Everything You Need to Know About JUUL

Jia Tolentino, a journalist for The New Yorker, wrote a revealing article on the state of vapes, Juuling, and nicotine addiction in the USA [1]. Here’s our take.

The Juul vaporiser uses cutting-edge electronic cigarette technology and is simple enough for a kid to use. It's the size and shape of a flash drive -- in fact, you can literally recharge it by plugging it into your computer's USB port. Pods (small cartridges filled with “juice”) contain up to 40 mg of nicotine and come in eight flavors – mango and mint are the most popular. The pod is inserted into the Juul and heated by an electronic spark when the user inhales on the end of the vape, creating a nicotine-infused vapor that is sucked into the lungs.

Juul and the litany of vapes modeled after it are a technological response to a major health issue. Cigarette smoking is the top cause of preventable deaths, and is responsible for more than 480,000 deaths in the USA each year – that's one in five deaths annually, or 1,300 every day [2]. Arsenic, hydrogen cyanide and ammonia are only a few of over 7,000 damaging chemicals found in cigarettes. However, nicotine has been shown to have little to do with the extremely deleterious health effects of smoking, and the delivery of nicotine isolated from tobacco may satisfy the addiction while reducing the high risk of cigarette-related disease [3].

But is vaping solving the problem, or creating a new one?

Today's e-cigarettes were modeled after a patent design by Hon Lik, a Chinese pharmacist who first conceived of vaporizing liquid nicotine with a heating device in 2003. Almost ten years later, this concept was expanded on by two Stanford grads, Adam Bowen and James Monsees, who created Juul's predecessor, Pax. Pax, also known as Ploom, was an iPhone-sized vaporiser that could be loaded with loose leaf tobacco -- though their marketing primarily targeted cannabis users. Both Bowen and Monsees were previous smokers who (much like the designers of nicotine gum) switched to cigarette replacements while testing their own early prototypes. As a company called Pax Labs, the product designers' next endeavor was Juul. A smaller, sleeker design that delivers only nicotine – no tobacco, and no room for herbal or illicit blends. Juul is tiny, the size of a flash drive, and comes with attractive flavor profiles like mint, fruit, dessert, or for the die-hards: tobacco flavor. Chemically, Juul is leagues above previous models, as well as cigarettes. For example, cigarette companies combine nicotine with ammonia to speed up the drug's delivery into the brain and blood. Instead, Juul engineers discovered that using benzoic acid with nicotine salts can do the same thing.

Great, no more ammonia. But what about the fast-acting nicotine?

Nicotine binds to receptors in the brain and stimulates the release of dopamine, adrenaline and noradrenaline – neurotransmitters that promote feelings of pleasure, contentment, satisfaction, motivation and achievement. The rapid absorption of nicotine from cigarettes and vapes causes a “rush” of these neurotransmitters and reinforces the effects of the drug on the brain, including its addictive nature [4]. Cigarettes contain extra ingredients that stop the breakdown of dopamine, increasing the risk of creating a stronger nicotine dependency in the brain [4]. While official Juul products don't contain those kind of ingredients, for some people the “rush” of fast-acting nicotine combined with the social and psychological aspects of vape addiction may be as strong as cigarette addiction [8].

The R&D engineer behind Pax has stated that, “We don’t think a lot about addiction here because we’re not trying to design a cessation product at all... anything about health is not on our mind.” [5] More recently though, Juul has committed to joining the fight against cigarette-related deaths, and the C.E.O. has called Juul a “cigarette-killing company”. But whether e-cigarettes are contributing to the problem is a point of contention, especially among parents and teachers.

High schoolers are getting hooked on nicotine via the super fashionable, easily concealed Juuls and their flavor-packed cartridges. Smoking is out, Juuling is in [1]. Schools are reacting by holding information sessions, banning flash drives and holding compulsory assemblies in an effort to deter teens from picking up a vaping habit. Parents are calling for a government crackdown on e-cigarettes. State senators have written open letters to Juul and to the FDA, stating that the company's vaping device is “putting an entire new generation of children at risk of nicotine addiction and other health consequences,” [6] and that, “it is imperative that the FDA take immediate steps to remove kid-friendly e-cigarette and cigar flavorings from the market.” [7]. The F.D.A. is further being sued by several groups including the American Heart Association and the American Lung Association for needlessly exposing consumers to “lethal and addictive substances”. The F.D.A. only began regulating e-cigarettes in 2016, and has recently extended the deadline for vape companies to submit an expensive and complex application before beginning production. The F.D.A.’s director has said, “We believe that nicotine delivery exists on a continuum of risk.” [1]

Jonathan Winickoff, a professor at Harvard Medical School and the former chair of the American Academy of Pediatrics Tobacco Consortium, has stated that “Juul is already a massive public-health disaster,” particularly for teens and children. He warns that dramatic action is needed to prevent the issue from becoming much, much worse. While Juul's ingredients are allegedly above-board, the liquids used in the hundreds of copycat vapes are questionable and, Winickoff says, “You don’t know what the drug might be laced with.” He suggests that the vape industry is hiding behind false wellness claims when the health risks are real and well-known. [1]

While the risks to both adult and teen health are gaining more attention and push-back, the market still appears to be growing with no sign of slowing down. Wells Fargo analysts predict that the vaporizer market in the USA will grow to $5.5billion this year. Over 60% of that rising market belongs to Juul. [1]

References:

[1] Tolentino, J. (2018) The Promise of Vaping and the Rise of Juul. The New Yorker. https://www.newyorker.com/magazine/2018/05/14/the-promise-of-vaping-and-the-rise-of-juul

[2] Centre for Disease Control and Prevention (2018) Smoking & Tobacco Use – Diseases and Death. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm

[3] Mishra, A., et al. (2015) Harmful effects of nicotine. Indian J Med Paediatr Oncol., 36:1, 24 - 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/

[4] Henningfield, J. et al. (2004) Reducing tobacco addiction through tobacco product regulation. Tob Control., 13:2, 132 - 135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1747873/

[5] Tiku, N. (2015) Startup behind the Lambo of vaporizers just launched an intelligent e-cigarette. https://www.theverge.com/2015/4/21/8458629/pax-labs-e-cigarette-juul

[6] Durbin, R. J., et al. (2018) Open letter to Kevin Burns CEO JUUL Labs, Inc. https://www.durbin.senate.gov/imo/media/doc/JUUL%20Letter%20-%20S%20IGNED.pdf

[7] Durbin, R. J., et al. (2018) Open letter to the Honorable Scott Gottlie Commissioner of the United States Food and Drug Administration. https://www.durbin.senate.gov/imo/media/doc/FDA%20Letter%20-%20SIGNED.pdf

[8] Belluz, J. (2018) Juul, the vape device teens are getting hooked on, explained. Vox. https://www.vox.com/science-and-health/2018/5/1/17286638/juul-vaping-e-cigarette