TOWNSHEND — On Rolf Parker's first day as a tobacco prevention specialist working at Leland & Gray Union High School, he learned cigarettes weren't his only foe.
Parker looked on as a school administrator showed him a cardboard box with devices confiscated from students.
Those little electronic cartridges, which looked like computer flash drives, each held liquid containing the same amount of nicotine as an entire pack of cigarettes, plus a flavoring agent to make the contents taste like some approximation of fruit or dessert.
These are Juulpods, used in Juul Devices, electronic cigarettes (e-cigarettes) that are developed, manufactured, and sold by the company of the same name.
When a user inserts a Juulpod into a cartridge and inhales, the device vaporizes the liquid - which is why the practice is called vaping - sending a dose of nicotine into their body. The user can recharge the cartridge by plugging it into a USB port.
Unlike tobacco cigarettes when smoked, Juulpods, when vaped, deliver to the user no tar or carbon monoxide, and leave the person's hair, clothing, and surroundings free of the tell-tale cigarette odor.
Consequently, some users might believe there's no harm in vaping.
Using e-cigarettes, like Juul, “is not as harsh” as smoking a traditional cigarette, Parker said. But, he noted, during the manufacture of the pods' liquid, the active - and highly addictive - ingredient becomes more bioavailable.
“Basically, you're freebasing nicotine,” said Parker.
In a recent article in The New Yorker, “The Promise of Vaping and the Rise of Juul,” Jia Tolentino describes the experience of using a Juulpod for the first time.
“I took a sharp experimental inhalation and nearly jumped. It felt as if a tiny ghost had rushed out of the vaporizer and slapped me on the back of my throat,” Tolentino wrote.
Even for users who don't smoke cigarettes, but vape nicotine products like Juulpods, the drug is absorbed by mucous membranes in the mouth.
The nicotine travels to the adrenal glands, where it stimulates the production of epinephrine, or adrenaline, which gives the user a little burst of energy. This increases blood pressure, respiration, and heart rate.
Nicotine also lights up the reward system in the brain, neural pathways that bring the user a feeling of pleasure. But the effect doesn't last forever, and the body signals it's time for another dose by engaging a series of negative responses, including irritability, headaches, and nausea.
That's withdrawal.
“What are electronic cigarettes?,” an article by the National Institute of Health's National Institute on Drug Abuse (NIDA) published at drugabuse.gov, discusses the use of these devices by young people.
“A major concern is that e-cigarettes' flavors, design, and marketing particularly appeal to youth, and that by introducing young people to nicotine and glamorizing a smoking-like behavior, e-cigarettes could open the door to cigarette use in a population that is particularly vulnerable to addiction and that has seen historic declines in cigarette smoking,” it says.
NIDA reports that, according to national survey data, “e-cigarettes were the most commonly used nicotine delivery product among youth,” and, “A review of the literature found that up to 20 percent of adolescents who currently use e-cigarettes had never smoked a traditional cigarette.”
When Parker began talking to middle- and high-school students through his work with West River Valley Thrives and the Brattleboro Area Prevention Coalition, “none of them knew there was as much nicotine in a single pod as in a whole pack of cigarettes,” he said.
Now, “kids are getting addicted through mango-flavored pods,” said Parker, “and [they're] going to have these withdrawal symptoms for the rest of their life when they try to stop.”
Where are children buying Juulpods?
Since 2016, it has been illegal to sell e-cigarettes to people under age 18. In Vermont, Parker said, “we have an excellent level of compliance with brick-and-mortar shops.”
In fact, one such business, 802 E-Cig Supply refuses to stock Juul products in its three southern Vermont stores, with proprietor Gaetano Putignano citing the ultra-high nicotine content and appeal to kids as factors that cross the line.
So, Parker wondered, where are children buying Juulpods?
He took to the internet and found a video created by a teen instructing other young people on how to score them online.
“You can get them on eBay,” said Parker.
The official policy of the auction site is that only “pre-approved sellers” may list e-cigarettes for sale, and sellers must use a shipping service “that will verify, upon delivery, that the buyer or recipient is at least 21 years old.”
Sellers must also link their e-cigarette sales pages to eBay's tobacco and smoking accessories page, and include the FDA's health warning in the item's description.
