The last half of 2019 has not been kind to the vaping industry in the United States. First, vaping was blamed for an outbreak of mysterious lung illness. An illness the CDC investigation later traced to vitamin E acetate used in black market THC oil. As it turned out, vaping an everyday e-cig had nothing to do was the outbreak of lung illness. But as Winston Churchill said, a lie gets halfway around the world before the truth can put on its boots.
And as far as the Vape industry was concerned, the damage is done. Vape shops had been closed and sales are reported falling anywhere from 30% to 70% depending on the state and location. To this day media and some politicians are still blaming vaping e-cigs for the mysterious lung illness. And as rough as all of that was for the American vaping community, it was only half the story.
The other half of the story was the alarm at the increase in underage electronic cigarette experimentation. In 2017 underage past 30-day e-cigarette use rates among youth were at a stable 11%. However, by 2019, that number increased to 28%. In response to the sharp increase, there have been more and more calls for banning electronic cigarettes and banning e-cig flavors.
On September 11th, 2019, the president along with Health and Human Services Secretary Alex Azar announced a nationwide ban of all electronic cigarette flavors except for tobacco flavor. Secretary Azar then added that if the data showed teens are still using tobacco flavor, he would then ban that too. While the White House is still deciding what the final FDA rules governing electronic cigarette flavors will be, a large number of states are not waiting for the feds. In fact, vape flavor bans and outright bands have occurred in almost a dozen states from Washington to New York.
Why Are Flavors Blamed For The Teen Vaping Crisis?
The consensus view among public health agencies and anti-vaping groups is that flavors are the reason why underage experimentation has increased. This view is based on the National Youth Tobacco Survey data. However, it should be noted that the survey questions provide limited options for reasons why underage people are attracted to e-cigs. There is no doubt that flavor is part of what makes vaping attractive to smokers. Who doesn’t like flavors? If you had a choice between something flavored like tobacco or something flavored like strawberries, it’s not really a tough call. But the survey does not distinguish between types of e-cigs. Nor does it distinguish between salt nicotine and freebase nicotine.
Besides, flavors have been around for a dozen years. The recent two-year massive upsurge in underage experimentation blend on flavors doesn’t really make sense. If flavors are responsible, why wouldn’t youth experimentation have been at 28% years ago? Why the last 2 years? That really is the question that researchers, politicians, and public health officials are failing to ask. And to determine the real answer, it just takes a little bit more effort than a cursory glance at survey data.
What is really going on with underage use?
It stands to reason that a notable increase in underage electronic cigarette experimentation in a two-year period signifies some sort of change. As mentioned earlier, flavors are not the change. Flavors have been around for over a decade. So what was the change? Surprisingly, it took very little effort and research to find an answer. It’s right beneath the surface and it is glaringly obvious. The answer is nicotine. Specifically, 50mg to 60mg salt nicotine.
- Freebase nicotine is the pharmaceutically extracted nicotine used in nicotine gums and patches as well as vapor products. Salt nicotine is made by adding benzoic acid to freebase nicotine. Once the nicotine is converted to a salt, it is much easier to ingest in large quantities.
Just a couple of years ago, the highest nicotine level sold by your typical American e-cig company was 24 mg. However, in the last 2 years, the most common nicotine level found in gas stations in corner stores across the country is 50mg salt nicotine. In other words, the nicotine content of most retail electronic cigarettes has doubled over the last two years. You can’t double the nicotine content and not expect to see some effect. The increase in underage e-cig experimentation is one of those effects.
In addition, the most prevalent type of e-cigarette now is the pod style vape. A pod vape is an electronic cigarette that looks like a USB memory stick. Easy to conceal and packs a 50mg salt nicotine punch.
JUUL was the original 50mg pod vape system. But now there are dozens and dozens of imitators and copycats. Not to mention counterfeits. And they are all flooding the US market. You can find the disposable 50mg to 60mg nicotine pods sold in almost every gas station for about ten bucks. In other words, kids can buy high nicotine pods for a few bucks in the same places that they buy candy bars and soft drinks.
Let’s recap the variables in our equation. First, a doubling of the nicotine level in the vapor products sold in gas stations in corner stores. Second, pods look like techy gadgets and are easy to conceal. Finally, they are available dirt cheap. Those are the precise elements that fueled the increase in underage use.
Why is no one talking about nicotine?
Why are public health officials and politicians so eager to blame flavors? Why is no one talking about the nicotine? In the American vaping community, the theory is that public health officials and politicians are in the pocket of big tobacco. Even while claiming to be opposed to Big Tobacco, the reality is the flavor bans will give Big Tobacco a huge advantage. E-cig flavor bans would wipe out most vape shops and independent e-cig companies leaving Big Tobacco as the last one standing.
While flavor bans do help Big Tobacco’s business model, there is another more human reason why policymakers may not be talking about nicotine. And that is they just don’t know about it. The awareness level of what electronic cigarette products are, what they do, and the differences between them are never considered in the course of high-level policy discussions.
If you asked your average public health official or politician what’s the difference between a pod vape system and a cigalike, they would not be able to answer. Among the general public at large vaping is a monolithic entity. Nor would they have much of a clue about nicotine levels in electronic cigarettes. And they certainly won’t know the difference between salt nicotine and freebase nicotine.
We tend to think of Health officials and policymakers as omniscient figures with incredible resources at their disposal to gather all the facts. But they are only human. Not to mention the fact that they deal with dozens of issues a day and e-cigarettes are just one of them.
Ultimately, there is no getting around the fact that the nicotine content of e-cigarettes has skyrocketed in recent years. Salt nicotine allows the user to ingest a massive amount of nicotine with ease. The nicotine “buzz” is almost instant. Why no one is talking about the nicotine is open to speculation. But the fact remains that nicotine content is being ignored. If we want to address the teen vaping crisis, that must change.
