JUUL

The Truth 

JUUL is a non-tobacco, e-cigarette product intended to wean smokers off traditional cigarettes. Invented by JUUL Labs, the product's primary ingredient is nicotine. JUULs and other e-cigarettes quickly became a pop culture trend. 

Yet early advertising campaigns for JUULs featured youthful models, implementing event activations that encouraged social media users to post about the product online. Lawmakers and regulators have attempted to rein in JUUL Lab's expansive marketing campaigns, particularly those that could be considered advertising to minors.

In the past six months, the United States has seen a series of respiratory-related hospitalizations that may have been caused by JUUL and e-cigarette use. At this time, the CDC, FDA and U.S. Drug Enforcement Agency (DEA) are working to understand the causes of lung illnesses and limit the damage caused by respiratory injury.

Studies + Science

JUUL Lung Injury

In April 2019, reports of young and otherwise healthy individuals hospitalized for severe respiratory distress became public knowledge. Regulatory agencies have referred to the outbreak of respiratory illnesses as lung injury, potentially caused by chemicals during inhalation. The U.S. Center for Disease Control (CDC) has classified this disease as e-cigarette, or vaping, product use-associated lung injury (EVALI).

Symptoms of EVALI begin mildly, including:

• Severe shortness of breath
• Vomiting
• Diarrhea
• Fever
• Fatigue

After an incubation period that varies from several days to a few weeks, symptoms escalate until hospitalization becomes necessary. According to the CDC, there are currently at least  2,807 cases of lung injury spanning all 50 states, Washington D.C., Puerto Rico, and the U.S. Virgin Islands. The CDC has also confirmed 68 fatalities as a result of this illness.

Officials are attempting to hone in on potential cures and causes. Although x-rays show lungs in a state that would indicate a severe bacterial or viral infection, tests for viral or bacterial infection turn up negative. So far, the CDC and FDA have presumed that the illnesses may be caused by chemical exposure that has resulted in severe respiratory reactions.

For now, the CDC and FDA have only been able to gather survey data on patients affected by the vaping illness. From a combination of patient testimonies and probes, officials are aware that:

• 72% of documented cases have occurred in males.
• 66% of deaths have occurred in males
• 67% of affected patients are between 18 and 34 years of age.
• 16% of cases are in minors under the age of 18.

The CDC and FDA have also found that many of the patients have used THC vape fluids and others have used illicit products acquired from unlicensed vendors. Authorities suspect that estimates are low, as consumers may fear legal consequences for reporting the use of illegal smoking products. Additionally, some patients have been unable to contribute to federal or state surveys due to the severity of their condition.

At this time, the FDA and CDC are unsure if any single substance or ingredient is causing respiratory distress. The outbreaks of lung injury may be a singular condition or multiple conditions with highly similar symptoms, as there is a lack of common factors across all cases.

The agencies have ruled out the possibility that the vaping illness is contagious, instead of focusing on the theory that it is triggered by chemical contaminants. Some regulators think black-market cartridges containing THC are the culprit. 

FDA officials and marijuana industry experts have suggested that vitamin E acetate, an agent added to THC oil to increase its viscosity and make inhaling the fluid easier, could be a potential cause for the lung injuries present in the vaping illnesses. 

According to experts, vitamin E acetate could be condensing in the lungs after inhalation, creating a dangerous oil coating. While neither the CDC nor the FDA has claimed this is a sole cause, both expressed an interest in pursuing Vitamin E acetate as a potential pathway to understanding the illness.

Regulation Recap 

• The FDA and CDC have taken steps to increase awareness of the risks of vaping illness and lung injury. 
• The FDA has suspended prosecution of patients for using illicit substances or devices in order to promote transparency.
• The FDA and DEA have combined resources to track down and prosecute illicit vaping fluids and devices.
• The CDC has begun using social media to survey information about the vaping illnesses from consumers who have not yet been hospitalized.
• The FDA and CDC have reiterated the risks of purchasing JUULs or e-cigarette fluids and accessories from unlicensed or black market vendors.
• The FDA and CDC have also advocated against the use or creation of home-brewed fluids.

For the time being, most of the FDA and CDC’s resources are being used to identify and isolate cases of lung injury in order to understand, cure and prevent further cases of vaping-related illness.

Next Steps 

In an effort to spread information, the FDA has asked consumers to report adverse events with as many details as possible. Additionally, the FDA and CDC have issued a series of guidelines for safely using e-cigarettes. 

Suggestions include:

• Avoid e-cigarette or vaping products if they are not being used as an alternative to tobacco
• Avoid inhaling fluids that use vitamin E acetate
• Avoid purchasing modified products or modifying vapor products in a way not intended by the manufacturer
• Exercise caution if you choose to continue to use THC inhalant products

Additionally, if consumers experience any symptoms of EVALI, it is advised that they immediately stop using e-cigarettes and see a health care professional.