JUUL and E-Cigarette Side Effects

Serious vaping side effects associated with JUUL and other e-cigarettes include severe and sometimes deadly lung injuries, respiratory problems, seizures, nicotine addiction, nicotine poisoning and an increased risk of heart conditions and stroke. The U.S. Surgeon General has reported that e-cig users are being exposed to potentially harmful chemicals, including some linked to serious lung disease.

Juul E-Cigarette
JUUL and E-Cigarette Side Effects
  1. ADDICTION Chronic use of JUUL and other e-cigarettes may lead to nicotine addiction.
  2. LUNG INJURIES AND RESPIRATORY PROBLEMS Vaping may cause severe lung injury and can result in bronchiolitis obliterans organizing pneumonia, popcorn lung, increased cardiovascular risks and even death.
  3. NICOTINE INTOXICATION Overexposure to nicotine in vaping liquid can result in nicotine poisoning.

The soaring popularity of JUUL has exposed potential health risks of the e-cigarettes once marketed as safer than tobacco cigarettes.

The U.S. Food and Drug Administration began regulating e-cigarettes in mid-2016. Before that, little, if anything, was done to establish guidelines regarding sales, marketing and manufacturing of the popular devices and their e-liquid device counterparts.

Therefore, little was known about possible dangers, including a faulty design that contributed to lithium-ion battery explosions.

But over time, investigations have linked the devices to a number of potential health hazards.

Researchers found that users are being exposed to an assortment of potentially harmful chemicals, including nicotine and formaldehyde, as well as heavy metals, such as lead. One chemical in many flavored e-liquids, diacetyl, has been linked to an incurable lung condition known as popcorn lung.

In 2019, the FDA catalogued more than 120 reports of e-cig users having seizures or other neurological reactions since 2010.

And the FDA, Centers for Disease Control and Prevention and several state health departments launched an investigation into a deadly lung condition directly linked to vaping that had sickened hundreds of people and killed several more.

The U.S. Surgeon General concluded that e-cigarette users were being exposed to potentially harmful chemicals, including:
  • nicotine
  • carbonyl compounds
  • volatile organic compounds

Additionally, the CDC has released data showing that e-liquid poisonings are “rapidly increasing.”

“There are several different side effects that have already been seen in terms of various lung diseases,” Dr. Joshua Mansour, a Los Angeles-based oncologist, told Drugwatch. “We’re also seeing that the overindulgence of nicotine in general is leading to increased heart rates, profuse sweating, dizziness, and perhaps even seizures though there’s no conclusive causation yet.”

Common Reactions to JUUL and Other E-Cigarettes

The liquid in electronic cigarettes typically delivers a vaporized mixture of nicotine, propylene glycol, glycerin, various flavorings and other chemicals.

E-liquid
E-liquid typically contains nicotine, propylene glycol and glycerin, plus various flavorings.

According to a 2014 study in the journal Tobacco Control, both glycol and glycerin are “known upper airway irritants” that can cause irritation of the throat and mouth and trigger dry cough.

Studies have found that these common side effects are more pronounced the first time a person uses an e-cigarette but appear to diminish with continuing use.

Long-Term Risks of Vaping

While serious adverse reactions are rare, the long-term risks of vaping aren’t entirely known. Although the devices contain fewer than the 7,000 chemical ingredients found in traditional cigarettes, they have been found to contain a variety of potentially harmful substances, including cancer-causing chemicals.

“We won’t fully understand the range of vaping’s harmful effects for some time to come,” Mansour said. “Just like tobacco and cigarettes in the past, it took several decades for us to really understand what the full harmful effects of those products were.”

And evidence suggests e-cigarette use may be related to multiple long-term health problems.

Potential Long-Term Health Problems Related to Vaping
  • Lung injuries
  • Respiratory problems
  • Heart attack or stroke
  • Reproductive issues
  • Low birth weight related to vaping while pregnant

Source: Live Science, May 16, 2016

Doctors now consider whether vaping may be related to their patients’ medical problems. Many have started asking patients if they vape, just as they have asked if they smoke for years.

