Vaping trails only alcoholic beverages as the preferred psychoactive drug delivery system of America's youth. In a December survey conducted by the National Institutes of Health, more than one-fifth of high school seniors—20.9 percent—reported vaping nicotine at least once in the preceding 30 days, compared to just 11 percent a year earlier. Whatever manufacturers are doing to get young people to try their products, it is working fantastically, which may be why more elected officials are looking into a vaping ban.
This pattern is troubling, presumably, for public health experts at places like the Centers for Disease Control, which says it has received reports of six deaths and over 450 possible cases of e-cigarette-related lung illnesses, and the Food and Drug Administration (FDA), which is investigating a nationwide outbreak of respiratory conditions linked to contaminated cannabis vaping products. This week, FDA officials issued a pair of letters to e-cigarette giant Juul that shine an unforgiving spotlight on the company's business model—and may signal the imposition of stricter federal regulations in the not-so-distant future.
Of particular concern to the agency is evidence presented at a July congressional hearing related to Juul's marketing to students. Experts at the hearing recounted Juul representatives characterizing the company's products as "totally safe" and "much safer than cigarettes," and telling prospective users that the FDA would back these claims "any day" or "very soon." The FDA's letter also notes with skepticism a statement from Juul CEO Kevin Burns posted on the company's web site, which calls the product a "simple and convenient" way to "deliver smokers the satisfaction that they want without the combustion and the harm associated with it."
In the second letter, the FDA also asked Juul, which commands nearly three-quarters of the American vape market, to turn over a host of documents related to the company's advertising and educational outreach efforts—especially as they relate to teen vape use. "We believe you have a continuing responsibility to take action to address the epidemic of youth use of your products, some of which appears to have been a direct result of your product design and marketing campaigns," wrote Mitch Zeller, director of the FDA's Center for Tobacco Products.
What's going on here? A federal law passed in 2009 requires tobacco companies to obtain explicit FDA approval before selling "modified risk tobacco products"—anything that is allegedly less dangerous, somehow, than other tobacco products for sale. (In the decade since, the agency has approved exactly zero applications for this modified-risk status.) Here, the FDA alleges that Juul's pitch could be "reasonably expected" to cause consumers to believe that vaping is less harmful than the available alternatives, even though that message has not receive the FDA's blessing. The company has 15 working days to dispute this conclusion or provide a written plan of corrective action; failure to comply, the letter added, could result in product seizures or monetary fines.
The FDA's document request, meanwhile, takes issue with a series of Juul campaigns that make prominent use of the word "switch": a "Make the Switch" campaign, for example, and a "Switching Program" that targeted members of the Cheyenne River Sioux Tribe in South Dakota. (Representative excerpts include "I was looking to find something to replace cigarettes. The switch was easy"; "It's time for an alternative to cigarettes"; and "Have smokers that can't quit? Juul has created a program where you can help them switch.") The not-so-subtle insinuation, the FDA argues, is that swapping cigarettes for vape pens entails tangible health benefits—and, thus, that Juul is an unsanctioned "modified risk tobacco product."
Juul, unsurprisingly, does not agree with this characterization. "Switching is not another word for cessation or safer,” spokeperson Joshua Raffel told the New York Times. “They mean very different things. For example, switching involves continuing to consume nicotine but from a different device, while cessation is about getting users to eliminate their nicotine consumption altogether.” (This statement did not draw an analogous distinction between "switching" and "safer," or answer the question of why one would consider switching nicotine delivery systems if not for an associated substantive benefit.)
Federal regulators are not the only ones taking notice of some of the company's more dubious business practices. Last month, the Lake County State's Attorney's office in Illinois filed a lawsuit accusing Juul of crafting an elaborate marketing campaign, replete with savvy hashtags and handpicked influencers, to appeal specifically to teenagers. (This is an old refrain within the tobacco industry, which famously advertised using kid-friendly cartoon mascots and teen-inspired taglines throughout much of the previous century.) Researchers at Stanford University have chronicled how the brand's early, heavy presence on Instagram (among other social media platforms) helped create online communities of "Juulers" who post videos of vapor-related stunts in an effort to go viral. One study estimates that a quarter of Juul's Twitter followers aren't even old enough to buy its products. The FDA echoes this concern, noting congressional testimony that after minors tried and failed to purchase Juul pods online, they nonetheless received email coupons to buy discounted "starter kits."
