Updates: Can Juul Cigarettes Prove They Benefit Public Health?

Even if you’ve been deliberately trying to follow the recent events transpiring between Juul e-cigarettes and the US Food and Drug Administration (FDA), it can be hard to keep up. 

Here’s what you need to know about the public health effects of e-cigarettes (also known as electronic cigarettes, vape pens, or vaping devices), the status of the FDA ban on Juul e-cigarettes, and whether e-cigarettes have been able to establish themselves as a method of tobacco cessation, and what is most likely to happen next. 

The Significance of E-Cigarettes When it Comes to Public Health 

Juul’s e-cigarettes, and other similar devices, have gained popularity in recent years because they do not burn tobacco—instead, they burn a heated liquid that turns into vapor. E-cigarettes can mimic the act of smoking, but they don’t carry as much risk of exposure to certain chemicals in traditional combustible cigarettes that are known to cause disease. For this reason, they have been marketed as a helpful bridge away from nicotine cigarettes for current smokers. However, most e-cigarettes still contain nicotine, which is highly addictive. They have caused many non-smokers (particularly adolescents and young adults) to become addicted to this substance when they may not have otherwise. There has also been a concern over the past three years about e-cigarette-related lung injuries, as well as research investigating the relationship between e-cigarettes and lung disease and heart disease. 

Recapping the Recent FDA Ban, Appeal, and Suspension of the FDA’s Order 

On June 23rd, the FDA instructed Juul to stop selling its vaping devices and flavored cartridges in US markets. On June 24th, Juul filed an emergency motion to hold this ban (allowing it to continue selling its products in US markets) while it appeals the FDA’s decision. The appeals court agreed with Juul, temporarily putting a hold on the FDA’s ban on US sales. According to reporting by National Public Radio (NPR), Juul officials argued that the FDA could not substantiate that there was a “critical and urgent public interest” in so quickly removing its devices from the market because the agency had allowed them to be sold during a review process transpiring over the past two years. 

On July 5th, the FDA then suspended its order (issuing an administrative stay), noting that it will continue conducting further review given scientific issues that are unique to Juul’s application for authorization. This means that, for now, Juul may continue selling its e-cigarettes in US markets. On July 6th, both companies agreed to pause their appeals court fight while the FDA conducts this further review. 

The Impact of the E-Cigarette Industry on Smoking Cessation 

Regardless of whether or not the FDA’s original ban (and Juul’s subsequent appeal and the FDA’s subsequent suspension of their original order) is eventually found to be warranted, underlying the events that have transpired is a fundamental question of how Juul e-cigarettes—and the e-cigarette industry at large—impact public health. A recent Cochrane review of 61 studies evaluating e-cigarettes as a method of smoking cessation found that three out of every one hundred people are more likely to quit smoking using e-cigarettes than using nicotine replacement therapy (such as gum or patches). Compared to behavioral support alone or no support, e-cigarettes were even more likely to help people quit smoking, assisting six more out of every one hundred people. However, because many of the studies evaluated had problems with imprecision and bias, this finding is less certain. 

How Can E-Cigarette Companies Show That Their E-Cigarettes Benefit Public Health? 

To continue selling vaping devices and flavored cartridges in the U.S., e-cigarette companies need to show that their devices are beneficial to public health. This means that they must be able to prove that their products help adults who are addicted to nicotine and smoking traditional cigarettes quit or reduce their reliance on traditional cigarettes. Additionally, e-cigarette companies also need to be able to show that their devices do not pose harm to anyone’s health. This is particularly relevant in the case of teenagers, many of whom have no history of cigarette smoking but who may begin their initial relationship with nicotine via an e-cigarette and then become hooked. 

What Will Happen Next with Juul and the FDA? 

The FDA is currently reviewing Juul’s marketing application to keep its products in U.S. markets. Once it completes this review, the FDA will signal whether Juul can continue selling e-cigarettes and cartridges in the U.S. It’s worth noting that Juul is not the only e-cigarette manufacturer, and since 2020, other e-cigarette companies have also been under FDA review to evaluate whether their products provide an overall benefit to public health (and some have been cleared to continue selling e-cigarettes in the U.S.). 

References 

[1] Outbreak of lung injury associated with E-cigarette use, or vaping. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html 

[2] ‘Vaping’ Increases Odds of Asthma and COPD. https://www.hopkinsmedicine.org/news/newsroom/news-releases/vaping-increases-odds-of-asthma-and-copd 

[3] Association Between E-Cigarette Use and Cardiovascular Disease Among Never and Current Combustible-Cigarette Smokers. https://pubmed.ncbi.nlm.nih.gov/30853474/ 

[4] Juul can keep selling its vaping products in the U.S. — for now. https://www.npr.org/2022/06/24/1107605984/juul-fda-vaping-e-cigarettes?utmsource=newsletter3992&utmmedium=email&utmcampaign=nphic-news-highlights 

[5] FDA Denies Authorization to Market JUUL Products. Currently Marketed JUUL Products Must Be Removed from the US Market.https://www.fda.gov/news-events/press-announcements/fda-denies-authorization-market-juul-products 

[6] Electronic cigarettes for smoking cessation. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub6/full 

[7] Will Vaping Lead Teens to Smoking Cigarettes? https://www.hopkinsmedicine.org/health/wellness-and-prevention/does-vaping-lead-to-smoking