“That is something I and other doctors currently do, and I think it is something that physicians should ask, especially since we know the detrimental effects that have occurred because of vaping,” Mansour said.

Health care workers started noticing mysterious vaping-related lung injuries in March 2019. State and federal public health agencies launched investigations into the outbreak in mid-2019. The CDC and state health departments created case definitions to classify confirmed and probable cases in a consistent manner.

The CDC named the new condition EVALI, which stands for e-cigarette, or vaping, product use associated lung injury. Doctors at the Mayo Clinic said the lung condition resembled a chemical burn to the lungs. They had examined tissue samples from 17 patients, according to The New York Times.

As of Oct. 29, 2019, the CDC had confirmed 1,888 cases of EVALI in 49 states, the District of Columbia and the U.S. Virgin Islands. At least 37 people had died, and the CDC expected the number of injuries and deaths to continue rising. The CDC routinely updates the extent of the outbreaks.

The outbreak focused new attention on vaping’s hidden dangers, shining a light on a nearly decade-long delay in aggressively regulating the vaping industry.

“I think if there had been better regulation of e-cigarettes, we wouldn’t see as many cases,” Mansour said. “When something like vaping is regulated, it’s harder for people to get, harder for children to get. That definitely plays a role in decreasing the likelihood of patients being hospitalized.”

The cases reported to the CDC included those that had happened prior to the outbreak. But the agency did not say at the time how far back the cases went. In September 2019, Bloomberg reported that it discovered at least 15 vaping-related lung injuries reported in medical literature prior to the outbreak. Those cases went back to 2011.

Virginia doctors in a 2016 case study named an e-cig user’s condition “vapor lung,” according to the Bloomberg report.

A report on early cases published in the New England Journal of Medicine found 94 percent of the people who developed the condition required hospitalization. Nearly 1 in 3 needed a mechanical ventilator or other medical intervention to keep them breathing.

What Causes Vaping-Related Lung Injuries?

Researchers suspect the condition results from chemical exposure during vaping, but they have not been able to identify exactly what chemical may be involved. No one product or substance has been linked to every case the agency has investigated.

Most patients reported vaping THC, the active ingredient in marijuana. But as of Oct. 15, 2019, 11 percent of 867 patients interviewed reported vaping only nicotine. While the CDC said THC is suspected of playing a role in the outbreak, investigators are looking at possible chemical combinations.

The CDC recommended that until researchers isolate the cause, people should avoid using e-cigs. If people continue vaping, they should notify a doctor if they experience any health problems or symptoms.

Symptoms of E-Cigarette-Related Pulmonary Condition
  • Abdominal pain
  • Chest pain
  • Coughing
  • Diarrhea
  • Fatigue
  • Fever
  • Nausea
  • Shortness of breath
  • Vomiting

Source: New England Journal of Medicine

As of mid-October 2019, the CDC reported that roughly 70 percent of the people who developed the condition were male. About 79 percent of patients were under the age of 35, and the average patient age was 23. The youngest patient was 13, according to the agency.

Lawsuit Information
Young adults and parents of teens filing lawsuits claim vaping led to seizures, serious lung disease and strokes.
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Popcorn Lung and Other Serious Respiratory Problems

Although rare, some individuals have developed severe respiratory problems from vaping. Chemicals commonly contained in vaping liquid have been linked to rare and irreversible lung diseases. Scientists say more research is urgently needed to determine what health risks the devices pose.

Potential Respiratory Risks of Vaping
Bronchiolitis obliterans
Also called popcorn lung, it affects the lung’s smallest airways, the bronchioles. It may cause damage and inflammation leading to scarring that blocks the bronchioles, according to the National Institutes of Health.
Bronchiolitis obliterans organizing pneumonia
Abbreviated as BOOP, it affects the bronchioles, the tiny air sacs along those air passages called alveoli and the walls of the small bronchi. It may also be called cryptogenic organizing pneumonia, or COP, according to the American Lung Association.

