U.S. Food and Drug Administration (FDA) chief Scott Gottlieb expressed his persistent disappointment with the e-cigarette industry during a Jan. 18 public hearing, threatening “game over” for vape manufacturers if vaping rates among children and teens continue to rise.

E-cigarette use among high school students peaked at 16 percent in 2015, but had decreased to just over 11 percent in 2016 and held steady in 2017, Administrator Gottlieb explained. But then something unexpected happened. In late 2017 and early 2018, an alarming surge in e-cigarette usage among middle and high school students occurred.

This sudden surge in teen vaping correlated to the same period that JUUL Labs debuted its e-cigarette products on the market and aggressively marketed them to youth.

“Indeed, the ubiquity of this one product became so entrenched so quickly that it gave rise to its own verb – juuling,” Dr. Gottlieb said.

Numbers don’t lie

Data from the 2018 National Youth Tobacco Survey shows that e-cigarette use among U.S. children and teens has spiked so high that it has become a national epidemic. From 2017 to 2018, there was a 78 percent increase in e-cigarette use among high school students and a 48 percent increase among middle school students.

The total number of middle and high school students using e-cigarettes in 2018 rose to 3.6 million — that’s 1.5 million more students vaping than in the previous year. Nearly 70 percent of students surveyed said they vaped flavored products.

“I fear that the survey data that we’ll get for next year will show continued increases in youth use of e-cigarettes,” Dr. Gottlieb said. “I’ll tell you this. If the youth use continues to rise, and we see significant increases in use in 2019, on top of the dramatic rise in 2018, the entire category (of e-cigarette products) will face an existential threat.”

Dr. Gottlieb pointed to the “escalating regulatory actions” the FDA took under his direction to beat back the epidemic but expressed his disappointment in the e-cigarette industry’s initiatives to discourage youth vaping.

“The major marketers of these products don’t seem to fully understand the scope of this challenge, or they don’t seem to be fully committed to their own stated commitments to curtail this youth use,” Dr. Gottlieb said.

“It matters if the e-cig makers can’t honor even modest, voluntary commitments that they made to the FDA,” he said, suggesting his agency is poised to take harsh measures that could destroy the e-cigarette industry.

“I think the stakes are that high. And would be a blow for all of the currently addicted adult smokers who, I believe, could potentially benefit from these products,” Dr. Gottlieb said.

E-cigarettes are widely marketed as smoking cessation devices — products designed to help adults quit smoking conventional tobacco cigarettes. However, evidence shows that few people successfully quit smoking by switching to e-cigarettes, and some studies suggest that vaping nicotine offers little benefit as a purported healthier option than combustible cigarettes.

E-cigarettes appeared on the market at a time when smoking had already dropped to historic lows and it appeared that the U.S. was poised to slay nicotine addiction in America, Dr. Gottlieb said. But instead of helping more people quit smoking, e-cigarettes have only created an entire new generation of nicotine addicts and reversing decades of progress made improving public health.

Exploding e-cigarettes

In addition to the mounting concerns about health risks and addiction, e-cigarettes also have been connected to serious injuries resulting from their exploding while in use. Most all e-cigarette explosions and fires are caused by the lithium-ion batteries that power the devices.

Almost all consumer electronics are powered by rechargeable lithium-ion batteries, which can catch fire or explode if they are damaged or their exposed terminals are short-circuited by other items. But while lithium-ion batteries can and do malfunction in other consumer products, such as laptops and cell phones, they usually don’t pose the same risks as e-cigarettes, which are held close to the face, inserted in the mouth, and often carried in a pants pocket.

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