Private plaintiffs, too, are suing the company, alleging that Juuling causes addiction among teens and creates elevated risks of strokes, seizures, and other medical issues. In response to this spate of litigation, a company spokesperson asserted that the product "has always only been intended to be a viable alternative for the 1 billion current adult smokers," not to appeal to new customers. It shut down its Facebook and Instagram accounts last fall in response to complaints, and pulled flavored tobacco products from brick-and-mortar retail locations. In another statement, the company similarly denied that Juul wants non-nicotine users to Juul, and reiterated its corporate raison d'être of "eliminating combustible cigarettes, the number one cause of preventable death in the world." (Again, it is not clear how this noble sentiment comports with the notion that "switching" and "safer" are not intended to be synonymous to consumers.)
Scientists generally believe that e-cigarettes are less bad and less deadly than conventional cigarettes, since vaping does not literally entail smoke inhalation or cause buildup of tar—the sticky, yellowish-brown byproduct of burning tobacco that causes lung cancer. Less bad, however, is not the same as good. Nicotine addiction is not dependent on the form in which the drug is delivered, and the nicotine concentration of a Juul pod is among the highest of anything available on the e-cigarette market—the equivalent of a pack of cigarettes. E-cigarette products are not free of toxic substances, and researchers at Stanford University have found that chemicals in flavored pods can damage human blood vessel cells independently of the associated nicotine content.
Experts are also concerned that vaping may be a dreaded gateway activity to more harmful cigarette use. There is evidence to support this hypothesis: A 2015 study found that teens who vaped were more likely than those who didn't vape to begin smoking within a year. A similar study conducted in 2017 yielded even more unsettling results: Vapers were seven times more likely than non-vapers to say they'd smoked combustible cigarettes six months later. Among teens who have tried cigarettes but do not smoke regularly, use of e-cigarettes has been positively linked to the future development of a full-blown smoking habit. Perhaps not coincidentally, Altria—the world's largest tobacco company and manufacturer of Marlboro-branded cigarettes—acquired a 35 percent stake in Juul in late 2018, which valued the e-cigarette company at a cool $38 billion.
Some jurisdictions have already made their choice about what to do next. Over the summer, San Francisco enacted a ban on the sale or shipment of flavored e-cigarette products within its borders, despite the fact the city is the home of Juul's global headquarters. Earlier this month, Michigan became the first U.S. state to prohibit the sale of flavored e-cigarettes altogether, imposing a six-month ban intended to protect children from the dangers of nicotine addiction. The federal government may not be far behind, either: On Wednesday, September 11, Health and Human Services secretary Alex Azar told reporters that the Trump administration is finalizing a ban on any and all e-cigarette flavors other than natural tobacco varieties.
The question, though, is whether vaping culture is now too firmly-established, especially among younger consumers most vulnerable to the consequences of use, for bans to have their desired impact. "Vaping has become a very big business, as I understand it," President Trump explained to reporters, voicing disapproval of "big problems" associated with the practice. He then invoked one of his most famous vagaries, which for once functioned as a fair assessment of the issue before him. "But people are dying with vaping, so we're looking at it very closely." Although given the failure of Prohibition and laws making particular drugs illegal, a ban may just drive vaping to the black market, not eradicate it altogether.
People on Drake's Instagram
Austin Lawrence, 21, has more than 320,000 followers on Instagram, has a direct line to Drake on his phone, and can manipulate smoke in ways that seem to defy all rational laws of physics. GQ infiltrated the nascent (and, if we’re being honest, a little strange) world of vaping to learn all about the Vape God’s pursuit of perfection.
Originally Appeared on GQ