Popcorn Lung

Bronchiolitis obliterans’ nickname, popcorn lung, came about after eight former workers of a microwave popcorn-processing plant became ill with the disease in May 2000. Their illness was linked to their inhalation of diacetyl, which is used to give popcorn and other foods their buttery taste.

Call for Urgent Action
Harvard researchers have called for urgent action to evaluate the extent of diacetyl exposure and related flavoring compounds in e-cigarettes. The chemicals have been linked to a rare and serious lung disease called bronchiolitis obliterans, or popcorn lung.
Source: Environmental Health Perspectives

Harvard University researchers tested 51 types of flavored e-cigs and cartridges for diacetyl and two other chemical substances called 2,3-pentanedione and acetoin. The researchers detected at least one of the three flavoring agents in 92 percent of the flavors tested.

The chemicals are used in the manufacture of many flavored foods, but also are known to cause bronchiolitis obliterans when heated, vaporized and subsequently inhaled.

Symptoms of the condition — such as coughing, wheezing and shortness of breath — are often mistaken for other lung diseases, such as chronic obstructive pulmonary disease, referred to as COPD, and asthma.

E-Cig User Diagnosed with BOOP

While the Harvard researchers suggested e-fluid chemicals could cause popcorn lung, doctors have actually diagnosed bronchiolitis obliterans organizing pneumonia (BOOP) in an e-cig user.

A 2016 case report published in the American Journal of Respiratory and Critical Care Medicine describes a 27-year-old man with no other health problems who went into respiratory failure after seven months of using an e-cigarette. According to the case report, he was using the device in an attempt to stop smoking traditional cigarettes.

The man’s symptoms included shortness of breath, a bloody cough and a fever. A CT scan of his chest revealed “innumerable” nodules in his lungs. The patient had to be intubated and placed on a breathing machine.

A lung biopsy eventually showed he was suffering from BOOP, which his doctors concluded was caused by his e-cigarette use. He recovered with high-dose steroid treatment and was discharged from the hospital two weeks later.

There have also been reports in medical literature of individuals developing acute respiratory distress syndrome (ARDS) from using e-cigarettes. The life-threatening condition, also known as wet lung, occurs when fluid builds up in the lungs’ air sacs and disrupts oxygen exchange with the bloodstream.

Seizures and Other Neurological Conditions

The FDA alerted doctors and health care providers in April 2019 that e-cigarette use may be associated with seizures, a known symptom of nicotine toxicity.

The agency had uncovered 35 reports of e-cigarette users having seizures since 2010. Most of the people affected were teens or young adults.

“Seizures have been reported among first-time e-cigarette users and experienced users,” the FDA’s original statement from April 2019 read. “Seizures have been reported as occurring after a few puffs or up to one day after use.”

The agency appealed to e-cig users to come forward with new reports if they had suffered seizures, fainting or tremors.

In August 2019, the FDA announced it had received 127 reports of e-cigarette users suffering seizures or other neurological symptoms. The agency said it was continuing to investigate a link and seek detailed reports from e-cigarette users who may have suffered symptoms.

“Seizures have been reported among first-time e-cigarette users and experienced users. Seizures have been reported as occurring after a few puffs or up to one day after use.”

Source: U.S. Food and Drug Administration

A 15-year-old North Carolina teen had to be taken by ambulance to an emergency room after a seizure his family blames on an e-cigarette habit, according to a 2019 report by NBC News. Luka Kinard was spending $150 a week on vaping products at the time.

Some e-cigarette lawsuits mention seizures related to JUUL products. Erin and Jared NesSmith filed a lawsuit in 2019 on behalf of their 15-year-old daughter identified in the complaint only as A.N. They claimed the Florida teen became addicted to nicotine after using a JUUL e-cigarette. Their complaint said she suffered seizures and other side effects as a result.

