To JUUL or Not to JUUL

To JUUL or not to JUUL? That is the ultimate question as of late.

Trends come and go at Colgate faster than you can say “conformity”; however, the latest trend to make its debut on Colgate’s campus, as well as college and even high school campuses across the United States, may be one that doesn’t so easily go out of style.  I am referring of course to the JUUL pen craze, the newest brand of e-cigarettes that some are hailing as the “iPhone” of electronic delivery systems (ENDs). From wild nights out, to the library during midterms, this little device seems to be a handy sidekick to many Colgate students from all walks of life.  However, this trend may be more insidious than most; medical professionals and neuroscientists everywhere are delivering a cautionary warning about an otherwise exploding trend. Along with the highly addictive potential of the JUUL’s nicotine, there is extensive evidence that long-term nicotine exposure starting in one’s young adult years leads to psychiatric mood disorders as well as attention and memory deficits later in life. 

What is a JUUL pen and how does it work?

Invented to serve as a smoking-cessation aid, e-cigarettes including the JUUL pen function to deliver the user a hit of nicotine to reduce their cravings due to drug withdrawal.  The JUUL pen is a device that electronically delivers nicotine to its users by slowly heating through a wick and heating coil system. PAX, the manufacturers of JUUL pens, claim their product is unique in comparison to other e-cigarette brands in that is uses “nicotine salts” instead of freebase nicotine, saying that this results in higher user satisfaction compared to its other END counterparts.  In addition, studies have found that because of the JUUL’s novel heating system, JUUL pens produce far less carcinogens than competing products, causing some people to hail them as the “healthier” option compared to traditional cigarettes and other e-cigarette brands.

How healthy is “healthier”?

However, despite being suggested to be less cancer-causing than other options, experts warn that not all the data is in regards to the long-term health implications associated with JUUL pens.  In an editorial written by Bastian and Oncken (2014), the doctors noted “the long-term health effects associated with the product will not be known for years”.  In addition, although e-cigarette companies like PAX advocate for their products saying that they are a “safe” nicotine delivering alternative, this claim is a little misleading to the consumer; the safest alternative to smoking is to not consume nicotine at all, as it is highly addictive and has wide-ranging health implications. Also, being a relatively new innovation, the e-cigarette industry is not yet regulated at all by the FDA, meaning no government health agency is holding these companies accountable for their health claims as of now.  

Ok, so no one really knows the definites about JUUL pen health implications. What is the best prediction science can suggest?

In terms of the respiratory effects of both the act of vaping and the carcinogenic nature of the chemicals found in JUUL products, the jury is still out. However, in terms of the long-term effects of nicotine, researchers have some ideas.

A young adult brain is a growing brain

The old myth that the brain cells you are born with are the only ones you ever get has largely been disproven by evidence from current cutting edge neuroscience research. Your brain is very similar to a piece of clay in that it is continuously being molded by your life experiences, constantly changing and creating new connections.  Then, around age 25, your “clay” brain becomes ceramic, and largely stays the same way throughout the rest of your adult life minus some special exceptions.  Thus, the decisions and experiences you are choosing to expose yourself to right now in college are going to directly affect the way your brain functions for the rest of your lives.  Following this, the impact of nicotine on your developing brain is a phenomena that is extremely pertinent in the research community.

What exactly does nicotine do?

Nicotine is a stimulant, meaning that it increases activity in the brain.  It does this by acting as a key, “unlocking” receptors on neurons that then in turn cause chemical messengers to be released in your brain.  Nicotine fits in many different locks, resulting in the diverse sensations you feel when using either a traditional cigarette or an electronic alternative like a JUUL. It can activate dopamine, resulting in the pleasurable feeling you seek out at parties, or acetylcholine, resulting in the memory boost that people use JUULs for when studying in the library.  If you’re thinking about how awesome nicotine sounds right now and are about ready to go out and invest in a JUUL of your own, you are not alone; these short-term benefits are largely the reason why nicotine is so well-received among young adults, as we are especially sensitive to the advantageous results of nicotine.  However before you stop reading this and go out and invest in a JUUL of your own, please bear with me for the next couple paragraphs while I explain why this “wonder drug” is not as harmless as it seems. 

So… what’s the catch?

