Tagged Tobacco

Vapers Seek Relief From Nicotine Addiction In — Wait For It — Cigarettes

Lucas McClain started smoking cigarettes in high school but switched to vaping after he heard e-cigarettes were a safer alternative.

His vape of choice became the Juul, the king of electronic cigarettes — which comes with a king-size nicotine hit.

Now 21, McClain wants to quit so badly that he’s turning back to the problem he fled in the first place: good old-fashioned cigarettes.

“Juul made my nicotine addiction a lot worse,” the Arlington, Va., resident said. “When I didn’t have it for more than two hours, I’d get very anxious.”

Even though McClain knows the dangers of cigarettes — lung cancer runs in his family — he thinks it might be easier to kick cigarettes than his Juul. Plus, his mom keeps warning him about the mysterious vaping-related illnesses that have sickened hundreds across the country.

So last month, McClain bought his first pack of cigarettes in years. Then he tweeted about it.

“Bought a juul to quit smoking cigarettes,” he wrote, “now I’m smoking cigarettes to quit the juul.” He ended with this hashtag: #circleoflife.

One Juul pod, which provides about 200 puffs, contains as much nicotine as a pack of cigarettes. On stressful days, McClain could finish a pod in three hours — and as he and others figure out just how potent these and other e-cigarettes are, many want out.

Some are turning back to combustible cigarettes — or taking them up for the first time — in a dangerous bid to lower their nicotine intake and ultimately get off their vapes.

“Isn’t it ironic that to quit juul I bought cigarettes,” says one Twitter user. Another points out that it’s “strange” that she used the device to quit smoking cigarettes but is now “far more addicted to my Juul than I ever was to cigs.”

“It sucks,” she said.

Lucas McClain holds a pack of cigarettes and his Juul at his home in Arlington, Va. McClain is back to smoking cigarettes in the hope of quitting the Juul. (Lynne Shallcross/KHN)

It isn’t a complete surprise that some young people are “going back to the product they were trying to quit in the first place,” said Pamela Ling, a professor of medicine at the University of California-San Francisco who studies tobacco and its marketing.

But it is worrisome because cigarettes contain toxins and chemicals that are dangerous to their health, she said.

Vaping may not be safe either. The Centers for Disease Control and Prevention is investigating more than 450 cases of lung disease in 33 states — mostly among young people — possibly linked to vaping nicotine and marijuana. Six people have died. California is investigating at least 60 cases.

The back-to-smoke trend flies in the face of the e-cig industry’s most insistent PR pitch: Vaping helps people quit smoking cigarettes. In fact, San Francisco-based Juul Labs, which commands 75% of the e-cig market, says in its mission statement that the company aims to eliminate cigarettes by giving adult smokers “the tools to reduce or eliminate their consumption entirely.”

In an emailed statement, Juul didn’t directly address the decision by some of its users to revert to cigarettes, but again clung to the refrain that its products are “designed to help adult smokers switch from combustible cigarettes to an alternative nicotine delivery system.”

Ted Kwong, a Juul spokesman, said Juul is not designed to get people off nicotine or to treat nicotine dependence.

For those who criticize Juul’s high nicotine content, Kwong noted that pods come in two strengths — 5% and 3% nicotine concentrations — letting users customize their “switching journey.”

Monday, the Food and Drug Administration reprimanded Juul for promoting its products as being safer than cigarettes without FDA permission. It gave Juul 15 business days to respond.

Vaping has become big business, with the global market projected to hit $48 billion by 2023.

Smoke or vapor, cigarette makers win either way. Altria, which sells Marlboro and other tobacco brands in the U.S., invested nearly $13 billion in Juul for a 35% stake last year. Altria has proposed reuniting with Philip Morris International, a unit it sold off in 2008.

One Juul pod provides about 200 puffs and can contain as much nicotine as a pack of cigarettes. As young adults realize how potent the Juul and other e-cigarettes can be, some are turning back to combustible cigarettes. (Ana B. Ibarra/KHN)

Even though the industry says vaping is intended for adults, Juul and other vaping pens took off among young people about two years ago when teens began taking the devices to school and teachers mistook them for flash drives. Students took hits in campus bathrooms and halls, and even in class when teachers weren’t looking.

The e-liquids inhaled from the devices contain nicotine and come in thousands of fruity flavors that appeal to kids.

