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Clinician’s Corner: Use of E-cigarettes

My wife, Denise and I had the privilege of attending a program sponsored by our local Chamber of Commerce, featuring Dr. George Zlupko.  Dr Zlupko is our areas leading pulmonologist, who founded the Lung Disease Center of Central Pennsylvania and has provided services to the Altoona area for 3 decades. He spent an hour discussing the latest health concern, that being of e-cigarettes.

JUULING—Today’s Health Concern

Juul® pods are becoming a health concern for health care providers and parents. The individual sucks on a small device that looks like a USB flash drive and it delivers unusually heavy doses of nicotine. Juuling is the act of vaping from a device known under the brand name Juul®. It looks like a flash drive and can be plugged into a laptop’s USB slot to recharge. The Juul® was developed by two men who found it inconvenient go outside to smoke. These devices were originally developed to be used adults using combustible tobacco and “marketed” to those that are committed to stop smoking. However, these devices are becoming increasingly popular to many teenagers.

According to the CDC, during 2016-2017, JUUL Labs’ sales increased 641 percent — from 2.2 million devices sold in 2016 to 16.2 million devices sold in 2017. By December of 2017, JUUL Labs’ sales comprised nearly 1 in 3 e-cigarette sales nationally, giving it the largest market share in the United States.

Both cigarettes and vape liquids contain nicotine, which is highly addictive. The first e-cigarette “Vuse®” was introduced in 2013 therefore there is less than seven years of experience to observe the outcomes.  No deaths have been reported yet, due to lack of long-term exposure data.

National Institute on Drug Abuse points out that the one-year increases in the prevalence of nicotine vaping translate into approximately 1.3 million additional adolescents who vaped in 2018, as compared with 2017. In September 2018, FDA announced the issuance of more than 1,300 warning letters and civil money penalty complaints to retailers who illegally sold JUUL and other e-cigarette products to minors.  These warning letters are important because found that 74 percent of youth who used JUUL reported obtaining the device from a physical retail store, and about half reported obtaining the device from a social source such as a friend or family member.

America’s teens report a dramatic increase in their use of vaping devices in just a single year, with 37.3 percent of 12th graders reporting “any vaping” in the past 12 months, compared to just 27.8 percent in 2017. These findings come from the 2018 Monitoring the Future (MTF)

HOW DO THEY WORK? “Smoking with a battery”

The Juul is battery operated and works by heating a pod of e-liquid or “juice”. This juice contains nicotine, flavorings and other chemicals. Once heated the liquid creates an aerosol or vapor that the user inhales, and the user gets a very quick and powerful burst of nicotine.

DOES JUULING CAUSE ADDICTION?

Each pod contains the same amount of nicotine that is in one pack of cigarettes. The nicotine cycle is one that is most difficult to break because nicotine is vaporized, travels through the body in only 5-10 seconds, crosses into the brain and releases dopamine. This “feel-good” neurotransmitter, dopamine causes one to crave more nicotine. When the nicotine level drops the smoker craves another puff on the Juul. The more addicted one becomes the more one must use to get the same effects. Nicotine suppresses insulin production, which staves off hunger, and provides appetite control. Weight gain is a common excuse people use when asked to consider stopping smoking.

People currently report an uptick in nicotine use when starting to vape because that initial buzz that is seen with cigarettes is not achieved, they use higher doses of nicotine. Vaping solutions are available in different concentrations: 0, 3, 6, 12, 18, 24 and 36 mg/mL. Depending on the flavor, JUUL pods are available in 3% or 5% strength.  Each 5% JUUL pod contains about 40 mg per pod. Each 3% JUUL pod contains about 23 mg per pod.  Each pod contains about .7ml of nicotine.

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Your Thompson Pharmacist is a great resource to help you quit smoking, whether e-cigarettes or regular cigarettes. We have a lot of tools such as Chantix or Wellbutrin that your physician can prescribe or nicotine replacement with patches, gums and lozenges.  Go Ahead and Ask… at Thompson Pharmacy it’s all for YOU!