Nicotine joins drugs like heroin and crack-cocaine in its addictive potential:

Since nicotine causes dopamine, the pleasure chemical, to be released, it places nicotine in the category of highly addictive drugs that take advantage of the human pleasure pathway in the brain. For reference of the severity of nicotine’s addictive potential, other drugs like heroin and crack-cocaine are nicotine’s counterparts on this list of highly addictive substances.  The pleasurable nature of nicotine causes the user to continue to administer the drug, which eventually elicits an effect that sensitizes the individual to the drug.  This means that the individual needs to take more and more of the drug to reach the same effect it had as it did in their very first hit of it. In addition, the individual’s natural dopamine receptors stop reacting to the body’s normal every day release of nicotine, meaning they have to use the drug to reach the normal level of dopamine release that they had previous to being exposed to the nicotine. This creates a vicious cycle in which an individual is constantly chasing that high, resulting in a physiological addiction over which a person has very little control. Sure the person can abstain from nicotine, but they will go through severe withdrawal symptoms that are extremely uncomfortable to tolerate and interfere with everyday life such as irritability, anxiety, difficulty concentrating, depression, and insomnia. Before you write off addiction as something that only happens to weak low-lives, know that addiction doesn't discriminate by age, sex, socioeconomic status, or moral standings; addiction can and does happen to everyone. 

Nicotine has been suggested to cause depression and other mood disorders in long term users who begin taking the drug during adolescence:

Since Nicotine is a stimulant, it is known for causing a short term high that makes the user feel good. However, as mentioned above, has the body becomes used to nicotine, less and less dopamine is being stimulated to be released, meaning the individual is experiencing chronic lower levels of pleasure. This is suggested to be the reason why that mood disorders like depression are often comorbid with long term drug abuse such as in the case of nicotine addiction. In particular, the adolescents seem to be the most at risk for developing depression in conjunction with long-term nicotine use. In studies that administer nicotine to rats, rats who received nicotine during adolescence were far more likely to display depression-like symptoms in conjunction with long-term nicotine use, as opposed to rats who start receiving nicotine in their adulthood after their brains had finished developing. The replication of this evidence from a variety of different researchers is highly suggestive that long-term nicotine use before the brain finishes developing can put nicotine users at risk for the development of depression and other mood disorders later in life.

Long-term nicotine use has resulted in observable deficits in memory, especially working memory, and attention when the individual abstains from nicotine:

Those who use JUUL pens as a study aid, listen up as this section was written for you! Short-term administration of nicotine has been observed to produce acetylcholine, a chemical that is vital for memory retrieval and consolidation.  This is why you may look around the library and see your fellow college students using JUUL pens while studying.  However, in the long-run nicotine seems to have the opposite effect: long-term use of nicotine starting in adolescence has been linked with deficits in working memory and attention.  Although ex-smokers are somewhat able to regain some of these abilities by long-term nicotine abstaining, there is evidence their skill levels in memory and attention areas never fully reach the baseline levels of performance before ever being exposed to nicotine. Thus, by relying on JUULs for an extra boost while studying, you could be doing more long-term harm than good in the areas of memory and attention, even after you quit nicotine administration. 

In addition to the health risks mentioned above, there has also been evidence of nicotine priming an individual for future drug abuse such as in the case of opioids and alcohol, as well as evidence that e-cigarettes such as JUULs can serve as “gateways” to the use of traditional cigarettes.  Taken altogether, this evidence dealing with the possible long-term health implications of e-cigarettes such as JUULs makes it no surprise that experts warn against the unknowns of this new technology and that companies like PAX are hesitant to claim the “healthiness” of JUULs and other alternatives to traditional cigarettes. 

However, to each their own; I am claiming no special medical knowledge nor am I passing judgement on people who choose to use JUULs. I do, however, think that Colgate students have the right and responsibility to be aware of the implications of the things they put in their body, hence my motivation in writing this article. So, to JUUL or not to JUUL? That is the current question at hand. 

 

Various sources collected during my research—for further consultation:

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Ernst, M. (2001). Effect of nicotine on brain activation during performance of a working memory 

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Klein, L. (2001). Effects of Adolescent Nicotine Exposure on Opioid Consumption and 

Neuroendocrine Responses in Adult Male and Female Rats. Experimental and Clinical 

Psychopharmacology. http://dx.doi.org/10.1037//1064-1297.9.3.251

Patterson, F. (2010). Working Memory Deficits Predict Short-term Smoking Resumption 

Following Brief Abstinence. Drug Alcohol Dependency

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Rinker, J. (2011). Exposure to Nicotine During Periadolescence or Early Adulthood Alters 

Aversive and Physiological Effects Induced by Ethanol. Pharmacol Biochem Behav. 

http://dx.doi.org/10.1016/j.pbb.2011.03.009

Trauth, J. A. (2000). Persistent and delayed behavioral changes after nicotine treatment in 

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Perceptions of Electronic Nicotine Delivery Systems. Nicotine and Tobacco Research

http://dx.doi.org/10.1093/ntr/ntw095

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Longitudinal Analysis. Psychology of addictive behaviors

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