“Do you all still JUUL?” I asked.
“No,” a unanimous response from the three students, Nicole, Autumn, and David*, sitting in a dorm room on campus.
Nicole begins to take a hit out of a long rectangular sleek vaping device almost identical to the JUUL…
“What is that?” I ask.
According to the group, JUULS are out and St!k is in. Unlike the JUUL which has disposable nicotine cartridges, The St!k is one piece, once it runs out the user throws it away and purchases a new one. Our conversation about nicotine and vaping is a continuation of the one we had back in November 2018 during their first semester of their freshman year at college. David and Nicole were first exposed to nicotine in middle school while Autumn was 16 when she first tried vaping. But in November of 2018 they were all under the same oppressive power of the JUUL; all were planning to quit some time in the near future. To really understand the journey of these three college kids who stumbled into the hands of a powerful substance, it is also important to understand just what these vapes are, where they come from and how they got so popular.
The CDC describes e-cigarettes or vapes as a device made to look like regular cigarettes, or everyday items. They produce an aerosol by heating a liquid that usually contains nicotine—the addictive drug in regular cigarettes, cigars, and other tobacco products. E-cigarettes can also contain THC, the active ingredient in marijuana, but cannot be purchased in states where marijuana is not legal. Additionally, many companies add flavorings and other chemicals that help to make the aerosol. It is these additional chemicals, particularly vitamin E acetate, that make vaping dangerous.
Prototypes for the foundation of the e-cigarette began arising as early as the 1930s, but it wasn’t until 2003 that there was the first commercially successful version of the e-cigarette. It didn’t take long for organizations like the World Health Organization (WHO) and the Food and Drug Administration (FDA) to start questioning the safety of these products. Governments began to regulate or ban e-cigarettes in their early phases. In 2009, after testing and trials, brands like NJOY began to be sold as they were considered “safe” by the FDA, meaning they contained less than 1% of toxic chemicals commonly found in other e-cigarettes. But within the year, they discontinued all flavors other than traditional menthol or tobacco.
While there were minor successes in the e-cigarette industry, it wasn’t until 2012 when the e-cigarette industry began to really gain popularity in the United States. From 2012 to 2018 the amount of vape users in the U.S increased from 10 million to over 40 million. JUUL launched its product in 2015 and within one year its sales increased 700% becoming the fastest growing and most popular vaping device on the market by 2017. Today, the United States makes up for a majority of the e-cigarette market.
It wasn’t long after JUUL’s launch when the company began receiving backlash due to an epidemic of high-school and middle-school aged children who were using the product. Testimonies from multiple sources claim that JUUL promoted their product on children’s websites, TV entertainment channels, or even in schools emphasizing the safety of their products. But it was the rise in a mysterious lung disease, referred to as e-cigarette, or vaping, product use-associated lung injury (EVALI), that really shook the e-cig market. The illness was first recognized by the CDC in August 2019 after a number of healthy individuals needed to be hospitalized after experiencing symptoms ranging from shortness of breath to fever. After further examination, doctors and researchers realized all the patients were using e-cigarette or vaping products. While the CDC thinks that vitamin E acetate is the likely culprit of this vaping-related illness, federal investigators have not yet identified a single ingredient that directly causes EVALI. It’s therefore unclear how the condition develops or why, a scary grey area for nicotine users. As of February 18, 2020, a total of 2,807 hospitalized EVALI cases or deaths have been reported to the CDC with sixty-eight deaths confirmed.
In 2018, FDA began a crackdown on JUUL motivated by the rise in users under 18 forcing JUUL to pivot their marketing and advertise to an older population and a discontinue of fruity flavors. Since 2019 we have seen a decline in EVALI cases. The CDC speculates reasons for the decline are likely multifactorial and may be related to increased public awareness of the risk associated with vaping, as well as removal of vitamin E acetate from some products and law enforcement actions related to illicit products.
While vape enforcement and research has come a long way in the past two years, there is still much more research to be done and much more action to take in order to bring down companies finding loopholes to regulations. For example, newer brands like the St!k have found ways to curb regulations and still manufacture fruity flavors. This loophole can be traced back to faulty policy. When the Trump administration decided to prohibit fruit, mint and dessert flavors in refillable cartridge-based e-cigarettes like the JUUL, a few exceptions were made for menthol and tobacco flavors. However, a footnote on page nine of the new policy permits all flavors to continue to be sold in devices that cannot be refilled and are designed to be disposed of after the flavored nicotine has run dry. This means, as long as its disposable (like the St!k), fruity and fun flavors are a go. Teens like David, Autumn, and Nicole have ditched JUUL for brands like St!k so they can satisfy that sweet vanilla or green apple flavored rush.
