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

The Full Story

Electronic cigarettes (e-cigarettes) are devices that heat and aerosolize mixtures of nicotine, flavoring, and other ingredients. Inhalation of e-cigarette vapor is known as “vaping”. E-cigarettes were initially developed to help people stop smoking traditional cigarettes, but the introduction of flavored e-cigarettes led to the expanded use of these products among adolescents. Over the last decade, flavored e-cigarettes became very popular among younger populations. A 2020 study found that e-cigarettes were the most commonly used tobacco product among middle school 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 may result in increased dependence on these products in adolescents, as well as nicotine addiction.

In response to the increased use of e-cigarettes in youth populations, in January 2020 the United States 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. Those who support the 2020 FDA ban argue that the legislation will prevent use of e-cigarettes by children and adolescents.

While the 2020 FDA ban restricted the sale of 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 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. Public interest in disposable e-cigarettes grew after the 2020 FDA ban, and these products are also now increasingly popular among adolescents. There are many videos on TikTok that feature use of disposable e-cigarettes; some of those videos have millions of views.

Although disposable e-cigarettes are not meant to be refilled and have a finite battery life, there are multiple websites and social media posts that provide detailed instructions for refilling and recharging these devices. 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 in young children. Symptoms of nicotine poisoning may include nausea, vomiting, tremors, and heart palpitations. In severe cases, seizures and death may occur.

For now, flavored disposable e-cigarettes remain legal in the United States, 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 these products (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