The Dangers of JUULing, Vaping…don’t let history repeat itself…

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EVALI, Mint & Menthol, and IQOS

Proactive in your child’s care. Empowering families for over 60 years.

The core mission of MPY is to provide prevention and intervention strategies in matters of health and safety for youth.

Victims of Vaping

Matt MurphyAddicted

Luka KinardAdmitted to Rehab

William Eric Brown1994 - 2019

Wake D'Elia1979 - 2018

JUUL Tank

Huge thank you to the protectors of our children's health!!

Attorney General Maura Healey

Who We Are

Lester Hartman, MD, MPH

Jonathan Winickoff, MD, MPH

Mark Gottlieb, JD

Patrick McKenna

2015 JUUL Launch Party

JUUL is a Genie You Can’t Put Back

Died of smoking related cancer.1929-1993 – Age 63

TBD1984-?

The Dangers of JUULing and Vaping…don’t let history repeat itself…

Audrey Hepburn

Katy Perry

In 1994, 7 Big Tobacco CEOs told Congress under oath that they did not believe nicotine was addictive.

500,000 People Die Every Year From Tobacco Relate Diseases…

Why Age Matters!

• 90% of lifelong smokers began before age 18

• 95% of lifelong smokers began before age 21

Addiction and the Teen Brian

• Until about age 25, the brain is still growing.

• Each time a new memory is created or a new skill is learned, stronger connections – or synapses – are built between brain cells.

• Young people's brains build synapses faster than adult brains.

• Because addiction is a form of learning, adolescents can get addicted more easily than adults.

• The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for addiction to other drugs such as cocaine.

Nicotine – Cocaine ConnectionNEJM - A Molecular Basis for Nicotine as a Gateway Drug;

Sep 4, 2014

“The majority (75.2%) of cocaine users were smoking the month they began using cocaine.”

“We found that the rate of cocaine dependence was highest (20.2%) among users that started cocaine after smoking cigarettes.”

“Dependence was much lower (6.3%) among people who began cocaine before smoking cigarettes.”

HENCE, nicotine appears to be a gateway drug to cocaine and maybe other drugs. But, cocaine is not a gateway drug to nicotine.

The New Look of Nicotine Addiction

FDA Bans Flavored CigarettesExempts Mint and Menthol (2009)

The ban is intended to end the sale of tobacco products with chocolate, vanilla, clove and other flavorings that lure children and teenagers into smoking.

Big Tobaccos First Pivot

Mint and Menthol Continues

The Pivot

Mint and Menthol

In 2009, the FDA took a bold step and banned all flavored cigarettes; however, they exempted mint and menthol.

When all other flavors were removed kids would default to the remaining mint and menthol flavored tobacco.

On average, menthol tobacco smokers delay quitting 20% longer than non-mentholated cigarette users.

Black Lives / Black LungsAmong all racial and ethnic groups in the United States, the black community has carried the greatest burden from tobacco-related diseases.

Black Lives / Black Lungs is dedicated to investigating the successful targeting of the black community with menthol products at the hands of the tobacco industry and how it has affected black lives.

Lincoln MondyFilm Creator

Phillip GardinerAnti-tobacco Activist

Mint and Menthol

Menthol tobacco is a race targeted product, specifically targeting black youth (80% mentholated).

African American youth between the ages 12 and 18 that smoke use menthol cigarettes 90% of the time.

Big Tobaccos Second Pivot

The Devices and Vape Products

The Amount of Nicotine in1 JUUL Pod = 1 Pack of Cigarettes

1 pack contains 20 cigarettes.

The Pivot Cont.

JUUL

Smoke and Mirrors

• The JUUL is the heroin of e-cigarettes.• The pleasure creates a positive feedback loop.• Nicotine causes the release of dopamine in the pleasure centers.Video URL: https://youtu.be/KTKu0A2ym0M

Coincidence?

