![]() ![]() JUUL’s share of the whole e-cigarette market is 49.7%. JUUL remains the most popular reusable e-cigarette device, with 51.6% of the reusable market share in April 2021. The most popular, JUUL, is a pre-filled pod system containing nicotine salts that emerged in 2015 and quickly established itself as a leading e-cigarette product.The latest generation of products feature a sleek, high-tech design and are disposable or use easily rechargeable batteries.E-cigarettes first entered the market in 2007 and have evolved many times since then, with older versions designed to resemble regular cigarettes, cigars, pipes, pens, and even USB flash drives.Unlike in Europe, where e-cigarette nicotine concentrations cannot exceed 2%, there are no nicotine concentration restrictions in the United States. Higher nicotine e-cigarettes have driven the surge in e-cigarette sales in recent years, with those containing at least 4% nicotine comprising nearly three-quarters of the e-cigarette market in 2018.The nicotine salt formulas allow for much higher levels and efficient delivery of nicotine with less irritation compared to earlier generations of e-cigarettes - prompting questions about the use, purpose and safety of this novel form of nicotine.The most recent generation of e-cigarettes on the market, which include pre-filled pod systems like JUUL, refillable systems like Suorin Drop and Kandypens, and disposable systems like Puff Bar, use nicotine salts in the e-liquids. Older generations of e-cigarettes used a form of nicotine called free-base nicotine.The CDC states, “it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants.” It continues to advise non-smokers to avoid vaping of any variety and especially products purchased “off the street.” While cases of EVALI have decreased since the initial outbreak, the California Department of Public Health reported eight cases of EVALI in April 2020, the first cases reported to them since February 2020.Because 82% of the cases with specific substance use information available involved individuals who reported using THC-containing products, the FDA has recommended that consumers avoid purchasing vaping products of any kind on the street, using THC oil, or modifying store-bought products. Vitamin E acetate was present in bronchoalveolar-lavage (BAL) fluid in 48 out of 51 EVALI patients from 16 states, but it was not found in BAL fluid from the comparison group of 99 healthy individuals. Data from a February 2020 study linked EVALI cases to vitamin E acetate, an additive in THC-containing vaping products. ![]() As of February 18, 2020, a total of 2,807 hospitalized EVALI cases had been reported to the CDC in the U.S. ![]()
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