Long Read: The “Evils” of Nicotine, JUUL and the Youth ‘Epidemic’

Settle down folks, this is going to be a long one.

I’ve recently had a few thoughts in my head about nicotine. The supposed “devil drug” that is “more addictive than heroin” (according to ASH Scotland from 2013, and debunked here – I know, debunked before ASH came up with that ‘FactSheet’; that’s just how inept they are), and how, in light of the US debacle, there are now circulating rumours of a nicotine cap.

Well, the EU has a nicotine cap of 20mg/ml and, for all intents and purposes, it’s dire.

I know what you’re thinking.

“But most e-liquids are way below the cap now!”

Yes, that’s absolutely true. But do you know why?

Well, there’s two schools of thought on this:

  1. There’s more below the cap because vapers want less nicotine
  2. There’s more below the cap because vendors don’t want to cross the legal lines

Let me, briefly, address both in turn. First, vapers may indeed want less nicotine concentrations in their liquids. This is mostly due to the dearth of high power, low-ohm devices that are on the market. Very few vapers will sub-ohm anything over 6mg and even fewer will do that at levels above the EU limit (I do, however, know one or two that do that).

The second is patently obvious. If caught out by the relevant authorities (in the UK it’s the MHRA) then you can bet that product will get the red light pretty damn quickly. There may even be financial penalties (though it isn’t clear in the legislation).

Nicotine

Now, astute observers will notice that nicotine comes in two “flavours” (for use in vaping products at least), freebase nicotine and nicotine salt. Freebase nicotine has been around for a long time and is the purest form of nicotine compared to other derivatives.

Nicotine in tobacco leaves has the chemical composition of a salt. A salt is made up of a chemical reaction that has a positive charge (Acid) and negative charge (Base).

Nicotine’s chemical nature is a weak base and made up of negatively charged particles. As a base, it seeks to find positively charged particles (Protons) to find stability and become Ionized. Nicotine in tobacco leaves or ions is not the most effective way of delivering nicotine into our bodies because ions have a harder time moving across organic membranes and are not easily vaporized.

This is where freebasing comes in. Phillip Morris found that if the nicotine was de-protonated (via ammonia) or to remove its positive charge, it can go back to its free state where it will be much easier to travel across membranes in our bodies. In a nutshell, nicotine in its freebase form makes it more bioavailable to your lungs and to your brain which makes it more potent.

H/t Ruthless Vapor

This is why (thanks to @plopnl) the throat hit from freebase is said to “hit like a train” at higher levels, and particularly in ‘better’ devices and also why a nicotine salt generally feels ‘smoother’, while still giving that (for some) much needed ‘kick’.

Does that mean there should be a nicotine cap? Well, considering that many vapers – particularly those who took this survey (H/T @VapingIT) – a number of comments stated starting at 20mg or above. According to ASH, 10% of vapers in the UK used a concentration greater than 18mg/ml (yet, they lobbied furiously for the limit anyway) in 2016, and in 2018 Dr Farsalinos along with Dr Russell published the results of the US Flavour Survey, which also included initial nicotine levels. While the most popular initial level was 1-6mg/ml, in close second it was 18-24mg/ml. 25 and above garnered 3.3 and 0.6 per cent (25-49, and 50mg/mL or above respectively).

In essence, the concentration used by an individual is tailored to the individual. Something that a number of e-liquid vendors seem to have forgotten considering that most don’t seem to carry anything over 6mg – particularly in the UK. I get it, the consumer has driven the demand for lower concentration liquids. The problem with that drive, is that the market isn’t really suitable for new switchers. The trouble is, this has been coming for a while.

As far as absorption rates goes, it entirely depends on the delivery mechanism. It is well known that cigarettes deliver a rapid spike of nicotine which degrades pretty quickly. On the other hand, freebase nicotine (which, you’ll remember, is the cornerstone of cigarettes) delivered via a vapour product isn’t absorbed as quickly. It does, in fact, take substantially longer to reach similar levels to cigarettes.

This is where JUUL stepped in.

Pods

In the now, pod mods aren’t new. There’s plenty of choice out there – which is a good thing by the way. But it all started, and I mean really started with JUUL. Which is one of the reasons why we’re having the “nic-limit” discussions (again), and why US health authorities are having a shit-fit about a few percentage points among the youf.

As this article points out, JUUL had a head-start. Nicotine salts. US JUUL pods contain 50mg/mL, while the EU variant contains 20mg/mL. Guess which side has the “youth epidemic”?

Yep. The US does. But. There’s a whole can of worms that needs to be opened first. Y’see, Campaign for Tobacco Free Kids kicked off the moral panic about JUUL in 2018 with this, featuring news articles and tweets from 2015 – no doubt CfTFK were watching JUUL closely, along with the youth vaping rates and waiting for the right time to go all panicky.

