Juul ramped up nicotine levels, and competitors followed, study says

The use of e-cigarettes has become controversial due to a lack of evidence on their efficacy as anti-smoking aids and warnings about possible long-term health effects.

Posted: Feb 7, 2019 6:40 PM
Updated: Feb 7, 2019 6:40 PM

Leading e-cigarette company Juul Labs spurred a "widespread rush" of companies seeking to boost their own nicotine concentrations in order to mirror Juul's success, according to a paper published Thursday in the BMJ journal Tobacco Control.

When Juul released its original 5% nicotine pods in the United States in 2015, the majority of competing products came in 1% to 2% concentrations, according to study author Dr. Robert Jackler, founder of Stanford Research into the Impact of Tobacco Advertising. Now, a number of competing brands reach into the 5% to 7% range.

Experts say that a single 5% pod delivers the same amount of nicotine to the body as a pack of cigarettes.

"That may be a benefit to addicted adult smokers, but it also makes it potently addictive to nicotine-naive teenagers," Jackler said.

Juul increased its own nicotine concentrations using a patented "nicotine salt." By combining nicotine -- a bitter base in its natural form -- with an organic acid, vape manufacturers can mask nicotine's naturally unpleasant taste and create higher-concentration products, experts say.

"As a consequence of that, nicotine gets delivered to the brain very rapidly," said Dr. Frank T. Leone, director of the Comprehensive Smoking Treatment Program at Penn Medicine. Leone was not involved with the new paper.

Leone said there are so many variations of pods, liquids and tank systems that it's been almost "impossible to put any regulatory guardrails around these products."

As teen vaping continues to increase, health advocates have called on the US Food and Drug Administration for more regulation -- including on the high nicotine concentrations and variety of flavors these products come in.

Instead of requiring e-cigarettes to undergo FDA approval before they could be sold, the agency decided in 2017 that it would allow such products that were on the market before August 2016 to stay on shelves until 2022 without pre-market review.

The FDA said in its 2017 announcement that it is "committed to encouraging innovations that have the potential to make a notable public health difference and inform policies and efforts that will best protect kids and help smokers quit cigarettes," thus extending the review timelines for certain products. "This action will afford the agency time to explore clear and meaningful measures to make tobacco products less toxic, appealing and addictive," the agency said.

But some experts think the agency could do more. "FDA should ... require pre-market review and authorization for any e-cigarettes that are sold," said Lauren Lempert, a law and policy specialist for the Center for Tobacco Control Research and Education at the University of California, San Francisco.

'The cost of nicotine addiction' has fallen

In a statement, Juul spokeswoman Victoria Davis said the company has fought back against knockoffs and other products that it says shouldn't be on the market.

"As part of our commitment to prevent underage use, we are taking swift and decisive action against counterfeit and infringing products," she said. These actions include lawsuits and referring cases to law enforcement, according to a company statement last week.

She also asserted that there were products on the market in the 4% to 5% nicotine range "prior to the rise of popularity of the JUUL device." However, Jackler said the majority of products were much lower when Juul launched, and it was indeed the popularity of Juul that sent nicotine concentrations soaring. His research group has been tracking the industry for nearly a decade.

"When Juul came out with very high-nicotine electronic cigarettes, it triggered a nicotine arms race amongst competitive companies seeking to emulate the success of Juul," Jackler said.

It wasn't just nicotine concentrations other companies were mirroring, Jackler argued. Some of the products he catalogs in the new study are Juul-compatible pods offering higher nicotine concentrations than Juul itself.

Other products offering higher nicotine concentrations include e-cigarettes that resemble Juul, as well as bottles of e-liquid that allow vapers to buy in bulk. Many of these products undercut Juul's prices, as well.

"The rush to higher and higher nicotine concentration has reduced the cost of nicotine addiction," Jackler said.

It also comes with "a huge poisoning risk," with some bottles lacking childproof caps and containing enough nicotine to kill an entire preschool class, he said. With the rise in e-cig popularity has come a rise in calls to poison control centers, he added.

'I was already hooked'

Phillip Fuhrman, 15, first tried a Juul in the eighth grade. A friend offered it to him, and he "didn't really know what it was." Before long, it became a habit he couldn't shake.

"I realized that I couldn't stop," he said. "When I started hearing all the facts and everything bad about it, it was already too late. I was already hooked onto it."

