1 June 2020
Dennis Thompson, US News
(HealthDay News) — Talk to a teacher if you want an idea of how addicted teenagers can become using Juul and other pod-based e-cigarettes.
That’s the suggestion of Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y.
“We’ve had teachers tell us that once they confiscate a Juul from kids in school, the teens beg to get them back because they’re so uncomfortable,” Folan said. “The withdrawal symptoms appear to be pretty intense.”
To her it’s not surprising that a new evidence review has concluded many aspects of pod-based e-cigarettes like Juul are designed to addict people to nicotine.
The way they deliver nicotine represents a technological advance, allowing people to more comfortably imbibe huge doses of nicotine, said senior researcher Andy Tan, an assistant professor with the Harvard T.H. Chan School of Public Health in Boston.
Further, the researchers concluded that these e-cigarettes are designed and marketed in ways that make them very attractive to children.
“More needs to be done to make sure there’s a comprehensive and thoughtful policy that keeps any form of e-cigarette product out of the hands of young people,” Tan said.
Juul Labs responded that its devices are not intended for underage use, and that the design of their e-cigarette is intended to help smokers wean themselves off traditional tobacco.
“Providing a similar nicotine effect and experience to combustible cigarettes is critical to facilitate an adult smoker’s transition from combustible use,” the company said in a statement. “Our clinical studies demonstrate a nicotine absorption curve for the Juul system that is competitive with, but lower than, a combustible cigarette.”
E-cigarette use among teenagers has increased substantially since the introduction of pod-based e-cigarettes, prompting the U.S. Surgeon General to declare youth vaping an epidemic, the researchers noted.
Pod-based e-cigarettes are so called because they use replaceable pod-style nicotine cartridges. They have proven immensely popular.
Within three years of Juul hitting the market in 2015, about one in 10 teens and young adults aged 15 to 21 had tried the device at least once, the researchers found.
To figure out why Juul and similar devices have been so successful, Tan and his colleagues reviewed 35 research papers produced about pod-based e-cigarettes between 2015 and 2019.
Pod-based e-cigarettes like Juul contain higher levels of nicotine salts rather than free nicotine in their liquids, Tan said. Nicotine salts are less acidic than regular nicotine. “It’s much less irritating and much less harsh compared to the earlier versions of e-cigarettes,” Tan said.
This allows users to vape more often, exposing themselves to higher accumulated amounts of nicotine over time.
It also makes it easier for teens to use Juul and similar products, Tan added.
“Young people who are experimenting with e-cigarettes are less deterred by the harshness of inhaling the vapor,” Tan said. “Because they are being exposed to higher levels of nicotine, they’re also more likely to develop nicotine dependence or addiction.”
Vaping with a pod-based e-cigarette is so comfortable that people can easily sicken themselves on nicotine, Folan said.
A 23-year-old patient who’d switched to vaping from smoking told her he couldn’t stop compulsively drawing puffs from his device.
“He felt like he had it in his mouth all the time,” Folan said. “It was making him nauseous — one of the side effects of too much nicotine is you’re nauseous and you vomit.”
Pod-based devices like Juul tend to look like a computer flash drive, with a stylish and small design that appeals to young people, Tan continued.
They’re “designed to be discreet and sleek,” Tan said. “They can be easily concealed.”
Juul and its competitors also tend to rely on social media for their marketing, as opposed to traditional TV, radio or print ads, Tan said.
“Young people are more exposed to such forms of marketing because of their higher use of social media platforms than other age groups,” Tan said.
The U.S. Food and Drug Administration in January finalized a ban on another aspect of pod-based e-cigarettes that appeals to teenagers — the wide variety of flavors available to vape. Juul stopped selling flavored pods in 2019, shortly before the ban took place.
However, Tan argues that e-cigarette manufacturers have already figured a way around the ban, which focuses solely on pod-based devices.
Disposable e-cigarettes — sold under brands like Puff Bar and Mojo Vape — come in a wide variety of appealing flavors, exploiting an apparent loophole in the FDA ban, Tan said.
Disposables cost around $10 and contain enough e-liquid for about 300 puffs, Tan said. The spent devices are tossed in the trash.
“It’s basically a whack-a-mole situation,” Tan said of attempts to regulate e-cigarettes. “Disposables represent a product that’s not being covered by the new policy in January.”
The new evidence review was published online June 1 in JAMA Pediatrics.