There are claims, and I say claims as I have yet to see concrete evidence, that JUUL deliberately used nicotine salt at high concentrations to induce ‘euphoria’ (more on this later) and ‘hook’ the youth on nicotine. This paper (Benowitz et al 1988) suggests that nicotine intake from cigarettes, snuff, and chewing tobacco all see a rapid uptick in blood nicotine concentration within the first 30 minutes of use. The outlier, of course, being nicotine gum that also reaches a peak at around 30 minutes but remains relatively consistent throughout the next 90 minutes.

This blood nicotine level (nicotine blood plasma level) ties in nicely with the self-titration (Dawkins et al 2016) theory. After all, and as the infamous Michael Russell once said “people smoke for the nicotine but they die from the tar”. So a rapid uptick in nicotine blood plasma is just fine and dandy for those that want it.

Sadly for us, there can be no direct comparison between the nicotine consumption from cigarettes and e-cigarettes. Mostly, as Dr Farsalinos points out, there is no standardised unit of consumption. In addition, absorption from ‘second-generation’ devices is, in fact, lower than cigarettes.

Farsalinos et al 2014

Conversely, nicotine salt absorption is still not as fast as traditional, combustible cigarettes.

O’Connell et al 2019

This, fundamentally, is why JUUL – and pod mods that use nicotine salts in general – have been immensely popular with young smokers – and even some young non-smokers.

As we all know, nicotine is a much-maligned drug. It does have some therapeutic properties – particularly for alzheimer’s and parkinson’s – unfortunately, when ingested in the “usual form” (i.e. combustible tobacco) there’s a bunch of additives that enhance the self-reward of ingesting the drug. The “addictiveness” that is often touted is from the monoamine oxidase inhibitor (MAOI – see here, and here) and possibly some other compounds found in cigarettes.

Euphoric Nicotine

I recently read this interesting article where the author states that ingesting nicotine, via a cigarette, for the first time was (and I quote) ” I can still remember the effects of my very first cigarette, very Euphoric!

I’m not particularly convinced by that argument, so I went off in search of some supporting literature (as I am wont to do) and, lo! I found something.

Sadly, the measurement of euphoria is entirely subjective. However, it is widely known that the act of smoking is reassuring for smokers as confirmed in the 2016 report from the Centre for Substance Use Research.

Is pleasure an analogue to euphoria? Maybe. Though I would submit that something being pleasurable is entirely different to it being euphoric.

The Oxford English Dictionary defines euphoric as:

“an extremely strong feeling of happiness and excitement that usually lasts only a short time”

I don’t know about you, but I definitely didn’t feel like that whenever I smoked. Not even for the first time. I suspect that, for all the aims of such research into ‘nicotine euphoria’, measuring something that is subjective and easily conflated with ‘pleasure’ is, for want of a better term, pointless.

So why, then, are kids so (supposedly) hooked?

Kids These Days

There’s many ‘reasons’ cited for the use of vapour products, and JUUL (or JUUL-like) products in particular. If you pay attention to CfTFK (which you really shouldn’t) it’s all about the “kid attracting flavours” – which, in case you really haven’t been paying attention, it isn’t. As I, and many others, have stated here and elsewhere, flavours are an integral part of why vaping can be so successful for so many people.

As noted here, JUUL came into their own from 2016 when they reported an average annual market share increase of 515% from 2%. Which, let’s face it, is pretty impressive.

King et al 2018

Unlike most modular vapour products, JUUL wasn’t in brick-and-mortar stores. It was in the general convenience store supply chain. The same place as combustible tobacco. Vaping went mainstream. There is, of course, a downside to putting a product like JUUL into a retail environment like a convenience store.

You guessed it. Age enforcement. Or should I say, lack thereof. Admit it, how many of us former smokers purchased our smokes from the local newsagent or convenience store when we were absolutely underage? I’d be willing to bet a large number of us did. Therein lies the problem. Or one of them, at least.

Convenience stores sell a broad array of products – that’s why they are called convenience stores after all – and are usually pretty busy with each customer buying a wide array of products. Is it really feasible, or fair even, to expect that on each purchase of JUUL, or any age-restricted product, in such a place would be subject to age verification?

See, this is one of ‘public health’s’ biggest follies. C-store employees just aren’t motivated to do age verification. They just aren’t. For the most part, they can’t be bothered. They do a quick visual on you to see if you “look old enough” and that’s it. Even if you are borderline old enough, you still (generally) get a pass.

Of course, JUUL has to share some of the blame here. They could have been more explicit with their retail instructions (perhaps they were, no way to know for sure), or they could have performed some kind of due diligence on whether or not the retail outlet was enforcing age verification consistently. Either way, the authorities are now gunning for the industry because of JUUL.

JUUL

What a fucking mess. I could just leave it there. But I won’t.

JUUL Labs was founded by former smokers, James and Adam, with the goal of impacting the lives of the world’s one billion adult smokers. We envision a world where fewer adults use cigarettes, and where adults who smoke cigarettes have the tools to reduce or eliminate their consumption entirely, should they so desire.

JUUL Labs Mission Statement

The overall mission statement is a noble ideal. However, their actions are somewhat – shall we say – machiavellian.