Likewise, eBay's policy for those wishing to purchase e-cigarettes must be 21 years old, and, “If the recipient is not the buyer, the buyer must make sure that the recipient is at least 21 years old.”
This is not how it actually works.
As Parker found out, first by watching the video the teen created, then testing it out himself by researching the Juulpod listings, eBay's policies seem to be seldom enforced.
Parker isn't claiming or implying that any of the eBay sellers have sold e-cigarettes to minors, but with so many sellers violating eBay's policies, and with eBay's spotty enforcement of its own policies, it's easy for youth to purchase Juul pods and other e-cigarettes this way.
“There's no warning of the health effects on eBay. There's not even an indication there's nicotine in the Juulpods, but there's supposed to be,” Parker said. Additionally, most sellers use standard U.S. mail, which requires no signature or proof of age.
“EBay claims only pre-approved sellers can sell e-cigarettes, but that's not the reality, and we have been documenting this,” he added.
A social pressure campaign
In response to complaints, in April, the FDA issued this statement: “We [...] contacted eBay to raise concerns over several listings for Juul products on its website. We're thankful for eBay's swift action to remove the listings and voluntarily implement new measures to prevent new listings from being posted to the web retailer's site.”
The day of the FDA's announcement, “all the Juulpods disappeared from eBay,” said Parker.
That didn't last long.
In early-May, Parker began documenting hundreds of violations on eBay. The ones the FDA thanked eBay for curing. “There were pages and pages of listings, and some of these sellers had thousands of sales,” said Parker.
In July, Olivia Moore, a LGUHS senior and West River Valley Thrives intern, began helping Parker take screenshots of major Juulpod sellers who violated eBay's policies.
“For 30 days, Olivia and I monitored it, and 24/7, it's a constant shop for the whole nation. There was something every day for any kid to get,” Parker said.
Since then, Parker and Moore have reported at least 30 big sellers of Juulpods, and the two of them cannot catch them all. None was “approved” by eBay as an e-cigarette seller, nor did any of them require age verification for ordering or shipping.
When asked if either Parker or Moore had received a response from eBay about all of the sellers they reported, Moore scoffed and said no.
“EBay is so big, it should be regulated,” said Moore.
Moore, who turns 18 in October, opened an eBay account using an LGUHS email address.
“I was browsing Juulpods for my work with West River Valley Thrives, and I started getting ads for Juulpods emailed to me,” Moore reported.
“They were Juulpods, not just generic vaping supplies, and the emails were sent by eBay. EBay was pushing this, after the FDA announcement, when they knew kids had access to this.”
“When we saw eBay actually had a policy, we realized we could mount a social pressure campaign,” said Parker.
Moore and Parker created a Facebook page, “Juulie's Army,” to get the word out and enlist others.
There's precedent for this strategy. Rebecca Williams, a researcher at the University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center and Center for Health Promotion and Disease Prevention, conducted a study showing that minors were successfully able to buy alcohol from eBay sellers, even while using their real underage IDs.
Soon after, the ABC television program 20/20 aired an episode in which a teen successfully ordered alcohol from the site. In late 2012, after negative media attention, eBay changed its policy.
“We want to let everyone know that they cannot just be upset about this, but they can do something about it. They can put pressure on eBay,” said Parker.
The people who operate eBay “are tech geniuses. They can easily program [the website] to not allow Juul sales, and not ship without a signature. It's totally ridiculous,” he added.
Parker has talked with Rhonda Williams, the chronic disease prevention chief at the Vermont Department of Health, about possibly working with the Department of Liquor Control - the agency that regulates tobacco sales in the state - to “do something about requiring signatures in Vermont for the delivery of Juulpods,” said Parker.
In a recent article at VTDigger.org, “Study further fuels state's concerns about e-cigarettes,” reporter Mike Faher noted that the Department of Health is looking into e-cigarettes, especially concerning minors, and is launching a public educational campaign in January.
The FDA is also investigating whether Juul targeted its marketing toward teenagers.
For its part, the company prominently features a link on its website to a page with nine prongs of a youth prevention initiative.
“We believe that these alternatives are not appropriate for people who do not already smoke,” the company writes on the website.
“My biggest concern is the nicotine that's going into kids' bodies,” said Parker. “Whether Juul is marketing to kids” isn't the most important factor, he said.
What is most urgent, Parker said, is the product “is easily getting to kids through eBay, and that channel needs to be shut down.”