JUUL Apple

JUUL is promoted as the iPhone of Cigarettes

Teens are voracious for fruity flavors

There are over 8,000 vaping flavors!

#1 Pod of Choice in Schools

JUUL controls 80% of

the vaping market.

Stomach function vs lung function

Eating Mango: Natural! Inhaling Mango: Not Natural.

NEJM Trial

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy (NEJM 2019)

Conclusion:

E-cigarettes were 2 X’s more effective for smoking cessation than nicotine-replacement therapy (NRT), when both products were accompanied by behavioral support.

NEJM – Why Claim is Misleading

In the trial, effectiveness was defined as the abstinence rate of cigarettes and NOT theabstinence rate of nicotine…

80% of the people in the study who were counted as having “abstained” were still consuming nicotine and the other toxins in the E-juice.

NEJM Correction

If the trial redefined effectiveness as the abstinence rate of all nicotine products…

After 1 year…• In the E-Cig group, only 1 in 25 were nicotine free. • In the NRT group, 1 in 10 were nicotine free.

Thus, NRTs are 2½ X’s better than ending nicotine dependencies!

Note: The median age of study participants is 41.

Nicotine LevelsEuropean Tobacco Products Directive (EUTPD)

Set maximum nicotine strength limits at 20 mg/mL in e-cigarette liquids

In the US

JUUL offers two nicotine level products:

- 5% which is *59* mg/mL

- 3% which is 35 mg/mL

In the US high nicotine products are the norm.

In the UK and across Europe, the average nicotine levels are about a third to a half of that in the US.

Hence, JUULing in the US is more addictive than JUULing in the UK and Europe, and extrapolating conclusions from British literature to US JUULing is irrelevant!

State Ranking of Frequency of Teen Vaping

** Legalized Marijuana; *Legalized RX Marijuana

https://www.cdc.gov/healthyyouth/data/yrbs/2017_tables/tobacco_use.htm#t66_down

Highest States Lowest States26.2%Colorado ** 7.6%Utah25.5%Hawaii * 9.0%Iowa24.7%New Mexico * 9.4%Nebraska23.8%New Hampshire * 10.3%Texas22.5%Montana * 10.6%Kansas22.2%Louisiana * 10.9%Missouri22.1%North Carolina 11.3%Pennsylvania *20.6%North Dakota * 11.5%Tennessee20.1%Massachusetts ** 11.6%Wisconsin20.1%Rhode Island * 11.8%Virginia

Paralleling Behavior Todayto Big Tobacco

(Lancet Respiratory Medicine)

• In Britain, Stoptober has become Swaptober.

• Originally, October was a time when Brits would try and stop smoking.

• However recently a vape company marketed and sponsored an event and changed the terminology to Swaptober aka switch your cigarette for an E-Cigarette.

Pod systems, JUUL, Phix, Suorin, MyBlu…

Imperial Tobacco Group

Small tank.

Altria

Nicotine is NOT Harmless

• Highly addictive substance the teen brain is thirsty for.

• It raises heart rate and blood pressure.

• E-Cigarettes doubles your risk of heart attack.

• Emerging evidence that it can rewire the vulnerable teen and young

adult addiction centers of the brain as well as effecting the executive

function of the brain.

• Gets processed in the liver into nitrosamines that are shown to cause

cancer. Not clear yet if nicotine causes cancer later in life.

• It causes temporary night blindness.

Harm of Nicotine Without the E-cig Toxins

1. School performance dropping, constantly going to a bathroom to use

2. Effects your DNA and causes abnormal cells to proliferate which can be a carcinogen

3. Exacerbate mood disorders in teens

4. Presence of the carcinogen N’-Nitrosonornicotine is in the Saliva and urine

It’s NOT just Nicotine and Water…

Ingredients

1. Acrolein aldehydes (Glyerol)

2. Chromium and Nickel

3. Flavors:

1. “Natural fruit flavors”?

2. aldehydes-diacetyl

4. Propylene glycol (formaldehyde)

5. Vegetable oil

6. “Natural oils”?

