Nicotine arms race: JUUL and the high-nicotine product market

Abstract

ObjectiveUntil recently, purveyors of vaping products marketed e-liquids in the 1%–3% range of nicotine concentration with those at 3% described as ‘super high’ intended for two packs/day smokers. The goal of this study is to evaluate the degree to which JUUL, with its 5% nicotine and 75% US market share, has spurred other e-liquid vendors to raise the nicotine levels of their products.MethodsOnline search to identify brands offering e-liquid in exceptionally high nicotine concentration (≥5%) and to catalogue the appearance of devices which emulate JUUL.ResultsJUUL compatible pods (14) and JUUL knock off devices (39) were identified which offer equal or higher nicotine than JUUL. More than 70 e-liquid brands sell high-nicotine products (≥5%) in bulk (≥30 mL) equivalent to >40 cigarette packs. All of these products come in multiple youth appealing sweet and fruity flavours. It was noted that nicotine percentage is inconsistently reported (eg, JUUL is 5% by weight vs 5.9% by volume).ConclusionsJUUL has triggered a widespread rush among aerosol purveyors to market e-liquid in unprecedentedly high nicotine concentrations. The rapidly rising popularity of high-nicotine e-liquids threatens to addict a generation of youth. When sold in large quantity bottles (eg, 30 mL) they represent a childhood poisoning risk. Labelling of nicotine concentration in e-liquids needs to be standardised to avoid consumer confusion. The addictiveness and toxicity of these products makes it imperative that regulators act swiftly to enact protective measures.

What are the respiratory effects of e-cigarettes?

“…For example, the addictive potential of nicotine salts may have contributed to the dramatic recent increase in 2018 in vaping among young people in the US, fueled by Juul. However, this addictive potential may be more satisfying to smokers who are switching to e-cigarettes 19. We note, however, that whereas Juul are currently sold with 59 mg/mL of nicotine salt in the US, they can be sold only with 18 mg/mL in the UK.…”

“…The nicotine concentration in US marketed Juul liquid cartridges (pods) is higher (5% weight/weight; 59 mg/mL; 127 mM) than in traditional e-liquids (typically 6-18 mg/mL of nicotine; 37-111 mM). Recent studies have shown that Juul users have similar blood nicotine concentration profiles to users of combustible cigarettes 19…”

Users’ Modifications to Electronic Nicotine Delivery Systems (ENDS): Interviews with ENDS Enthusiasts

“…One product frequently mentioned was salt nicotine e-liquid. Compared to traditional e-liquids, salt nicotine e-liquids allow users to vape higher nicotine strengths while experiencing a less harsh throat hit [13]. Due to its high nicotine content, it also mimics the sensation of smoking a combustible cigarette.…”

Who is JUULing and Why? An Examination of Young Adult Electronic Nicotine Delivery Systems Users

“…JUUL, a new ENDS product, provides a high amount of nicotine, with one "vape pod" containing a comparable amount of nicotine as a pack of cigarettes [4]. JUUL has exploded in popularity because it was first introduced to the U.S. market in 2015, now accounting for roughly 75% of sales in the ENDS retail market as measured through convenience store data [5]. Many in the public health community believe the rise of JUUL is largely responsible for the increase in ENDS product use among young people [3,6].…”