The settlement of North Carolina’s lawsuit against Juul announced today underscores Juul’s culpability in causing the epidemic of youth e-cigarette use and addiction in the United States and the responsibility of the FDA to deny Juul’s application to continue selling products that put our kids at risk. This settlement highlights the role that Juul’s flavored products, including menthol-flavored products, and its high-nicotine products played in creating and now sustaining the youth e-cigarette epidemic.
As North Carolina Attorney General Josh Stein said today, it is time for the FDA to act because it is the FDA that has the authority to prohibit the sale of the flavored and high-nicotine e-cigarettes that are fueling the youth e-cigarette epidemic. It would be a complete abdication of the FDA’s responsibility to protect America’s kids and public health if the FDA were to allow Juul to continue to sell the products that caused this youth addiction epidemic in the first place, especially in light of Juul’s wrongdoing that led to today’s settlement.
We applaud Attorney General Stein for his leadership in holding Juul accountable for causing the youth e-cigarette epidemic and urge other state attorneys general to build on this settlement. The North Carolina settlement has positive elements, including marketing and sales restrictions and public disclosure of Juul documents uncovered in this lawsuit. However, marketing and sales restrictions are not enough to end this youth addiction crisis, as demonstrated by the fact that Juul remained the most popular e-cigarette brand among kids in 2020 even after the company voluntarily adopted similar restrictions. Attorney General Stein is absolutely right that while state attorneys general can make meaningful change, only the FDA can take comprehensive action that applies to all manufacturers. We won’t end this epidemic until the FDA eliminates the flavored and high-nicotine products that are addicting our kids.
There is no question that Juul drove the huge increase in youth e-cigarette use from 2017 to 2019, when e-cigarette use among high school students more than doubled (from 11.7% to 27.5%). Juul recklessly and knowingly addicted kids with a combination of appealing flavors including menthol, technological innovations that quickly delivered massive doses of nicotine, and slick marketing campaigns featuring attractive young people. In 2020, Juul remained the most popular e-cigarette brand among kids. Now Juul has applied to the FDA to continue selling e-cigarettes that contain as much nicotine as a full pack of 20 cigarettes, putting kids at risk of rapid addiction, and it wants to sell these products with menthol flavor that appeals to and is widely used by kids. The FDA must reject this application and stop Juul from addicting even more of our kids.
The evidence is clear that Juul’s high-dose nicotine products caused the youth e-cigarette epidemic and that the introduction of these high-nicotine products is directly associated with the unprecedented growth in youth e-cigarette use starting in 2017. The evidence is also clear that menthol flavor appeals to kids and kids shifted to menthol products after the FDA prioritized enforcement against other flavors in pre-filled cartridge products (like Juul) starting in February 2020. In 2020, 37% of all high school e-cigarette users used menthol products, according the 2020 National Youth Tobacco Survey. Among all youth who use flavored, pre-filled cartridge products like Juul, 44.5% used menthol products.
We won’t end the youth e-cigarette epidemic as long as flavored and high-nicotine products, including Juul, continue to be sold. The FDA must not greenlight the continued sale of the very products that caused this epidemic in the first place and continue to endanger our kids today.