The Potential Dangers of Disposable E-Cigarettes Puff Bars, E-Cigs, and JUULs

What are e-cigarettes?

Electronic cigarettes (e-cigarettes) are devices that heat and aerosolize mixtures of nicotine, flavorings, and other ingredients. Inhalation of e-cigarette vapor is known as “vaping.” E-cigarettes were initially intended to help people stop smoking traditional cigarettes, but the introduction of flavored e-cigarettes has led to the expanded use of these products by adolescents. Over the last decade, flavored e-cigarettes have become very popular among young people, even though e-cigarette sales are supposed to be limited to those at least 21 years of age. A 2021 study found that e-cigarettes were the most used tobacco product among middle- and high-school students. Since the adolescent brain is still growing and is quite sensitive to the pleasant effects of sweet-tasting items, the use of flavored e-cigarettes might result in increased dependence on these products in adolescents, as well as nicotine addiction.

Aren’t e-cigarettes banned?

In response to the increased use of e-cigarettes by minors, in January 2020, the U.S. Food and Drug Administration (FDA) restricted the sale of most flavored, cartridge-based e-cigarettes. This ban meant that major e-cigarette companies like JUUL were no longer able to sell most of their flavored e-cigarette devices. As of October 2021, the only JUUL products that remain available for purchase are the Menthol and Virginia Tobacco pods. A rule prohibiting the use of menthol as a flavoring in cigarettes is currently under consideration. Those who support the 2020 FDA ban argue that the legislation should reduce the use of e-cigarettes by children and adolescents.

What about disposable e-cigarettes?

While the 2020 FDA ban restricted the sale of most JUUL and other cartridge-based e-cigarettes, it did not prohibit the sale of disposable e-cigarettes. Unlike cartridge-based products, disposable e-cigarettes (sold under the brand names Puff Bar, EonSmoke, Posh, and others) are not meant to be refilled. They are battery-powered and do not require external charging. Many disposable e-cigarettes are brightly colored and feature flavors (including cotton candy, watermelon, and sour gummy) that are appealing to children and adolescents. These products are currently legal and can be purchased online as well as at tobacco retailers and are now increasingly popular among adolescents. There are many videos on TikTok that feature the use of disposable e-cigarettes; some of those videos have had millions of views.

Although disposable e-cigarettes are not meant to be refilled and have finite battery lives, there are multiple websites and social media posts that provide detailed instructions for refilling and recharging them. Because these products can be manipulated, opened, and refilled, the potential for exposure to liquid nicotine remains a concern. Some disposable e-cigarettes contain up to 7% nicotine, which is higher than the amount typically found in JUUL pods. Swallowing the liquid contents of a disposable e-cigarette can be very dangerous, especially for young children. Symptoms of nicotine poisoning can include nausea, vomiting, tremors, and heart palpitations. In severe cases, seizures and death can occur.

For now, flavored disposable e-cigarettes remain legal in the U.S., and these products will likely continue to be used by adolescents and other vulnerable populations. Until additional laws are passed to restrict the use of these products, the potential for toxic effects from them (as well as nicotine addiction) remains a concern.

For questions about poisonings from e-cigarettes, get help online with webPOISONCONTROL or call 1-800-222-1222. Both options are free for the public, and available 24 hours a day.

Kelly Johnson-Arbor, MD
Medical Toxicologist

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