News this week that the manufacturer of the electronic cigarette Juul will voluntarily limit sales of its flavored liquids to online purchases is a step in the right direction but certainly not snuffing out the problem, according to some Hartford HealthCare providers.
“Regulatory action preventing Juul sales would be great,” says Dr. J. Craig Allen, medical director of Rushford, noting that Food and Drug Administration is pushing to stiffen control of the sale of e-cigarettes like Juul. “The nicotine aerosolized in e-liquid ‘pods’ is highly addictive, especially for the developing brains of adolescents, with Juul having twice the nicotine content of the average e-cig. The more nicotine, the more potent and the quicker someone will become addicted.”
The FDA already bans the sale of such products to anyone under the age of 18, but Dr. Allen says Juul’s announcement that it will shift sales of the flavored liquids out of stores and to the Internet may not be enough to deter young users.
“In my experience, kids are pretty savvy about navigating the Internet,” he says.
“We need to lobby that the age to purchase e-cigarettes be raised to 21. Cigarettes are 21, how did the e-cig lobby get the age down to 18?” she asks.
Juul is especially easy for younger smokers to use because it’s small, the size of a computer flash drive, and more discrete. Dr. Allen says one teen reported he was in a class where every time the teacher turned his back to write something on the board vaping students took a rip from their Juul behind the teacher’s back.
In addition, he notes that “parents, teachers, healthcare providers and the community need to understand the dangers of vaping,” which has been marketed by Juul and other e-cigarette manufacturers as a smoking cessation tool and less dangerous than cigarettes.
“There are at least seven studies that show adolescents who use e-cigarettes are more likely to progress to smoking traditional cigarettes. It’s a new pathway for big tobacco,” Dr. Allen says.
Dr. Namerow agrees, underscoring specific health effects of e-cigarettes, including the fact youth with attention deficit hyperactivity disorder (ADHD) are particularly susceptible to the addicting power of nicotine.
“When we reviewed the health impact of nicotine, it was remarkable to read that the carcinogenic effects of cigarettes is much more related to the nicotine itself rather than anything in the tobacco,” she says. “You may lower your chances of COPD (chronic obstructive pulmonary disease) but not cancer!”
She has been working to inform area pediatricians of the problem, asking them to hang posters in their waiting rooms to let parents know what Juul cartridges look like.
“They need to know that the thing they might see in their kids’ bedrooms is not a USB flash drive but a nicotine-containing Juul,” she notes, adding that many teens use nicotine as a stimulant to stay up at night and play video games, then show up at school extremely fatigued. “Poor sleep can leed to depression and, worse, mania. The psychiatric impact of nicotine, even in addition to the addition itself, can be quite significant in the areas of anxiety and mood.”
On Nov. 15, the FDA said brick-and-mortar stores could sell flavored e-cigarettes only from restricted areas inaccessible to minors, stopping short of a ban some members of Congress had expected. The agency will host a hearing Dec. 5 on what it calls the epidemic of e-cigarette use among teens.