Nicotine Addiction, Poisoning and Side Effects

Each JUUL pod contains as much nicotine as a pack of tobacco cigarettes. Competing e-cigarette manufacturers have also increased nicotine levels since JUUL hit the market. Nicotine is highly addictive and can affect the body in a number of ways.

“Nicotine itself still has its own series of harmful effects including headaches, seizures, jitteriness, elevated heart rate and other harmful effects,” Mansour said.

While e-cigarettes have been marketed as a method to help people quit smoking cigarettes, not everyone who vapes kicks the habit.

In fact, according to the CDC, most smokers who switch to electronic cigarettes are not switching completely and end up using both products — and some people end up smoking even more.

A 2018 study by researchers at the University of California, San Francisco found that so-called dual users average one more cigarette per day compared to those who only smoke cigarettes. The researchers published their findings in PLOS One.

Did You Know?
A 2016 study by physicians at the University of California in San Diego found that nearly 44 percent of dual users were still using e-cigarettes two years after attempting to quit smoking cigarettes.

Teens Getting Hooked on Nicotine

Young people are particularly vulnerable to the lure of e-cigarettes. Nearly 36 percent of high school seniors reported vaping in the most recent Monitoring the Future survey, which tracks substance use by adolescents and teens. Teens have also been credited with creating the term juuling as a synonym for vaping.

“In some cases, our kids are trying these products and liking them without knowing they contain nicotine. And that’s a problem, because as we know the nicotine in these products can rewire an adolescent’s brain, leading to years of addiction,” FDA Commissioner Scott Gottlieb warned in a 2018 statement outlining a massive crackdown on the sale of e-cigarettes to minors.

According to the National Institute on Drug Abuse, studies suggest that e-cigarettes are a gateway substance that encourages young people to experiment with conventional cigarettes and other substances.

“In some cases, our kids are trying these products and liking them without knowing they contain nicotine.”

Source: FDA Commissioner Scott Gottlieb in a 2018 statement

A 2018 study in the Pediatrics journal, for instance, found that e-cigarette use among youth doubles the risk of marijuana use a year later.

Nicotine Poisoning

Nicotine can be toxic to humans when consumed in large, concentrated amounts, such as those sometimes found in e-liquid cartridges. Liquid nicotine used in e-cigarettes is absorbed far more quickly compared to nicotine from tobacco in traditional cigarettes. While most e-liquids are sold with concentrations at 2 percent, others can go as high as 10 percent.

Liquid Nicotine Poisonings
In 2018 alone, poison control centers handled at least 2,555 exposure cases related to e-cigarette devices and liquid nicotine.
Source: American Association of Poison Control Centers

Accidental ingestion of e-liquids can result in poisoning, quickly affecting the cardiovascular, circulatory, gastrointestinal and nervous systems. Nausea and vomiting are the most common symptoms of nicotine poisoning, but some cases can be life threatening.

Other signs and symptoms of nicotine poisoning include:
  • Abdominal cramps
  • Depression
  • Burning sensation in the mouth
  • Drooling, or increased saliva
  • Fainting or coma
  • Convulsions (seizures)
  • Headache
  • Muscle twitching
  • Vomiting
  • Weakness
  • Breathing that may be difficult, rapid or stopped
  • Agitation, restlessness, excitement or confusion
  • Palpitations (a heartbeat that is fast and pounding and often followed by a slow heart rate)
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Individuals with nicotine poisoning may initially develop symptoms associated with over-excitation of the central nervous system, such as elevated heart rate and blood pressure, anxiety, muscles spasms and seizures. Later on, as the poisoning progresses, the patient will develop slow breathing, a slowed heart rate, lethargy and paralysis.

