Nicotine delivery and user reactions to Juul EU (20 mg/ml) compared with Juul US (59 mg/ml), cigarettes and other e-cigarette products

Phillips-Waller, Anna; Przulj, Dunja; Smith, Katie; Pesola, Francesca; Hájek, Peter

doi:10.1007/s00213-020-05734-2

Cited by 28 publications

(31 citation statements)

References 11 publications

(22 reference statements)

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“…Taken together, the presented results suggest that European JUUL has a lower nicotine delivery in total and in the acute phase in comparison to tobacco cigarettes and the US version (59 mg/mL nicotine) in experienced users despite the product modification. This is in line with the recently published results 33 , 44 . According to these data, it becomes likely that abuse liability and addictiveness of the European version is lower.…”

Section: Discussionsupporting

confidence: 94%

“…These findings are in agreement with the recently published study led by Phillips-Waller et al . who compared EU JUUL (20 mg/mL), US JUUL, and tobacco cigarettes 33 . As the initial JUUL version was declared to contain 20 mg/mL while the modified version was labelled with 18 mg/mL 32 , it is assumed that Phillips-Waller et al .…”

Section: Discussionmentioning

confidence: 99%

“…have used the initial version in their study. They have demonstrated that the US American version with 59 mg/mL delivers comparable amounts of nicotine as tobacco cigarettes in experienced e-cigarette users 33 . The authors have reported a slightly lower nicotine delivery after EU JUUL consumption compared with our results 33 .…”

Section: Discussionmentioning

confidence: 99%

“…They have demonstrated that the US American version with 59 mg/mL delivers comparable amounts of nicotine as tobacco cigarettes in experienced e-cigarette users 33 . The authors have reported a slightly lower nicotine delivery after EU JUUL consumption compared with our results 33 . A recent study by the manufacturer came to lower nicotine deliveries by the European JUUL versions in a study with 5-min ad libitum use sessions and pre-directed use sessions that were similar to the ones in this study 44 .…”

Section: Discussionmentioning

confidence: 99%

“…After a technical modification of the wick material inside the pods that provides liquid to the coil, vapor generation of the EU version increased and nicotine content per puff approximated the US version 32 . A recent human consumption study showed a lower nicotine delivery for the European JUUL version 33 , but did not analyze whether this can be improved by the technical modifications of the different European products. However, data on the nicotine delivery by different versions of JUUL can provide general insight into the capacity and limitations of modern low powered e-cigarettes and is required for their risk assessment.…”

Section: Introductionmentioning

confidence: 99%

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Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification

Mallock

Rabenstein

Gernun

et al. 2021

Sci Rep

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The emergence of e-cigarettes on the consumer market led to a tremendous rise in e-cigarette consumption among adolescents in the United States. The success of JUUL and other pod systems was linked to its high nicotine delivery capacity. In compliance with the European Tobacco Product directive, liquid nicotine contents in the European JUUL variants are limited to 20 mg/mL or below. A short time after launching the initial version in Europe, JUUL pods have been modified in terms of the wick material used. This modification has been demonstrated previously to lead to an elevated aerosol generation, consequently, to a larger amount of nicotine per puff generated. The present study was designed to assess whether the mentioned differences between the “initial” and “modified” JUUL versions may cause a significant difference during consumption, and how nicotine delivery compares with tobacco cigarettes. In this single-center three-arm study, nicotine pharmacokinetics and influence on urge to smoke/vape were compared for tobacco cigarettes, the “initial” version of the European JUUL, and the “modified” version of the European JUUL. Participants, 15 active smokers and 17 active e-cigarette users, were instructed to consume their study product according to a pre-directed puffing protocol. Venous blood was sampled for nicotine analysis to cover the acute phase and the first 30 min after starting. Nicotine delivery and the reduction of urge to smoke/vape upon usage of both European JUUL variants were lower in comparison to tobacco cigarettes. This suggests a lower addictive potential. Modification of the pod design did not result in significant differences at the first ten puffs, as confirmed by a vaping machine experiment. Apparently, the limitations by the initially used wick material only come into effect after longer usage time.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification

