5 things FDA should do about JUUL e-cigarettes

A new type of e-cigarette is putting a generation at risk of nicotine addiction and threatening to undermine decades of progress in reducing youth tobacco use.

JUUL, a sleek device that looks like a USB flash drive and comes in a variety of flavors, including fruit medley, mango, cool cucumber and creme brulee, has gained popularity with young people and captured more than half of the e-cigarette market share in just two years.

While less toxic than cigarettes, e-cigarettes can make youth more likely to use regular cigarettes and still contain toxins and the addictive chemical nicotine, which is harmful to adolescent brain development. A new Truth Initiative® study published in Tobacco Control found that 63 percent of JUUL users between 15 and 24 years old did not know that the product always contains nicotine.

Six public health and medical groups, including Truth Initiative, are calling on the Food and Drug Administration to act.

“The alarming increase in youth use of JUUL makes this an urgent public health problem that requires strong and immediate action,” the groups wrote in a letter to FDA Commissioner Scott Gottlieb. “The FDA is responsible for regulating tobacco products, including e-cigarettes, and it is unacceptable that the FDA has yet to take action to address the skyrocketing youth use of JUUL.”

The groups are calling for five actions.

1. Order the removal of certain JUUL flavors 

The FDA should order the immediate removal of JUUL flavors, including the highly popular mango and cool cucumber flavors, which violate FDA regulation. The flavors were introduced after Aug. 8, 2016, without the required FDA marketing order. The law prohibits the introduction of new or changed e-cigarettes after the August 2016 effective date without prior FDA review. According to JUUL’s social media posts, the mango and cool cucumber flavors were not introduced until 2017.

2. Suspend internet sales of JUUL 

Although the maker of JUUL says it is intended for adults who want to quit smoking, and the legal age of purchase is 18, minors are getting their hands on the products in a variety of ways, including internet sales. 

The FDA should suspend internet sales of JUUL until adequate rules are established to prevent sales to kids, such as requiring effective age verification both at the time of sale and delivery. At the same time, the FDA should dramatically step up its enforcement of the ban on underage sales of JUUL by brick-and-mortar retailers.

3. Reverse the decision to delay e-cigarette regulation

The FDA should reverse its unlawful 2017 decision that allows e-cigarettes already on the market as of Aug. 8, 2016 to stay on the market until at least 2022, without filing applications and undergoing a public health review by the FDA. 

The rapid growth in the popularity of JUUL among kids underscores the public health importance of requiring manufacturers of these products to undergo agency review and to demonstrate that the sale of these products is appropriate for the protection of public health.

4. Prohibit branded merchandise

Merchandise with the JUUL name and JUUL trademarks, including t-shirts, hoodies and JUUL “wraps” or “skins,” are being sold on the internet and have helped fuel the brand’s popularity with kids. 

FDA rules prohibit cigarette brand names from being used on other products because of the impact on youth. The FDA should apply the same rule to JUUL and all tobacco products. 

5. Order the removal of JUUL look-alikes

As JUUL’s popularity has grown, new products that look and reportedly perform like JUUL have been introduced without first seeking FDA review. The agency should order the removal of these products unless and until they comply with the law by going through FDA review.

The six public health and medical groups recommend an additional step if JUUL does not take measures to decrease youth use of their product.

“If JUUL fails to take the steps necessary to curtail youth use before the start of the next school year in fall 2018, the FDA should take strong, additional enforcement action up to and including suspension of JUUL sales.”