Juul ignored evidence its electronic cigarette was hooking teens

Juul ignored evidence its electronic cigarette was hooking teens
A man exhaling smoke from a Juul electronic cigarette in Washington, DC. In just three years Juul has swallowed the American market with its vaporettes in the shape of a USB key. Picture: Getty Images.

Executives knew young people were flocking to its breakthrough e-cigarette shortly after it went on sale in 2015 with its potent nicotine blend, writes Chris Kirkham.

The San Francisco startup that invented the groundbreaking Juul e-cigarette had a central goal during its development: captivating users with the first hit.

The company had concluded that consumers had largely rejected earlier e-cigarettes, former employees told Reuters, because the devices either failed to deliver enough nicotine or delivered it with a harsh taste.

Developers of the Juul tackled both problems with a strategy they found scouring old tobacco-company research and patents: adding organic acids to nicotine, which allowed for a unique combination of smooth taste and a potent dose.

Employees tested new liquid-nicotine formulations on themselves or on strangers taking smoke breaks on the street. Sometimes, the mix packed too much punch — enough nicotine to make some testers’ hands shake or send them to the bathroom to vomit, a former company manager told Reuters.

In the end, it worked. The formula delivered nicotine to the bloodstream so efficiently, in fact, that the company’s engineers explored features to stop users from ingesting too much of the drug, too quickly.

Juul’s founders applied for a patent in 2014 that described methods for alerting the user or disabling the device when the dose of a drug such as nicotine exceeds a certain threshold.

One idea was to shut down the device for a half-hour or more after a certain number of puffs, said Chenyue Xing, a former Juul scientist who helped patent its liquid-nicotine formula. The concern stemmed in part from the fact that a Juul — unlike a cigarette — never burns out, Xing said in an interview.

“You hope that they get what they want, and they stop,” she said. “We didn’t want to introduce a new product with a stronger addictive power.”

The company never produced an e-cigarette that limited nicotine intake. Xing was not directly involved in the engineering of the device and said she didn’t know why the firm did not adopt a dosage-control feature.

Juul Labs Inc is now the central player in a broader controversy sweeping the US over the safety of its products along with those of a wave of high-nicotine imitators. The rise of Juul sales tracks closely with an epidemic of teenage nicotine use that has brought a hail of criticism and regulatory scrutiny on the company.

US congressional investigators, state attorneys general and health advocates have so far focused on whether Juul targetted young people through its marketing and the dessert-like flavours of some Juul nicotine liquids, such as creme brulee or mango.

But a Reuters investigation has found that, from the company’s earliest days, insiders discussed and debated concerns over more fundamental attributes of the product: its potency and addictiveness.

The breakthrough “nicotine salts” formula that made the Juul e-cigarette so addictive — and ignited the company’s explosive market-share growth made Juul especially attractive to teenagers and other new users who otherwise would never have smoked cigarettes, according to interviews with more than a dozen tobacco researchers, paediatricians, and a Reuters review of Juul patents and independent research on nicotine chemistry.

The device delivers the drug more efficiently than a cigarette, according to emerging academic research into Juul’s formula and the company’s own documents. In written answers to questions from Reuters, Juul said it never intended to attract underage users.

The company acknowledged it needed to “earn back the trust of regulators, policymakers, key stakeholders and society at large” in light of a surge in youth vaping to “unacceptable” levels.

Juul declined to comment on why it never installed the features it considered to limit nicotine intake. It said it designed its products to mimic the experience of cigarettes because that was key to getting smokers to buy them. Citing studies it commissioned, the company said Juul users have far more success in quitting smoking than those who tried earlier e-cigarettes.

Pitching addiction to retailer

The firm seldom mentioned nicotine in early consumer marketing, which featured young, hip models and sold the product as a stylish alternative to cigarettes. But the company’s sales force — tasked with convincing reluctant retailers to give Juul shelf space — emphasised the device’s unique addictive power by showing store owners charts depicting how the Juul device delivers nicotine to the bloodstream as efficiently as a traditional cigarette, said Vincent Latronica, who headed sales and distribution for the company on the US East Coast from 2014-2016.

That argument became a central selling point, Latronica said, allowing the young company to overcome retailer scepticism of early e-cigarettes and to break into sales channels long dominated by tobacco companies. “Everyone wanted it,” Latronica said.

Juul did not answer questions from Reuters on why the company emphasised the addictive qualities of its product to retailers and downplayed them in advertisements to customers.

Inside the company, the first signs Juul had a strong appeal to young people came almost immediately after the device went on sale in 2015, according to the former company manager, who spoke on condition of anonymity.

Employees started fielding calls from teens asking where they could buy more Juuls, along with cartridge-like disposable “pods” that contain the liquid nicotine.

