the generation that is in high school today by not reacting, and it is up to the MPs to react and repair the damage."
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