Nicotine delivery and users’ reactions to Juul compared with cigarettes and other e‐cigarette products

Abstract

Aims To assess the pharmacokinetic (PK) profile of, and users' reactions to, Juul (59 mg nicotine/ml) as an indication of its therapeutic and dependence potential. Design Cross-over, within-subjects study in which participants attended after overnight abstinence on separate sessions and smoked a cigarette or used Juul or eight other types of e-cigarettes (EC) ad libitum for 5 minutes. The Juul product used was the version available in the United States that has more nicotine in the eliquid than the one available in the European Union. Setting Laboratory setting in the United Kingdom. Participants Twenty dual users (smokers who also vape) provided data on Juul and cigarettes, with eight also providing data on other EC products. Measurements At each session, number of puffs taken was counted during the 5-minute product use period and blood samples were taken at baseline and at 2, 4, 6, 8, 10 and 30 minutes after starting smoking/vaping and analysed for nicotine. Participants also monitored their urges to smoke and rated the products on a range of characteristics. Findings Juul's PK profile was close to the PK profile of cigarettes [maximum concentration (C max ) = 20.4 versus 19.2 ng/ml; time to maximum concentration (T max ) = 4 versus 6 minutes; area under the curve (AUC): 307.9 versus 312.6, respectively]. Compared with other EC products, Juul had shorter T max [4 minutes, (IQR = 2.5-4.0) versus 6.3 minutes, (IQR = 4.7 -8.1), P = 0.012] and higher C max (28.9 (SD = 15.6) versus 10.6 (SD = 5.5), P = 0.013) despite a lower number of puffs (12.5 (SD = 4.2) versus 17.0 (SD = 4.2), P = 0.084). Compared with other e-cigarette products, it also provided faster reduction of urges to smoke and obtained more favourable subjective ratings.Conclusion Juul's PK profile and user ratings suggest that it could be more effective than other EC products in helping smokers to quit smoking, but it may also have a higher potential to generate regular use in non-smokers.

Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16

“…The e-cigarette market is highly diverse and is evolving. As such, the findings here may not extend to newer, more efficient e-cigarette designs, some of which may deliver nicotine as effectively as cigarettes [39]. Our data show that the majority of smokers try to quit without use of an e-cigarette or pharmaceutical aid, and this is as effective as any other method.…”

Nicotine pharmacokinetics of electronic cigarettes: A pooled data analysis from the literature

“…PLOS One [ 37 ] 24 10 (41.7 %) 24 10 (41.7 %) 2020 Hajek, et al, (2020). Addiction [ 2 ] 40 40 40 40 Maloney, et al, (2020). Tobacco Control [ 38 ] 72 72 72 0 (0.0 %) Total Total 2630 2553 (97.1 %) 2058 (78.3 %) 1337 (50.8 %) …”

“…The pharmacokinetics of nicotine delivery from electronic cigarettes has been proposed to be a key performance metric; in particular maximum blood concentration (Cmax), time to maximum blood concentration (Tmax), and overall blood nicotine exposure (as defined by the area under the concentration-time curve (AUC)) [ 1 ]. It is thought that the closer the pharmacokinetic profile is to that obtained through cigarette smoking, the more likely it is that electronic cigarettes will be accepted as satisfying alternatives to cigarettes among smokers [ 2 ].…”

Response to Flavored Cartridge/Pod-Based Product Ban among Adult JUUL Users: “You Get Nicotine However You Can Get It”

“…These devices have a sleek design, user-friendly functionality, and an array of flavor options [ 3 ]. They are also known to deliver nicotine in doses that are higher than many earlier devices [ 4 , 5 , 6 ]. This type of device was made popular by the market leader called JUUL [ 7 ].…”

“…In 2020, 19.6% of high school students and 4.7% of middle school students in the United States reported using an e-cig in the past 30 days, which makes e-cigs the most widely used tobacco product in this age group [ 26 ]. Most youth e-cig users report using pod-based products [ 26 , 27 ], like JUUL, which are capable of delivering nicotine in high doses that are similar to a cigarette [ 5 , 6 ]. In addition, the majority of youth e-cig users reported initiating e-cig use because of the appealing flavor options [ 28 ].…”