The calls and other early signs of teen use kicked off an internal debate, the manager said. Some company leaders, including founder James Monsees, argued for immediate action to curb youth sales. Monsees served as chief executive and a company director at the time.

The counter-argument came from other company directors, including healthcare entrepreneur Hoyoung Huh and other early investors, the former manager said. They argued the company couldn’t be blamed for youth nicotine addiction because it did not intentionally advertise or sell to teens, said the manager.

“Clearly, people internally had an issue with it,” the manager said, referring to sales of Juuls to teenagers. “But a lot of people had no problem with 500% year-over-year growth.”

Company leaders also clearly understood the long-term benefit of young users on its bottom line, the manager said. It was well-known young customers were “the most profitable segment in the history of the tobacco industry” because research shows that nicotine users who start as teenagers are the most likely to become lifelong addicts.

In its written answers to Reuters, Juul said that Monsees “did not recall” the internal debate in 2015 over whether to take action to stop youth sales. Huh and other board members who served at the time of the company’s product launch did not respond to requests for comment. Board member Harold Handelsman declined to comment, citing pending lawsuits against the company.

Juul declined to make Monsees or company co-founder Adam Bowen available for interviews.

Following the product’s launch, it took nearly three years — and pressure from regulators and US senators — before Juul in April 2018 announced what it called a “comprehensive strategy” of measures to curb youth sales.

By that time, a leading US government youth tobacco survey showed that more than three million US high school students — one in five — had tried an e-cigarette in the prior month. More than a quarter of those vaped at least 20 days a month. The latest available data from the same survey, in September 2019, shows yet another increase: More than one in four high schoolers reported using e-cigarettes in the previous month.

The measures to prevent youth sales and use came two days after the US Food and Drug Administration (FDA) announced a nationwide crackdown on underage sales of Juul products.

The company committed $30 million for youth prevention efforts, including distributing educational materials to retailers and conducting research into technologies to prevent youth sales.

Asked why the company did not act sooner, Juul noted two measures to curb youth sales that it took half a year earlier, in August and September of 2017: raising the minimum age for online purchases through Juul’s website to 21 even though some states allow retail sales to anyone over 18, and starting a “retail monitoring programme.”

The company repeated it now needs to earn back the public’s trust and said the firm “reacted to the information that it had, and increased its youth prevention measures as more data came out over the years.”

The former manager’s account of the early debate over young users contradicts repeated statements from executives that the firm was caught off-guard by teenage addiction beginning last year — “completely surprised,” as Chief Administrative Officer Ashley Gould put it in a CNN interview.

The firestorm around Juul also led to the abandonment of merger talks between Philip Morris International and Altria Group, which has a 35% stake in Juul after a $12.8 billion investment last year. Altria last week had to write down that investment by $4.5 billion, citing the regulatory risks.

Altria declined to comment for this story, noting it purchased its stake a year ago, well after Juul developed its products.

Several US state attorneys general and a US congressional oversight committee are also investigating if Juul marketed products to underage users.

Monsees and other company leaders have said they regret some of the company’s early marketing but maintain it targeted customers in their mid-20s to early 30s.

As youth e-cigarette use continues to rise — after a long decline in teenage cigarette smoking — doctors, scientists and researchers are grappling with how to treat nicotine addiction among teenagers. Emerging research suggests serious risks to the developing adolescent brain.

The combination of a “very, very addictive” product and a developing brain has dangerous implications, said Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University’s medical school. “Rather than your brain getting pleasure from exercising or relationships, your brain becomes rewired to get pleasure from nicotine,” she said.

Juul did not comment on the research into how e-cigarettes harm teenagers. It said it has launched a “robust scientific programme to assess the harm-reduction potential of Juul products, including their impact on the individual user” as part of a larger effort to comply with FDA regulations

Early advertising around Juul featured fluorescent colours and young models. Customers were urged to “share a #Juulmoment” and revel in its iPhone-like design with mottos such as “Simple. Smart. Satisfying.”

The early advertising and social media campaigns eventually spawned an avalanche of user-generated content on Instagram and Twitter, with young people posting photos of themselves using the devices, often under hashtags such as #doit4juul or #juullife.

Some teenagers posted YouTube videos of themselves reviewing the device or its pod flavours or performing stunts such as smoking multiple Juuls at once.

After regulators cracked down on the company in April 2018, Juul asked social media networks to take down any content promoting youth use of its products. Last autumn, Juul ended its own social media marketing efforts.

More nicotine than a Marlboro

In 15 puffs, a Juul emits about 15% more nicotine than a Marlboro Red cigarette, according to research from the American University of Beirut.

Researchers at Portland State University will soon release research into the chemistry of Juul’s nicotine blend that finds it is an almost exact match for the addictiveness and ease of inhalation found in a Marlboro, James F. Pankow, a chemistry and engineering professor at the school, told Reuters.