At his peak, he estimated, he was going through a pod roughly every day and a half.

"The 5% thing, I've always seen since I started it -- on Juul packs and everything -- but I never knew what it was," Fuhrman said. "Five percent doesn't seem like that much, out of 100%."

Davis said Juul decided on its signature 5% nicotine pods in order to draw to adult smokers to what the company says is a less harmful alternative. The company also offers 3% pods, but only in tobacco and mint flavors. "We continually evaluate our product portfolio to meet the needs and preferences of adult smokers who want to switch from combustible cigarettes," she said.

In other countries, such as the UK and Israel, Juul markets 1.7% pods because regulations prohibit the concentrations sold in the United States, Davis said.

Fuhrman ultimately ditched his vaping habit and focused his sights on becoming a teen anti-vaping advocate -- along with his friends and mother, Dorian Fuhrman, a co-founder of the group Parents Against Vaping e-cigarettes.

"I don't want this to be a thing that my 7-year-old sister is going to be experiencing when she's in seventh, eighth, ninth, 10th grade," he said.

"I just want this to stop as soon as possible so we can stop addicting younger kids."

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 319704

Reported Deaths: 7369
CountyCasesDeaths
DeSoto22276267
Hinds20677421
Harrison18407317
Rankin13880282
Jackson13689248
Madison10249224
Lee10056176
Jones8464167
Forrest7827153
Lauderdale7260242
Lowndes6509150
Lamar634888
Lafayette6310121
Washington5420137
Bolivar4837133
Panola4669110
Oktibbeha466098
Pearl River4604147
Marshall4573105
Warren4440121
Pontotoc425373
Union415777
Monroe4155135
Neshoba4061179
Lincoln4008112
Hancock386687
Leflore3515125
Tate342486
Sunflower339491
Pike3369111
Alcorn325972
Scott320174
Yazoo314171
Adams307486
Itawamba305178
Copiah299966
Coahoma298784
Simpson298189
Tippah291968
Prentiss283861
Leake271974
Marion271280
Covington267283
Wayne264442
Grenada264087
George252051
Newton248663
Tishomingo231568
Winston229981
Jasper222148
Attala215073
Chickasaw210559
Holmes190374
Clay187854
Stone187833
Tallahatchie180041
Clarke178980
Calhoun174132
Yalobusha167840
Smith164034
Walthall135347
Greene131833
Lawrence131024
Montgomery128643
Noxubee128034
Perry127138
Amite126342
Carroll122330
Webster115032
Jefferson Davis108033
Tunica108027
Claiborne103130
Benton102325
Humphreys97533
Kemper96629
Franklin85023
Quitman82216
Choctaw79118
Wilkinson69532
Jefferson66228
Sharkey50917
Issaquena1696
Unassigned00

Alabama Coronavirus Cases

Cases: 548323

Reported Deaths: 11288
CountyCasesDeaths
Jefferson809531565
Mobile42066826
Madison35663525
Tuscaloosa26162458
Shelby25595254
Montgomery25081612
Baldwin21839313
Lee16265176
Calhoun14718325
Morgan14626285
Etowah14171363
Marshall12449230
Houston10764288
Elmore10295213
Limestone10182157
St. Clair10160251
Cullman9941201
Lauderdale9596249
DeKalb8967189
Talladega8458184
Walker7335280
Autauga7230113
Blount6944139
Jackson6922113
Colbert6414140
Coffee5627127
Dale4929114
Russell454941
Chilton4472116
Franklin431083
Covington4273122
Tallapoosa4136155
Escambia401780
Chambers3726124
Dallas3607156
Clarke352961
Marion3242106
Pike314078
Lawrence3129100
Winston283572
Bibb268464
Geneva257581
Marengo250665
Pickens236862
Barbour234659
Hale226878
Butler224071
Fayette218162
Henry193843
Cherokee187245
Randolph187044
Monroe179341
Washington170439
Macon162951
Clay160159
Crenshaw155657
Cleburne153244
Lamar146537
Lowndes142054
Wilcox127030
Bullock124242
Conecuh113430
Coosa111429
Perry108626
Sumter105732
Greene93534
Choctaw62025
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We continue to monitor a tropical disturbance in the Gulf of Mexico. This will be in heavy rainfall two locations across the southeast over the course of the weekend, and flooding rainfall could be in tow as well. Things are looking better for Father’s Day itself, thankfully.
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