The Vape Epidemic

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

In just the last few years JUUL, Puff Bar and other e-cigarette (vape) products have managed to reverse nearly two decades of progress in reducing teenage addiction to nicotine. JUUL, a Silicon Valley startup created a slickly designed liquid nicotine pod system and then engaged a tsunami of social media marketing cynically directed at adolescents. 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 exposures to kids across the globe. The fad took off like a rocket, but unlike fidget spinners or hover boards, this fad didn’t fade, because nicotine is one of the most addictive drugs on the planet.

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.

12 Grade Cigarette vs. E-Cigarette Use

Use in Past 30 Days – National Youth Tobacco Survey

Ohio State University Undergraduates – Fall 2018

All E-Cigarette Use    JUUL Use Alone

Now, according to the CDC, 3.5 million middle school and high school kids are using e-cigarettes. 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.

How could this happen? What is most disturbing is that all of these products are actually illegal. Federal law prohibits the entry of new nicotine and tobacco products into the market without first gaining approval from the FDA. But, in a disastrous blunder the FDA chose not to enforce sales restrictions, hoping that these products would help smokers quit. Unfortunately, the data shows they do not help with cessation, but e-cigarettes have been overwhelmingly and tragically tempting to teenagers. E-cigarettes rely on flavors to entice kids, and mask the bitter, harsh taste of nicotine. What starts off as just a quick hit off a friend’s device, soon becomes a habit.

As the teen vaping epidemic exploded, tens of thousands of terrified and angry parents protested to political leaders. Teens themselves sounded the alarm. In response, the Trump administration promised to eliminate flavors in vape devices, but under industry pressure they quickly backtracked in favor of a partial flavor ban covering only pod-based systems like JUUL. Predictably e-cigarette retailers began pushing heavily flavored single use devices (like Puff Bar) that aren’t covered by the ban and millions of kids switched.

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 or a Puff Bar?

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 worked 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 cooked up a specialized 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, Puff Bar 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, Puff Bar and friends tend 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 they 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.