Victims of Vaping

Matt MurphyAddicted

Luka KinardAdmitted to Rehab

William Eric Brown1994 - 2019

Wake D'Elia1979 - 2018

Juul Tank

Who We Are

Lester Hartman, MD, MPH

Jonathan Winickoff, MD, MPH

Mark Gottlieb, JD

Patrick McKenna

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

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.

Darth VAPOR

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 too 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

Black Lives / Black Lungs

Video URL: https://youtu.be/hchZrPY7IOM

Black Lives / Black Lungs

Video URL: https://youtu.be/ATbNGu25HXY

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.

Mint and Menthol

Video URL: https://youtu.be/TP1mzyzaNqU

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

Teens are voracious for fruity flavors

There are over 8,000 vaping flavors!

Favorite JUUL Pod Flavors

Coincidence… who’s using these…

Stomach function vs lung function

Eating Mango: Natural! Inhaling Mango: Not Natural.

Hence

• Like tobacco in the beginning of the 20th

century, the intent is to addict you.

• This device is designed to make maximal profits by claiming it is a cessation device but really it is not!

“A teen nicotine addiction initiation device.”

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 Wrong

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!

The 2017 YRBS found past 30 day electronic vapor product use by 9th - 12th graders highest in 9 of 10 states

that legalized marijuana (all >20%).Note that 11 States didn’t ask this question (AL, GA, IN, MN, MS, NJ, OH, OR, SD, WA, WY) ** Legalized Marijuana; *Legalized RX Marijuanahttps://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

Nicotine is NOT Harmless

• Highly addictive substance to nicotine thirsty teen brain.

• 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.

• 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

Harm of E-cigarettes

1. Doubles your risk of a heart attack

2. Most likely the nicotine form in E-cigs is more addictive than tobacco cigarettes

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!

Brain Health - Ask Yourself…

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

&

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

Are E-Cigs being sold as the methadone of tobacco?

JUULs Spoken and Unspoken Spin

Spoken

“Harm reduction”

Unspoken

“Addiction initiation”

What the FDA is doing…

• The FDA wants to ban menthol and mint from cigarettes.

• The FDA is not attempting to ban mint and menthol as flavors in vape!

What JUUL is doing…

• Claiming to suspend sale of all flavors to retailers / convenience stores (except for mint and menthol)

• However,– They have not stated that it will permanently ban it’s other

flavors from retail / convenience stores. – Internet sales of their flavored pods continue.

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.

Stock sale

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

What You Can Do!

– Request a ban on internet sales for vape and pod devices!

– Lawsuit against the FDA by AAP, AMA, ACS, AHA, ALA, TFK

Send emails to…

Scott Gottlieb, MD

Commissioner of the FDA

CommissionerFDA@fda.hhs.gov

Mitchell Zeller, JD

Director of Tobacco Control

Mitchell.Zeller@fda.hhs.gov

DON’T FORGET:JUUL IS A NICOTINE INITIATION DEVICE, NOT AN ADULT CESSATION DEVICE.

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

www.wmpeds.com

Questions & Comments