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Inventor of nicotine patches questions FDA's claims as the administration targets Juul

The Food and Drug Administration has given Juul an ultimatum: prove they can keep their products away from minors within 60 days, or pull its products from store shelves and face criminal charges.

But Jed Rose, director of the Duke Center for Smoking Cessation and professor of psychiatry and behavioral science, is skeptical of the FDA’s claims that Juul used flavored nicotine to attract teenage customers.

“E-cigarettes are one of the most promising developments in the field of smoking cessation,” Rose said. “Currently, over 500,000 Americans die every year of smoking related disease, a number that continues to rise. Cigarette smoking imposes a completely unacceptable burden of death and disease.”

Rose, who has studied nicotine since 1979, has helped invent stop-smoking products such as nicotine patches and the prescription drug Chantix. Smokers don't just crave nicotine—they also crave the physical action of smoking a cigarette, Rose said. 

“We’ve done studies where we’ve intravenously administered smokers with the same dose of nicotine they would get from a cigarette and found that this doesn’t satisfy their craving,” Rose said. “On the other hand, if they smoke a denicotinized cigarette, their craving is relieved quite a bit.”

Unlike other cigarette alternatives like nicotine gum and patches, e-cigarettes replace the physical behavior of smoking and deliver nicotine in a way familiar to smokers.

Rose said the Duke Center for Smoking Cessation is doing a Juul trial and that there is "good reason to believe" it can help people quit smoking. Although the FDA claims that e-cigarettes are introducing minors to nicotine, Rose said it is worth the risk. 

“The ‘epidemic’ of youth addiction is greatly exaggerated,” Rose said. “This isn’t good, but it has to be weighed against the 500,000 preventable deaths that can be lessened using e-cigarettes.” 

Rose disagreed with the notion that youth addiction to e-cigarettes is prevalent, but Duke students seem to feel differently. Out of 50 students that The Chronicle spoke to in the Brodhead Center, only six said that they use Juuls. But all 50 said they have close friends who use them, and 48 people said they knew someone whom they thought was addicted. 

“The impact on young people is clear,” said senior Ankit Rastogi.

“People Juul in libraries, inside buildings, between classes—sometimes literally in class,” Rastogi said. “I think Juul is more than just an alternative to cigarettes. The company definitely targets a niche audience.”

According to sophomore Hannah Park, social pressure may be one of the reasons Juul is so prevalent on campus.

“At parties, Juuling is inevitable,” Park said. “It’s like drinking water.”

Students also mentioned the e-cigarettes’ visual appeal. 

“Juuls are marketed in the same attractive ways as cigarettes were in the ’70s and ’80s,” said first-year Jessie Xu. “In a way, Juuls are like Apple products: chill, modern and simplistic.” 

David Mallen, assistant director of the Wellness Center, advises against the use of e-cigarettes but acknowledges their presence on campus. 

“In order to remain as low risk as possible, it is advised that individuals abstain from consuming substances in general,” Mallen wrote in an email to The Chronicle. “But if an individual is choosing to partake in alcohol, vaping, etc., we want them to have as much information as possible so they can make informed decisions about how their current choices may affect them in the future.”

Rose clarified that, while e-cigarettes are less harmful than traditional ones, they still pose risks—including not just the obvious risk of addiction, but also the unknown effects of nicotine on adolescent brains and the trace amounts of cancer-linked compounds. Still, Rose maintained that e-cigarettes are a much safer alternative to the paper and tobacco. 

“Ultimately, if you’re going to do something, do the thing that’s less harmful,” Rose said. “We do that with things like safe sex and clean-needle exchanges for heroin users, so it should also apply to cigarette smoking—which kills more than all those other things put together.”

In terms of e-cigarettes being gateways to tobacco, Rose was skeptical.

“If anything, restricting e-cigarettes may incentivize youth to try combustible cigarettes instead,” Rose said.


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