Vaping Without Nicotine Still Presents Risks

Every brand name JUUL pod contains nicotine. There are some vape fluids that are nicotine-free that vapers may opt for to prevent or reduce nicotine dependence, but even these can cause side effects.

A 2019 study in the journal Radiology found that inhaling e-cig vapor without any nicotine or flavoring caused immediate and negative effects on people’s vascular systems. The study involved 31 healthy, nonsmokers and first-time vapers between the ages of 18 and 35. Each took 16, 3-second puffs.

“[W]e caution against the widely held opinion that e-cigarettes are safe.”

Aaron Scott and colleagues, University of Birmingham

Researchers used an MRI to measure their blood vessels before and immediately after vaping. They found that after vaping, the participants had less oxygen in their blood, stiffer arteries and worse circulation.

A 2018 study in the journal Thorax found that heating e-fluids to create vapor makes the chemicals in them especially toxic to cells in the lungs.

“[W]e caution against the widely held opinion that e-cigarettes are safe,” researchers wrote in their conclusion.

E-Cigs May Cause Stroke and Double Heart Attack Risk

Recent studies have associated e-cigarette use with stroke and heart attack risks.

According to a 2018 study by researchers at UC San Francisco and George Washington University, using electronic cigarettes on a daily basis may nearly double a person’s risk of a heart attack.

The results of the study, which were based on national health interview surveys with more than 70,000 people, showed that heart attack risk was five times greater among dual users, who smoke traditional cigarettes and e-cigs.

Proponents of e-cigarettes have criticized the study. They say the study did not differentiate between individuals who had heart attacks before they started vaping versus those who had heart attacks after taking up the devices.

Research presented at the American Stroke Association’s 2019 international conference found e-cig use increases a person’s risk of heart attack, stroke and coronary heart disease. It was the largest stroke and e-cigarette study to date, tapping into a database 400,000 people from all 50 states. More than 66,000 people who participated were regular e-cig users.

American Stroke Association: Increased Risks for E-Cig Users Compared to Non-Users
  • 71 percent higher stroke risk
  • 59 percent higher heart attack or angina risk
  • 40 percent higher coronary heart disease risk

Research showing a link between e-cig use and significantly higher heart attack and coronary artery disease was also presented at the American College of Cardiology’s 2019 scientific session.

American College of Cardiology: Increased Risks for E-Cig Users Compared to Non-Users
  • 56 percent more likely to have a heart attack
  • 44 percent higher risk of circulatory problems
  • 30 percent more likely to have a stroke
  • 10 percent higher risk of coronary artery disease

The American College of Cardiology study also found e-cig users were twice as likely to suffer from depression, anxiety or other emotional conditions.

Can JUUL or Other E-Cigarettes Cause Cancer?

While e-cigarette vapor is generally recognized as less hazardous than cigarette smoke, a growing body of evidence suggests that vaping still exposes users to cancer-causing agents.

Nicotine in JUUL and other e-cig vape fluids may also lead indirectly to increased cancer risks.

“There’s no direct link between nicotine and cancer, but nicotine is very addictive and can cause people to continue using harmful products that can lead to cancer,” Mansour said.  

Formaldehyde is a known cancer-causing agent that can be formed during the vaping process, according to an analysis published by the New England Journal of Medicine in 2015.

The analysis examined many samples of propylene glycol and glycerol, two base substances present in e-liquids. Results showed that when these substances are heated in the presence of oxygen to temperatures reached by e-cigarettes at high voltages, more than 2 percent of the mixture is converted to formaldehyde-releasing agents.

Inhaled formaldehyde has been linked to an increased risk of nasopharyngeal cancer and leukemia. Researchers found no elevated risk of a formaldehyde-related cancer when people use low voltage e-cigs. But they concluded that the lifetime risk of developing a formaldehyde-related cancer is five to 15 times higher with high-voltage vaporizers than with cigarettes.