7. Benzoic Acid (JUUL)

While these may be okay for your stomach – we have no idea about how they will effect your lungs!

Two Forms of Nicotine

Basic pH

Irritatingto throat

More vapor exhaled

Acidic pH

Smoother “hit” to throat

Less vapor exhaled

More nicotine gets into blood

+ BENZOIC ACID

Brain Health - Ask Yourself…

Don’t you want a strong brain like a 6 pack abs?

&

“Healthy” Vapers Airways Look Abnormal!

Non-Smoker Vaper Smoker

Devastating Effects of Nicotine

Do you really want to be seen as the vaping guinea pigs and lab rats of the

future?

The Price of Cool: A Teenager, a Juul and Nicotine Addiction

E-cigarettes may help tobacco smokers quit. But the alluring devices can swiftly induce a nicotine habit in teenagers who never smoked.

Matt Murphy, a 19 year old from Reading MA, would come to hate himself for being dependent on the tiny device, which he nicknamed his “11th finger.” Yet any thought of quitting made him crazy-anxious.

• Knew vaping habit was out of control when it started costing $150 a week

• Was doing anything and everything to get money

• Went from being a straight-A student to an F student

• Seizure landed him in ER • Ended up spending 40 days in

an addiction rehabilitation program before he was able to kick his habit.

Teen Vaping Has Created Addicts With Few

Treatment Options

Luka Kinard

Texas man dies after e-cigarette explodes in his face

• His e-cigarette exploded and cut his carotid artery in his neck.

• The explosion was so strong that it melted the ashtray in his car.

• This was a mod vape and not a JUUL.

Similar to this

William Eric Brown

Vape pen explosion fatally wounded St. Petersburg man

• Vape pen exploded, firing pieces of the device into his brain

• The explosion was so strong it set his house on fire

• This was a mod vape and not a JUUL.

Similar to this

Wake D'Elia

Young people use technology for health.. and quitting

On Reddit:

Young people use technology for health.. and quitting

On Twitter

JUULs Spoken and Unspoken Spin

Spoken

“Harm reduction”

Unspoken

“Addiction initiation”

What the FDA, HHS, and the President have proposed…

• Announced plans for the temporary removal of flavored e-cigarettes and nicotine pods from the market.

• However, this is not a "ban" as was cited by the President.

• JUUL and other vaping companies will be able to submit their own safety data for potential approval by the FDA to re-enter the market starting in May of 2020.

• The plan made no mention of a ban on mint and menthol combustible tobacco products.

JUUL Sale to Altria

JUUL employees get an average of $1.3 Million bonus thanks to Big Tobacco … Altria (AKA Phillip Morris) purchasing 35% of JUUL’s stock.

But How Does this Affect You Now?

Cost to JUUL for a year: $1,459.08

1 Pack every 4 days = 91.25 packs @ $15.99

You could buy….

5 PS4s

14 Day Trip from Boston to Sydney on June 4th.

3 Front Row tickets to Bruins Playoff Game 1

Tickets to both weekends of Coachella.

6 Floor Tickets to Taylor Swift

E-Juice Now Comes in….

• Vitamins

• Cialis (ED)

• Essential Oils

• Adderall

Dab Pens (Marijuana Vapes) Come in All Sizes!

New Heat Not Burn

JUUL IQOS

New Heat Not Burn

JUUL Pods IQOS HEETS

JUUL Launch Party

IQOS Launch Party

Catania, Italy (2017) Kyiv, Ukraine (2017)

Cape Town & Johannesburg Cape Town & Johannesburg

Acute Lung Injury from E-Cigarettes

• E-cigarette or Vaping product use Associated Lung Injury (EVALI)

• JUUL accused of selling 1 Million tainted pods

EVALI

See CDC website for updates

• As of October 30th – there were 1,604 reported cases of EVALI across 49 states, with 34 deaths.