Mallock

Rabenstein

Gernun

et al. 2021

Sci Rep

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Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer

et al. 2019

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IMPORTANCE Emergency department visits and hospitalizations after starting systemic therapy for cancer are frequent, undesirable, and costly. A score to quantify the risk of needing acute care can inform decision-making and facilitate the development of preventive interventions. OBJECTIVE To develop and validate a score to predict early use of acute care after initiating systemic therapy for cancer. DESIGN, SETTING, AND PARTICIPANTS A retrospective population-based cohort study was conducted between July 1, 2014, and June 30, 2015. Patients with cancer were eligible if they started a new systemic therapy for cancer, regardless of line of therapy. A total of 12 162 patients in Southwestern Ontario, Canada, formed the development cohort and 15 845 patients in Northeastern Ontario formed the validation cohort. Data analysis was conducted from December 1, 2016, to August 10, 2019. EXPOSURES The Prediction of Acute Care Use During Cancer Treatment (PROACCT) score was created based on logistic regression in the development cohort. Combinations of cancer type and regimens were grouped into quintiles based on risk of needing acute care. The score was assessed in the validation cohort. MAIN OUTCOMES AND MEASURES At least 1 emergency department visit or hospitalization within 30 days after starting systemic therapy for cancer identified from administrative databases. RESULTS Among the 12 162 patients in the development cohort, 6903 were women and 5259 were men (mean [SD] age, 62.9 [12.6] years); among the 15 845 patients in the validation cohort, 9025 were women and 6820 were men (mean [SD] age, 62.9 [12.6] years). Use of acute care occurred within 30 days after initiation of systemic therapy in 3039 patients (25.0%) in the development cohort and 4212 patients (26.6%) in the validation cohort. Three characteristics predicted early use of acute care and formed the PROACCT score: combination of cancer type and treatment regimen, age, and emergency department visits in the prior year (C statistic, 0.67; 95% CI, 0.66-0.69; P < .001). Other characteristics including patient-reported symptoms did not improve performance. In the validation cohort, the PROACCT score was associated with use of acute care (odds ratio per point increase, 1.22; 95% CI, 1.20-1.24; P < .001), had a C statistic of 0.61 (95% CI, 0.60-0.62; P < .001), was reasonably calibrated, and provided net benefit in decision curve analysis. CONCLUSIONS AND RELEVANCE The PROACCT score predicted the risk of early use of acute care in patients starting systemic treatment for cancer and could be incorporated at the point of care to select patients for preventive interventions. Future studies should validate the PROACCT score in other settings.

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Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users

et al. 2022

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Rationale Oral tobacco–derived nicotine products include on!® nicotine pouches (NPs) which are tobacco-leaf free and available in multiple flavors and nicotine levels. Switching completely to NPs from cigarettes and moist smokeless tobacco (MST) has the potential to reduce harm for adult tobacco consumers. However, the dependence potential of NPs is not established. Therefore, we characterized the abuse potential of NPs with different nicotine levels compared to cigarettes and MST. Objectives To evaluate nicotine pharmacokinetics (PK) and subjective effects of NPs (ranging from 1.5 to 8 mg nicotine) compared to own brand cigarettes (OBCs) and MST (OBMST). Methods We used a randomized, in-clinic, partial single-blind, 7-way crossover design to assess nicotine PK and subjective effects in dual users of cigarettes and MST. Results The mean nicotine Cmax for NPs increased with nicotine level, ranging from 3.5 ng/mL (1.5 mg NP) to 15.4 ng/mL (8 mg NP), compared with 12.2 ng/mL for OBCs and 9.8 ng/mL for OBMST. Nicotine tmax was much longer for all NPs and OBMST (32.5–34.4 min) compared to OBCs (8.5 min). Reductions in urges to smoke after use of the 2 mg, 3.5 mg, and 8 mg NPs were not statistically different (p > 0.05) relative to OBC. Also, NPs resulted in lower ratings of positive subjective effects relative to OBCs and OBMST. Conclusions Overall, based on the study results and literature reported nicotine PK values for cigarettes and MST, the abuse potential of NPs is not likely to be higher than OBCs and OBMST. NPs may be potentially acceptable switching products for users of cigarettes and MST products.

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Nicotine delivery and user reactions to Juul EU (20 mg/ml) compared with Juul US (59 mg/ml), cigarettes and other e-cigarette products

Cited by 28 publications

References 11 publications

Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification

Nicotine delivery and relief of craving after consumption of European JUUL e-cigarettes prior and after pod modification

Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer

Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users

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