But other things are happening. That pod the child tossed out (JUUL’s flavors include mint and mango. Other companies sell unicorn and bubblegum.) contained as much nicotine as a pack of cigarettes. JUUL’s product allows users to inhale high levels of nicotine more easily and with less irritation. With this vaporized delivery system, fine particles of cancer-causing chemicals go deep into the lungs. E-cigarette batteries have caught fire and exploded, causing serious injuries. Adults and children have been poisoned by swallowing, breathing or absorbing e-cigarette liquid. And then there’s the fact that the nicotine is being delivered is highly addictive and damages the still-developing adolescent brain.
What can follow that vaping experience is a trip to the emergency room and even death. As of Sept. 27, 2019, the CDC had reported 805 cases of confirmed or probable lung injury from vaping, including 12 deaths. More than two-thirds of the cases were male and 62% aged 18-34 years. Forty cases emerged in North Carolina, including one death in Greensboro Sept. 25.
JUUL’s founders proclaim on their website that JUUL was all part of their quest to develop a product that would “invite its own ritual” for adult smokers. But the consumers who really latched onto the product in the U.S. were teenagers: JUUL has created a new ritual for them. Some brands emit giant clouds of vapor. Websites show how to perform tricks with the mist: Ghost Inhale. Dragon. Waterfall. Companies market colorful “skins” for the JUUL device.
While smoking cigarettes among teens is down, use of e-cigarettes is up. Nearly 28% of high school students say they vaped in the last 30 days. Tobacco smoking among adolescents has fallen to 6%, as compared to 16% in 2011 and the peak of 36.4% in 1997.
E-cigarettes first hit the U.S. in 2007. By 2014, they had found their niche when they became the most commonly used tobacco product among youth. This is about the time JUUL entered the market in 2015. By 2017-2018 one-fifth of all high school students were vaping. Only 3.2% of U.S. adults were using them during this time.
JUUL markets itself as a product for adults who want to transition off cigarettes. But the FDA has never approved the device as an aid to help quit smoking. Also, vaping is cheaper than buying cigarettes, which, in addition to the flavors, is another advantage for kids. While cigarettes cost less in North Carolina than most any other state at $4.87 a pack, the calculator on JUUL’s website says someone in North Carolina smoking one pack a day would save $365 a year by switching to JUUL.
Buying the products is no problem for adolescents, either. While North Carolina banned sales of e-cigarettes to minors in 2014, a 2015 study by a researcher at the University of North Carolina found minors could easily buy e-cigarettes online.
The response to the vaping crisis from the federal government has been painfully slow, even though the CDC warned of the dangers of e-cigarettes in 2013. Speaking before Congress, the FDA chief recently admitted a lack of inaction and vowed to do better.
Now, even though the American Lung Association and others sued—including North Carolina’s attorney general—the FDA didn’t act until people started getting sick and dying. Now the FDA plans to banish all e-cigarette flavors except for tobacco and is drafting other rules aimed at curbing adolescent use. But this may be too late, since the nicotine products are highly addictive and the devices wildly popular. A generation of users is already vaping, getting sick, and dying. Companies still could reintroduce the flavors later, as long as they submit to the FDA’s premarket approval process.
The CDC still doesn’t know what is causing the widespread lung injury from vaping. More study into which chemical exposure or brand may be involved is needed. Once this is targeted, it’s up to the FDA to act swiftly.