Vaping: the astonishing surge in e-cigarette use

The US Food and Drug Administration has officially raised the minimum age to buy tobacco products like cigarettes, electronic cigarettes, and vaping products that contain nicotine from 18 to 21.

After President Donald Trump signed the new age limit into law on December 20 as part of a larger government funding bill, the federal agency also released its updated rules around the sale of tobacco and vaping products — expressly prohibiting their sale to anyone under the age of 21 — the same day.

Vaping was introduced into the US market as a tool for helping adult smokers quit. But that’s not who has been buying e-cigarettes in mass.

The latest survey data on adolescent e-cigarette use, published this week in JAMA, shows another year-on-year surge in nicotine e-cigarette use among teens.

It was the stream of young, otherwise healthy patients landing in the intensive care unit with trouble breathing that made Utah pulmonologist Dr. Dixie Harris suspect something was up.

The first patient presented at the Salt Lake City hospital, where Harris works, on August 6. The man, in his 20s, was vomiting and had aches and pains. He also couldn’t breathe properly. So Harris tried to figure out if an infection may be causing the problems — and found nothing.

When e-cigarettes first appeared on store shelves a few years back, they were marketed as a sleek, discreet technology that could help adult smokers kick a potentially deadly habit.

Flash-forward to 2018, the year the Juul vape device took over three-quarters of the US e-cigarette market. Instead of catering to adult smokers, the e-cigarette industry appeared to overwhelmingly target nonsmoking youth.

It’s not that often that you hear a top Trump official unabashedly blaming a US company for a health crisis. But that’s exactly what FDA chief Scott Gottlieb did Tuesday in an interview during his final week in office.

“The dramatic spike of youth [vaping] — that was driven in part at the very least if not largely by Juul,” the maker of hugely popular vape products, Gottlieb told Vox by phone. “I hope they recognize the problem that’s been created has been created largely by their product.”

The Food and Drug Administration is investigating whether nicotine-induced seizures are a potential side effect of vaping.

In the past decade, the agency has received at least 35 reports of seizures — sudden and uncontrolled disturbances in the brain — following e-cigarette use. The cases were picked up by poison control centers across the country, and through the FDA’s adverse event reporting system, a database of voluntary reports from patients, product manufacturers, and health professionals.

Vaping has exploded in popularity in recent years — but not among the people it was intended for. Rather than adults trying to quit smoking, young people who’ve never picked up a cigarette are now vaping in record numbers.

According to a new Vital Signs report, published by the Centers for Disease Control and Prevention, in 2018, some 4.9 million high school and middle school students used tobacco in the last 30 days, an increase from 3.6 million in 2017. E-cigarettes were the most popular tobacco product among the children and adolescents.

Smoking is the leading preventable cause of death in the US, and vaping companies have long claimed their e-cigarettes can help smokers quit. But what do we really know about how well they work?

The short answer: Not much.

Juul, the Silicon Valley startup that’s taken over three-quarters of the US e-cigarette market, has repeatedly declared it is in the business of helping adult smokers quit tobacco.

But a new analysis of its early advertising campaign tells a very different story.

This story was originally published on May 1, 2018.

Elijah Stewart first heard about the Juul three years ago, during his sophomore year of high school.

The e-cigarette Juul burst onto the market in 2015 with the purported goal of making cigarette smoking obsolete.

On Wednesday morning, we learned that 35 percent of the vape company had been purchased by the cigarette maker Altria — the parent company of Philip Morris USA — making Juul’s value a staggering $38 billion.

I sit in my living room, contemplating the slim, smooth aquamarine tube. Its color is a few shades removed from Tiffany blue, and it’s an inch or so longer than a cigarette. I do not smoke anything ever, but in order to psyche myself up for the full experience of the thing, I try to channel that famous picture of Audrey Hepburn on the Breakfast at Tiffany’s movie poster, a long, slim cigarette holder hanging out of her mouth.

This isn’t a cigarette, though. It’s a Breathe “citrus flavored vitamin B12 mist” — a.k.a. a vitamin vape. It costs $45 for three pens. And disposable vaporizer pens like this one, containing substances like vitamins and essential oils instead of nicotine “e-juice,” are increasingly being marketed to wellness-minded consumers.

In an unusually candid letter, the Food and Drug Administration chief, Scott Gottlieb, announced on September 12 that the agency could intensify its crackdown on e-cigarettes in the face of an “epidemic” of teen use — a trend that’s caught the agency off guard.

“I use the word epidemic with great care,” Gottlieb wrote. “E-cigs have become an almost ubiquitous — and dangerous — trend among teens.”