The Juul Epidemic

What’s wrong with JUUL? – It turns out EVERYTHING!

In just two years the JUUL e-cigarette has managed to reverse nearly two decades of progress in reducing teenage addiction to nicotine. This Silicon Valley startup created a storm of social media marketing cynically directed specifically at kids. JUUL purchased youthful “influencers” to target large teen audiences on Instagram, Snapchat, YouTube and other platforms. Within a few months, the result was hundreds of millions JUUL use views to kids across the globe.

The JUUL device itself is a small, concealable, sleek and dramatically different product. It’s often called the “iPhone” of e-cigarettes, and more closely resembles a memory stick or USB “thumb” drive than any other e-cigarette.

Teen E-Cigarette Use (Vaping) is Surging

12th Graders – Nearly Two Decades of Improvement Wiped Out

Source: “National Adolescent Drug Trends in 2018,” NEJM

Ohio State University Undergraduates – Fall 2018

All E-Cigarette Use    JUUL Use Alone

According to the FDA, 3.6 million middle school and high school kids have already addicted to e-cigarettes, principally JUUL. There’s also good evidence that a similar number of college-age students are also regular users. That’s seven million young people on the road to long term nicotine use. Early nicotine addiction is a powerful gateway to lifelong combustible cigarette use, as well as abuse of other addictive substances. There is also increasing evidence that mental illness including bipolar disease, schizophrenia, serious depression and anxiety is attributable to early nicotine addiction in susceptible individuals.

As with all e-cigarettes, JUUL relies on flavors to hook kids, and JUUL comes in eight varieties. What starts off as just a quick hit off a friends device, soon becomes a habit. JUUL has become such a high school phenomenon that bathrooms are often designated as the “JUUL rooms”, and they’ve become the bane of teachers and school resource officers.

The FDA talks tough with JUUL but in reality has done nothing to actually crack down on this totally unregulated product.

What is a JUUL device?


3” long battery with an LED light that comes on with an inhalation.


Two electrodes attach the battery magnetically to the USB port plug.


The yellow liquid is nicotine – equivalent to 30 cigarettes. That end inserts in the battery. The other end is the mouth piece

JUUL is the perfect size…

for a teen to use stealthily in math class!

But why would kids even pick up a JUUL?

It’s the flavors: crème brûllée, mango, cool mint, fruit medley, cool cucumber, menthol.

Most kids start off unaware of the nicotine, unaware of anything but the flavor, the tingle and the little “buzz” they get. Until it’s too late.

The reason JUUL works so well in getting kids started but not so well in helping adults quit is because JUUL has modified their delivery system to maximize initiation, but unfortunately that also minimizes its use as a cessation agent. JUUL doesn’t use regular nicotine. Instead, they’ve substituted a benzoate salt of nicotine, and they deliver it at a lower temperature. To make up for this, JUUL uses a large amount of nicotine. Each pod is worth 30 cigarettes – a pack and a half.

What’s the difference?

A carefully engineered combustible cigarette like Marlboro delivers “free-base” nicotine within seconds, directly to the deep lung. Absorption there is incredibly rapid – much faster than an intravenous injection. That’s the “impact” that smokers feel and anticipate. JUUL delivers a lot of nicotine, but not the quick stuff. Moreover, JUUL and other e-cigarettes, because they work at lower temperatures, produce particles that are 50 times the volume of those produced by a Marlboro. These bigger particles are more likely to stick in the upper reaches of the lungs where they are absorbed much more slowly.

9th Grade E-Cigarette Users Are More Likely to Start Smoking

Started Smoking Within Six Month
(Cigarettes, Cigars or Hookah)

Association of Electronic Cigarette Use with Initiation of Combustible Tobacco Smoking – Leventhal, Strong, Kirkpatric JAMA August 2015

An Addiction Paradigm

There’s a parallel here with the opioid crisis. JUUL tends to function as a starter addiction system, something like Oxycodone. While to a smoker, a Marlboro is like heroin. Not many heroin users go back to Oxy when then can get the real stuff. Similarly, the data shows a few combustible cigarette users move completely to e-cigarettes. They smoke when they can, and vape when they must. Unfortunately, this dual-use probably does not reduce their risk of illness and may expose them to the dual health threats of traditional cigarettes and untested flavored vapes.

In terms of addicition, JUUL is like Oxycodone, but Marlboro is heroin. Addicts tend to stick with the hard stuff.