After the useful idiots started banging the drum about “kid friendly” flavours, with specific reference to JUUL (not that the flavours they list were actually sold by JUUL) and a Federal investigation, where numerous documents were seized, JUUL decided to capitulate with their “Youth Prevention” programme.

Naturally, this just incensed US ‘public health’ so much that no US school would entertain the JUUL youth prevention team.

Strike one JUUL.

Next they decided to “fully support” Tobacco 21. Idiots. Tobacco 21 is another pointless endeavor from the tobacco control industry. It’s a classic “got to be seen to be doing something” while not achieving anything. Something that tobacco control is very good at.

Strike two JUUL.

Next up, flavours.

Again, US public health orgs were banging the drum (as they had been for a while) and, rather than try to talk to them, JUUL decided to unilaterally pull all flavours except mint, menthol and tobacco. Guess what happened next?

You got it, a sudden rise in the use of the JUUL mint pods.

Well, who would have thought? When you take away a popular flavour from a product, those that actually like the product (for whatever reason) are going to switch to a different flavour. This isn’t rocket science folks. This is basic consumerism.

I bet you can guess what happened next, right?

Yep, JUUL decided to pull the mint pod, leaving only menthol and tobacco flavours. Bet you can’t guess what’ll happen at the next survey.

If you said that menthol (and probably tobacco) sales would increase, give yourselves a gold star.

Strike three JUUL. You’re out.

It’s quite a shame really. JUUL solved three problems with vaping:

  • Rapid nicotine uptake to mimic that of cigarettes
  • Small, convenient devices
  • Removed the harshness of high levels of freebase nicotine

That, and the fact that due to the innovation of the product led to an increase in the downward trend of cigarette sales.

Y’see, going back to the absorption rates of nicotine salt, JUUL (and other pods that use nicotine salt) are designed to closely mimic the act of smoking in its entirety. You could argue that 50mg/mL is too high, and maybe it is. But going down the EU route and having 20mg/mL is too low. A balance needs to be struck.

Don’t get me started on the TPD that sets the 20mg limit. It’s utter bollocks. It’s based on a mis-interpreted (deliberately) paper from Dr Farsalinos and should never seen the light of legislative day. I’d tentatively suggest that 36mg may be about right if a cap is to be imposed. Maybe, just maybe, 36mg on freebase and 20mg on nicotine salt would be one way forward. After all, the absorption rate of nic-salt is very close to a cigarette. But, I wouldn’t go as far as actually calling for a cap. I can see why some would want to do that but, in essence, it’s a bad idea.

That’s probably its saving grace. That and the fact that it doesn’t need a monster mod to drive it. A simple 750mAh cell can drive a 1.6 ohm coil with 20mg nicotine salt and, for me, it works just fine. But that’s also a problem. It might not work fine for Joe Bloggs who smokes 80 a day.

Compromises like a nicotine cap, flavour bans, or any other regulation that is designed to limit youth use, but essentially indiscriminately targets all vapers should not be supported by vapers or the industry. There is no way to know what science and technology will come up with in the future. Placing arbitrary limits on the current generation will only inhibit future innovation which may, or may not, provide better solutions.

Unfortunately, as I’ve mentioned before, there is little to no common ground for vapers, the industry and public health to work with. Particularly since the latest news from the US clearly shows that the likes of CfTFK don’t want to compromise.

Solutions?

Given the current state of affairs, I highly doubt any proposal put forward by vaping advocates, activists and the industry will be met with anything nearing courtesy.

The current enforcement of underage sale, across the board, is woeful. The laws are already in place, we don’t need new ones.

Public Health England gets it (somewhat) right with their guidelines for vaping in the workplace. It should entirely be down to the discretion of the premises owner.

Aside from making sure that there isn’t anything notably harmful to human health in the liquid or aerosol, there really shouldn’t be much that regulators should do. There’s only really three types of regulation that can be targeted: access, marketing and risk communication.

Enforce current age restrictions and tell the truth.

That’s not asking much, is it?

6 thoughts on “Long Read: The “Evils” of Nicotine, JUUL and the Youth ‘Epidemic’

  1. Isn’t that only some kind of new nicotine-myth that nicotine salt is “more bioavailable and potent”? Because, if it is, then how come Juul needs to put a whopping 58 mg/ml into their liquids?

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      • As far as I understand it, the whole “nic salts” thing doesn’t add up.
        Do you by any chance have a working knowledge of German? If so, I recommend this YT video by Prof Bernd Mayer (head of the Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, Karl-Franzens-Universität Graz, Graz, Austria ) – he does a much better job explaining than I ever could ;-) https://www.youtube.com/watch?v=BylytYpboS8

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        • I am familiar with Mayer and his work (which I have referenced elsewhere), specifically his review of the literature on the LD50 of nicotine. Sadly, my spoken German is non-existent and my understanding of such is incredibly limited. Auto-translate gave me some pointers during the video which I’ll follow up as and when I can. Naturally, if my understanding is wrong I’ll update the post. I like to go where the evidence takes me :)

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