• The youngest death was in 17 year-old patient

LegendNumber of lung injury cases per state

What Happening in the State

• As of now, 38 cases of vape-related pneumonias

• 6 teens hospitalized at Boston Children’s Hospital

• Two deaths reported in Massachusetts

Potential Lung Diseases Caused by Vaping

– Lipoid Pneumonias

• Fatty deposits from vegetable oil in the lungs

– Allergic Eosinophilic Pneumonias

• Maybe due to the food products or chemicals in vape

– Popcorn Lung

• From diacetyl in vaping products

– Chemical Pneumonias

• Unknown causes

3rd Hand Vape

• Heavy metals effecting infant and child brain development by both inhalation and ingestion

Harms of Mint and Menthol

1. When candied cigarettes were banned in 2009, the Tobacco industry negotiated the exemption of mint and menthol – they knew what they were doing for their business. Mint is the number one flavor JUUL sells as per JUUL inventor and CPO James Monsees and high schoolers number one choice is mint.

2. Other flavors are mixed with menthol to attract youth such as mentholated mango dream cream.

3. One of the purposes of mint and menthol is to numb the back of the throat to suppress any coughing reflex and enables youth addiction to nicotine.

4. Big Tobacco intentionally marketed menthol cigarettes to black youth and 90% of black teen cigarette use is mentholated cigarettes.

5. The decision to quit mentholated cigarettes takes 20% longer than nonmentholated cigarettes.

6. When surveyed at least 65% of youth would stop cigarettes if menthol was removed. 90% of what vaping teens use is flavored.

7. Banning menthol in Ontario almost doubled the quit attempt rate in adults.8. The FDA banned pulegone - a carcinogen found in mint (peppermint, spearmint,

etc) and is detected in large doses in mint and menthol flavored e-cigarettes and smokeless tobacco.

Approved Quitting Programs

www.ThisIsQuitting.com www.BecomeAnEx.org www.MakeSmokingHistory.org

What You Can Do Nationally!

Request a ban on all flavored tobacco products – including Mint and Menthol!

Send emails to…

Norman Sharpless, MD

Acting Commissioner of the FDA

CommissionerFDA@fda.hhs.gov

Mitchell Zeller, JD

Director of Tobacco Control

Mitchell.Zeller@fda.hhs.gov

What You Can Do At the State Level!Send emails to…

Robert DeLeo

Speaker of the House

Robert.DeLeo@mahouse.gov

Aaron Michlewitz

House Ways and Means Chair Aaron.M.Michlewitz@mahouse.gov

Tell them you support HOUSE BILL 1902 & SENATE BILL 1279!Tell them you want Mint and Menthol included in their flavor ban!

What You Can Do At the Local Level!Send emails to…

Contact your local Board of Health to request a ban on all flavored tobacco products (including mint and menthol)!

Keep Your Eye on the BallPredictions on how JUUL will Attempts to Distract

• JUUL will likely accept no blame for the recent vaping lung diseases, they will continue to blame incidents of tainted 3rd party “street pods”.

• That’s like saying…

– We got a bad batch of heroine…

– We made the gun, you bought the bullets…

Keep Your Eye on the BallPredictions on how JUUL will Attempts to Distract

• JUUL will attempt to distract public from emerging research that is beginning to show how dangerous JUUL is…– Emerging evidence that 150 seizure disordered are

associated with e-cigarettes and JUUL– Heating coils include chromium and nickel, which leach – My experience and prediction is that e-cigarettes and JUUL

will damage arteries, that will lead to strokes and heart attacks

• JUUL is an adolescent nicotine addiction initiation device, not an adult smoking cessation device

REMEMBER THESE BILLS

• Bans all flavored nicotine products, including mint and menthol.

Contact your state legislator today - tell them you support these bills!https://malegislature.gov/Search/FindMyLegislator

• Bans all flavored nicotine products, including mint and menthol.

Proactive in your child’s care. Empowering families for over 60 years.

www.wmpeds.com

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