Michigan last week became the first state to ban sales of flavored e-cigarettes in an attempt to end teen vaping. In June, the San Francisco Board of Supervisors banned the sale of all e-cigarettes, beginning in early 2020. Juul is fighting back with a November ballot measure, Proposition C, backed by millions of its own dollars.

Many former smokers attest that vaping was the only thing that helped them quit cigarettes, but the science is mixed. Some studies have shown that many vapers continue to smoke cigarettes.

The FDA has approved seven treatments for smoking cessation, including patches, gums and lozenges. Vapes are not among them, said Dr. Elisa Tong, an associate professor of medicine at the University of California-Davis.

Tong said vapers may be using more nicotine than they realize. She understands why some choose to go back to cigarettes, but she doesn’t recommend it.

“What they’re doing is trying to taper down super high levels of nicotine,” she said. “Unfortunately, manufacturers don’t have a manual on how to quit their devices.”

Dr. Amanda Graham, senior vice president of innovations at the Truth Initiative, an anti-tobacco advocacy group, said she is seeing “desperation and misguided approaches” from teens and young adults trying to free themselves from nicotine.

“Young people are fumbling in the dark with what seems logical,” Graham said. “But there is no safe level of cigarette smoking.”

Early this year, Graham’s group launched a digital program to help teens and young adults quit their vaping devices. Since then, 41,000 people between 13 and 24 have enrolled in “This is Quitting,” which sends them tips and support via text messages.

Chris Gatus of Whittier, Calif., switched from traditional cigarettes to Juul because he thought the device would help him quit smoking, he said.

But because his Juul is always glued to his palm, he found himself using it everywhere and all the time.

“I’ve sort of forgotten what it’s like not to be on nicotine,” said Gatus, 21.

He switched back to cigarettes this year after noticing his growing addiction, but that only resulted in his using both. Now he’s trying different vaping pens, looking for something less harsh than the Juul or cigarettes, he said.

Last week, Ryan Hasson of New York City threw out his Juul after experiencing strong chest pains and labored breathing when exercising — and after hearing about the growing number of vape-related illnesses. He had never felt such strong symptoms when he smoked old-fashioned cigarettes, he said.

“I don’t plan on ever smoking again, but if I had to choose, I would much rather buy cigarettes over a Juul,” said Hasson, 25.

The same is true of his friends, he said.

“I think a lot of people are quitting completely or going back to cigarettes,” he said. “They’re waking up to the reality that maybe this isn’t as safe as we once thought.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

KHN’s ‘What The Health?’: Despite Booming Economy, Uninsured Rate Ticks Up


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The annual report from the Census Bureau, released this week, found that 27.5 million Americans were without health insurance last year, an increase of nearly 2 million from 2017. The 0.5 percentage point increase in the uninsured rate — to 8.5% — was the first in a decade and came as unemployment and other economic indicators have been good.

Meanwhile, the Trump administration signaled that it is moving to ban flavored vaping liquid used in e-cigarettes. Companies making the products have been accused of marketing to underage users with flavors like mango and bubble gum.

And Congress is back from its summer break, with legislation to address rising prescription drug prices and surprise medical bills still on the agenda.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Tami Luhby of CNN and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • The Census Bureau’s report this week defied usual economic models. Normally, the more people employed, the more people insured.
  • Health advocates blame a variety of actions by the Trump administration for the lower rate of insured Americans. Those include policies intended to deter people from staying on or signing up for Medicaid; the elimination of the tax penalty for not having coverage; and the announcement that immigrants’ use of public benefits such as Medicaid could affect their ability to get a green card allowing them to live and work in the U.S.
  • The biggest surprise in the Census Bureau report was the increase in children without insurance. Coverage for kids has generally been a bipartisan goal on Capitol Hill. It’s not clear what caused that drop. It could just be a result of differences in how the survey was conducted, or it may be another sign of immigrants worried about whether using public insurance could lead to their deportation.
  • The administration’s announcement that it is moving forward on a ban of flavored vaping products comes as worries grow among parents and public health officials about an epidemic of lung problems around the country. Among those worried parents is first lady Melania Trump.
  • House Speaker Nancy Pelosi appears to be inching closer to releasing her plan to curb high drug prices. It’s not clear yet whether President Donald Trump will sign on to her effort. But Sen. Chuck Grassley (R-Iowa) is seeking support for his more modest plan instead, arguing to his Republican colleagues that if they don’t stand with him, they may be forced to accept Pelosi’s legislation if she manages to make a deal with the president.
  • Opponents of some of the legislation to curb surprise medical bills appear to have made progress over Congress’ August recess with a major advertising campaign saying the measures would hurt local hospitals and doctors. Advocates say the legislation is not dead, but the strong momentum it had is waning.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Vox.com’s “This life-threatening pregnancy complication is the next frontier in the abortion debate,” by Anna North

