How Did E-Cigarettes Quietly Get on Regulators' Radar?

More and more people are falling ill after smoking. At least 42 people have died, and thousands have been injured, raising questions about the federal government's role in regulating e-cigarettes as the pandemic worsens. NPR's Jim Zarroli reports.
 
Jim Zarroli, BYLINE: In his sophomore year, Yan Dichev started using a vaping product called a box mod. He liked the clouds of vapor it produced.

YAN DICHEV: My friends and I would just sit in my car, and we - we called it hotboxing. We would just blow a lot of smoke into the car and then roll down the windows, thinking it looked really cool to see the smoke dissipate.

ZARROLI: That was six years ago. By the time he got to college, a nicotine-flavored vaping product called Juul had emerged.

DICHEV: It was really cool to vape at parties in college, especially at parties. If you weren't drinking and weren't smoking, you would vape Juul.

ZARROLI: Juul's marketing aimed to help smokers quit cigarettes, but many non-smokers, especially kids, also started using it, and an industry that didn't exist a decade ago now has about 10 million users. One reason vaping has taken off so quickly is the slow pace of government regulation. In 2009, President Obama signed the Family Smoking Prevention and Tobacco Control Act.

PRESIDENT OBAMA: After decades of effort to protect our children from the harmful effects of tobacco, we have won. Today, change has come to Washington.

ZARROLI: The law meant that the FDA now had the authority to regulate tobacco products, including e-cigarettes, but the time it took to do so has far exceeded expectations. Big Tobacco has many lawsuits that have delayed the regulatory process. Karen Wilson from the American Academy of Pediatrics says regulators simply haven't had the time to focus on e-cigarettes.

KAREN WILSON: I think they are still trying to deal with the implications of the Tobacco Control Act on the tobacco industry - you know, the tobacco industry - let alone trying to figure out how to regulate this emerging business.

ZARROLI: Some lawmakers have complained about inaction. Ohio Democratic Senator Sherrod Brown told NPR that the Obama administration may have been too cautious about allowing Big Tobacco to buy into the newly formed vaping companies.

SHERROD BROWN: The slower these regulations are, the easier it is for young people to get addicted. Allowing this slow-moving government to continue will lead to terrible public health problems.

ZARROLI: By 2016, the FDA finally proposed a rule to regulate e-cigarettes, but the Trump administration decided to delay its implementation until 2022. Scott Gottlieb, who was then head of the FDA, believed there was some evidence that e-cigarettes could help smokers quit.

SCOTT GOTTLIEB: We know that e-cigarettes are not safe, but we believe that e-cigarettes are less harmful than combustible tobacco because, after all, it is not nicotine that causes all the deaths and diseases associated with tobacco use. It is combustion. It is lighting tobacco on fire.

ZARROLI: Gottlieb said that rushing to regulate e-cigarettes could mean hindering the use of products that could legally help people quit smoking. A federal judge has ordered the agency to expedite its review process, but that decision is under appeal. This means that long after the Tobacco Control Act became law, the FDA still has not reviewed hundreds of vaping products to determine whether they are safe. Matthew Myers is the president of the Campaign for Tobacco-Free Kids.

MATTHEW MYERS: Today, nearly a decade after these products were first introduced, not a single e-cigarette has been reviewed for safety, addictiveness, youth abuse potential, or effectiveness in helping smokers quit.

ZARROLI: Each year, more people start using e-cigarettes. A government survey shows that 25% of high school students vaped in the past month, and this year, 42 people have died after vaping. They ingested vitamin E acetate, often used as an additive in THC (the active ingredient in cannabis). Scott Gottlieb stated that the enormous success of Juul has made regulating e-cigarettes more difficult.

GOTTLIEB: Indeed, the driving force behind this development is a single product. It is Juul. And we did not anticipate the explosive popularity of that single product.

ZARROLI: Partly due to Juul, youth vaping has reached an all-time high this year. Juul has tried to address criticism. For example, it no longer advertises in the U.S. and has stopped selling fruit-flavored products that appeal to youth. Nevertheless, Karen Wilson from the American Academy of Pediatrics says many teens have become entrenched nicotine addicts.

WILSON: We see kids using four pods a day, which is equivalent to four packs of cigarettes a day. I mean, the amount of nicotine delivered in these products is staggering.

ZARROLI: This includes Yan Dichev. He is now a senior in college and uses Juul every day.

DICHEV: I have to hit it, so if I don't hit it, I get a little anxious. So I hit it, and it brings me back to myself and makes me feel normal.

ZARROLI: He thinks he will try to quit after graduation, but in the meantime, he says he is already addicted.

Jim Zarroli, NPR News, New York.