The Portland State researchers found Juul’s addition of benzoic acid smoothed out the harshness common in earlier e-cigarettes while retaining the “kick” that smokers loved in a Marlboro.

The researchers noted Juul had rapidly duplicated — and improved — a formula that it took tobacco growers and purveyors centuries to perfect.

“If you think Marlboros are bad because they’re addictive, then this is like a Marlboro on steroids,” said Pankow, who has long studied the chemistry of nicotine and tobacco smoke.

“You’re taking away the smell; you’re putting it in a more discreet and sexy package; you’re not lighting it on fire. It has all of the positive points and it takes away a lot of the negative points.”

Cigarettes also deliver nicotine efficiently to the lungs, the most direct path to the brain, research shows. But some of the smoke is absorbed into the mouth and throat, giving users a so-called throat hit that’s pleasurable but also harsh enough to slow the intake of smoke and nicotine.

Unlike a cigarette, a Juul delivers “high doses of nicotine without it hurting the mouth and throat” at the moment when a user inhales, said Ted Wagener, a tobacco researcher at Ohio State University.

Juul’s patent documents highlight that its nicotine aerosol “is more readily delivered to the user’s lung,” as opposed to the mouth or throat, where nicotine would absorb more slowly, with a “less satisfying effect.”

Addiction can set in quickly among young vapers. Susanne Tanski, a paediatrician and former chair of the tobacco consortium at the American Academy of Pediatrics, said she and colleagues are observing first-time Juul users becoming addicted within two months, compared to two years or more for a smoker to become dependent on cigarettes.

Young Juulers may also be taking in more nicotine than young smokers, according to a study last year by scientists at the Roswell Park Comprehensive Cancer Center and Stony Brook University in New York.

They found that the levels of a nicotine indicator in the urine of young regular users of Juul or similar e-cigarettes was nearly 60% higher than that of regular cigarette smokers of the same age.

Researchers at Harvard Medical School and Massachusetts General Hospital surveyed more than 1,600 high school students in the Boston area and found 58% of those who had ever tried Juul or similar high-nicotine devices continued to use them, compared to just 17% of teens who ever tried cigarettes.

“The person who is becoming addicted to cigarettes has to be more determined; they almost have to want to become a smoker,” said Dr Jonathan Winickoff, a paediatrician at Mass General Hospital for Children in Boston, who was involved in the survey.

“With Juul, you get trapped much more easily. There’s nothing about it that’s telling your body that it’s harmful.”

There’s a surprising lack of long-term research on nicotine’s health effects, mostly because other toxins in cigarettes, which cause cancer, have always been the primary concern.

But emerging studies suggest serious harmful effects on the developing brains of teenagers.

Throughout childhood and into the mid-20s, the human brain is in constant flux, forming new neural pathways that govern how people learn, control impulses and form emotions.

Early exposure to nicotine hijacks that process, studies suggest, training the young mind to fixate on acquiring nicotine instead of forming connections that control mood disorders and impulsive behaviour.

This interruption has a particular impact on parts of the brain that control risk-taking, one reason why nicotine addiction is correlated with later use of drugs such as cocaine.

Beyond nicotine, other compounds in e-cigarette aerosols have been shown to raise the risk of heart attacks and lung disorders. There’s little long-term clinical research on exposure to e-cigarettes, however, because the products are so new.

That research gap has frustrated efforts to pinpoint a root cause of more than 1,800 cases of severe lung illnesses tied to vaping in recent months in the US.

E-cigarette enthusiasts and some researchers point to studies showing far fewer carcinogenic compounds in e-cigarettes than traditional cigarettes, which result in preventable fatal diseases in up to half of all lifetime users, according to the World Health Organisation.

The British Royal College of Physicians, for example, has concluded e-cigarettes are 95% less harmful than cigarettes, citing a reduction in the risk of serious disease and death.

For Smith, the Massachusetts high school senior, a hit of a Juul was at first “relaxing and soothing” — until it wasn’t. Last school year, he often took multiple bathroom breaks during class to sneak vape hits. “The second you’re done hitting it, you want to use it again,” he said.

Taking tests and completing homework became hard because the urge for a Juul hit interfered with his focus, he said. His grades slipped: He nearly failed his second year of algebra after earning an “A” the year before.

William’s father, Christopher Smith, said it seemed like “no time at all” between first finding his son’s nicotine stash and the family’s decision to seek help.

Since March, Smith has been seeing Winickoff, the Mass General pediatrician, to try to shake his Juul habit.

He’s planning to take off a year between high school and college, in part to restore his ability to concentrate.

“It’s hard to sum up,” he said. “It’s something that’s made my life worse, made my life terrible. I wish I had never started it.”

Smith wears a prescription nicotine patch 24 hours a day and carries nicotine gum as a supplement.

And he still sometimes hits a Juul: “Occasionally, I do give in.”

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