Joanne Kenen: The New York Times’ “Nursing Homes Are a Breeding Ground for a Fatal Fungus,” by Matt Richtel and Andrew Jacobs

Rebecca Adams: Kaiser Health News’ “‘UVA Has Ruined Us’: Health System Sues Thousands Of Patients, Seizing Paychecks And Claiming Homes,” by Jay Hancock and Elizabeth Lucas

Tami Luhby: The New York Times’ “Bernie Sanders Went to Canada, and a Dream of ‘Medicare for All’ Flourished,” by Sydney Ember

To hear all our podcasts, click here.

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Vaping By The Numbers

The explosive rise in a serious lung illness linked to vaping spotlights the popularity of e-cigarettes among teens and young adults — and how little is known about the devices’ safety and use.

As of Tuesday, federal health officials were investigating at least 450 possible cases of the mysterious pulmonary illness across 33 states, including six cases that resulted in death. California has reported nearly 60 cases of lung illness since late June in patients with a history of vaping; one of those patients, in Los Angeles County, has died.

Vaping has surged in the past two years, particularly among teenagers and young adults. More than 20% of high school students reported vaping in 2018 — almost twice the 2017 rate — according to the federal Centers for Disease Control and Prevention. That translates to 3 million high school students using e-cigarettes in 2018 — well more than double the number who reported using traditional cigarettes.

Vaping is the popular shorthand for using electronic cigarettes to “vaporize” nicotine or an array of liquid concentrates. The devices initially were marketed as a way to inhale nicotine without the risks associated with burning tobacco. But they quickly evolved for use with hundreds of combinations of flavorings and chemical compounds, including THC, the psychoactive ingredient in marijuana, and other marijuana extracts.

Federal and state investigators say many of the people who have fallen ill said they had vaped THC, and officials are focusing on contaminants in black-market products containing THC as possible culprits. Other patients reported using nicotine cartridges, and authorities stress that they have yet to identify a specific device or chemical at play. For now, officials are warning people of all ages to avoid e-cigarettes, particularly products purchased on the street.

Vaping is now so pervasive among high school students that federal health officials say its use has fueled a sharp reversal in what had been a celebrated two-decade decline in overall tobacco use by teenagers. As of 2018, the CDC’s National Youth Tobacco Survey showed overall tobacco usage among high schoolers had reverted to levels not seen since 2004. Though marketed as a healthy alternative to traditional cigarettes, e-cigarettes can contain substantial levels of nicotine, which is highly addictive.

Juul, the San Francisco-based company that dominates the e-cigarette trade, and other manufacturers publicly market their devices as a tool to help adults quit smoking. But government surveys show the sleek devices — and multitude of copycat products — are far more popular among high school students than adults. While the legal age to buy e-cigarettes is 18 in most states — and 21 in California — the products are widely available online and not all sellers require proof of age. And vaping kits now come in the form of pens, flash drives, key fobs, even watches — making them both stylish and easy to disguise.


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Listen: Health Officials Warn People To Stop Vaping

As the number of patients combating mysterious lung illnesses grows, state and federal public health officials are warning people to stay away from e-cigarettes and vape pens, especially those obtained off the streets.

As of Friday, public health officials were investigating more than 450 possible cases of severe pulmonary disease related to vaping, including five deaths, in 33 states, according to the Centers for Disease Control and Prevention. Investigators are looking into 60 possible cases in California, including one death.

Though the exact cause of the outbreak has not been determined, CDC officials said that the cases could be linked by some sort of chemical exposure, but that it is too early to single out one product or substance.

In the majority of the cases, patients reported recent use of THC, the psychoactive chemical in cannabis, officials said. A smaller group reported vaping only nicotine.

Public health experts recommend that people stop vaping while the investigation continues. If they develop symptoms, including cough, chest pain, shortness of breath and fevers, they should seek medical attention.

California Healthline reporter Ana Ibarra appeared Monday on “The Brian Lehrer Show” on WNYC to discuss what we know — and don’t know — about this growing number of vaping-related illnesses.