Around the time of the interview in November 2018 the three claimed to have been in the peak of their addictions. Autumn tracked how many rips per day she took by making a tick mark on her arm, she calculated she was taking 90 rips every day. However, “I probably got more cancer from the ink soaking into my skin than the JUUL,” she says. Nicole claims she had to take a rip every five minutes. While Autumn and David don’t regularly vape anymore, they have switched to other mechanisms to help ease their nicotine addiction. “David and I switched to the occasional cigarette, probably like once a day, on the weekends very much more,” says Autumn “Probably like six yesterday, but we split them.” Nicole smokes about two cigarettes per day but continues to vape. “Cigs have less nicotine, you know what’s in them so it’s less scary,” said David. “I know people who used to smoke who are still kickin’ it, there’s proof that it’s not 100% going to kill you versus the ambiguity and uncertainty of vapes, it’s less convenient, you go outside, it’s not always around.You smell like it too so you can’t do it before class or before an interview.”
Nicole, Autumn, and David aren’t the only three who have used cigarettes to help with their addictions. According to a recent study, U.S. youths are four times more likely to try cigarettes and three times more likely to currently use cigarettes if they previously used e-cigarettes. The study also estimated that e-cigarettes are likely responsible for 22% of new cigarette use and 15.3% of current cigarette use for the same group, totaling nearly 200,000 new cigarette initiators. While vapes started as big tobacco’s competitor, they might have ended up being their biggest supporter.
While the three have, in a way, expanded their nicotine palette, they all agree their addictions have gotten better. Autumn knows if she stops at some point the nicotine is not, definitely, 100%, for sure, going to take her down. They claim one of the more prominent downsides of switching to cigarettes is that people are much more judgemental to seeing you smoke a cigarette as they are if they see you smoking a JUUL in the middle of class. Smoking a cigarette has a lot more stigma surrounding it than the popular party nicotine sticks. If you hit a JUUL, you’re just having fun, if you smoke a cigarette you’re an addict. Autumn feels like “people look at me like ‘that girl used to have a JUUL, I saw that girl smoking a cigarette!’”
On top of cigarettes, David and Autumn take part in “T-rips” when tobacco is packed into a bowl or bong and smoked. The two claim T-ripping is much more unhealthy as, “cigarette tobacco is filtered really heavily, but in T-rips it’s all going into your lungs so you’re getting the tar and everything.” The three also smoke weed every day, Nicole at least six times a day, David at least four, and Autumn around once or twice.
“I probably spent $100 a week on weed $30 a week on nicotine,” said Nicole
“A year ago you said you were gonna die before you quit,” said Autumn
“Yeah I did, I’ve been doing this shit for like six years now, like how the fuck am I gunna to stop? It just didn’t make any sense, but now I’m getting there.”
Nicole has been addicted to nicotine since age 13; in the fall she was hospitalized claiming she couldn’t breathe and was vomiting continuously. The doctors had suspicions it was from extended JUUL usage. “My boyfriend was getting mad at me because I was still trying to get it from him before the results came back, I was in the perfect place to do it,” she says through laughter. “I was ready to be like fuck this and give it up.” Lucky for Nicole, it ended up being a potassium imbalance, and thus, she continues to vape.
Autumn feels guilty that she struggles in the same ways those who have been addicted for much longer. “I feel like I don’t have the right to have a hard time with it because Nicole started when she was young, David too, it was junior year, I was thinking, ‘Wow! What’s that? Wow! I got tingles all through my body! That’s nice’, it wasn’t that long ago and I didn’t use it that heavily until senior year. Watching other people who have had more years of addiction is very inspiring.”
Autumn, at age 19, feels she’s too inexperienced, three years into nicotine addiction, to struggle with it like her friends; forgetting she was 16 when she was first exposed to nicotine, but that’s old in ‘kid years’.
I referenced the new Muhlenberg College smoke policy to see if this policy may have changed their relationship with nicotine.
“Boy that shit is so stupid, I’m 19 you cant tell me not to smoke, it is illegal to buy, it is not illegal to smoke,” said Nicole with a quick and rash response. “Like you’re really gonna make those Sodexo workers walk all the way to the corner to have a cig?”
The group came to the conclusion the only reason the school has this policy is so we look good on paper, nobody actually cares, “the worst I’ve gotten is a ‘can you put that out please’,” added David.
The e-cigarette devices, created to help people kick their nicotine habits have sustained a different fate, acting as a gateway to big tobacco, creating a whole new generation of teens addicted to nicotine.
David doesn’t want to quit, “I like it.”
“I want to be nicotine free by the end of sophomore year,” said Nicole.
Autumn, unsure where she stands but makes a point to add as of right now her relationship has calmed down, it’s not until the end of a long and hard day that she uses a cigarette to relax.
“But I’d like to stop eventually.”
*All names have been modified for confidentiality