A 2018 study in the journal of Pediatrics, meanwhile, found elevated levels of carcinogenic compounds in the urine of adolescents who vaped. The levels of the compounds were up to three times greater in adolescents who vaped than in study subjects who did not use e-cigarettes. Adolescents who smoked cigarettes and vaped had levels of toxicants three times higher than those who just vaped.

Risks of Vaping While Pregnant

JUUL and all other e-cigarettes are not safe for pregnant women, according to the CDC.

Health experts have long warned that pregnant women should not use tobacco during pregnancy because of nicotine’s dangerous effects.

“Nicotine is a known toxin that can affect fetal brain and lung development,” Bridget Kuehn of the CDC wrote in a 2019 article in the Journal of the American Medical Association Network.

A 2019 CDC report found that in one study more than a quarter of women who had vaped during pregnancy did not know their vaping products contained nicotine.

“The effects of nicotine exposure during fetal development are well known and include effects on multiple organ systems.”

Source: Obstetrical and Gynecological Survey

A 2018 study in Obstetrical and Gynecological Survey reported that more pregnant women had been switching from tobacco cigarettes to vaping because e-cigs were marketed as safer than smoking, despite no proof of safety.

The researchers found that the amount of nicotine consumed in cigarette smoking was similar to the amount of nicotine consumed with e-cigarettes.

“The effects of nicotine exposure during fetal development are well known and include effects on multiple organ systems,” the study’s authors wrote.

Risks of Vaping Before Surgery

Like smoking, vaping before surgery can slow healing and may lead to complications.

Nicotine in JUUL or other e-cigarettes may significantly increase the risk for surgical and anesthesia-related complications, according to the American Association of Nurse Anesthetists.

“It’s the nicotine found in vapes and tobacco that results in poor wound healing, increases anesthesia risk, and may lead to a host of other potential complications for surgery patients,” association’s president, Bruce Weiner, said in a 2017 statement.

“[E]vidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, with or without nicotine present.”

Source: Archives of Plastic Surgery

A 2017 review of 123 medical articles published in the Archives of Plastic Surgery found only three that specifically looked at e-cigs and surgery risks. The authors pointed out that nicotine increased the risk of infection and dead skin around the surgical scar in plastic surgery.

“Despite limited objective data, evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, with or without nicotine present, and may have a significant deleterious effect on wound healing,” the researchers wrote.

Exploding E-Cigarette Batteries

In 2016, physicians at the University of Washington Medical Center in Seattle reported treating 15 patients for injuries resulting from e-cigarette explosions between October 2015 and June 2016.

The explosions resulted from faulty lithium-ion batteries, the doctors explained in a letter to the New England Journal of Medicine.

The most common injuries among those treated were flame burns, which occurred in 80 percent of patients, but a third of patients suffered from chemical burns and more than a quarter experienced blast injuries. Many required surgery and skin grafts, as well as wound care.

Most Common Injuries
Patients experienced injuries to their face, hands, thighs and groin, with explosions causing flame burns in 80 percent of those treated, chemical burns in 33 percent and blast injuries in 27 percent.
Source: The New England Journal of Medicine

In 2018, a Florida man died after his vape pen exploded. The 38-year-old man suffered burns to 80 percent of his body and was killed by two pieces of his vape pen that penetrated his skull.

Please seek the advice of a medical professional before making health care decisions.

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Terry Turner
Written By Terry Turner Writer

Terry Turner has been writing articles and producing news broadcasts for more than 25 years. He covers FDA policy, proton pump inhibitors, and medical devices such as hernia mesh, IVC filters, and hip and knee implants. An Emmy-winning journalist, he has reported on health and medical policy issues before Congress, the FDA and other federal agencies. Some of his qualifications include:

  • American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member
  • Centers for Disease Control and Prevention Health Literacy certificates
  • Original works published or cited in Washington Examiner, MedPage Today and The New York Times
  • Appeared as an expert panelist on hernia mesh lawsuits on the BBC
Edited By

62 Cited Research Articles

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