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Nicotine arms race: JUUL and the high-nicotine product market
  1. Robert K Jackler,
  2. Divya Ramamurthi
  1. Stanford Research into the Impact of Tobacco Advertising, Stanford University, Stanford, California, USA
  1. Correspondence to Professor Robert K Jackler, Department of Otolaryngology, Stanford University, Stanford, CA, 94305, USA; jackler{at}


Objective Until recently, purveyors of vaping products marketed e-liquids in the 1%–3% range of nicotine concentration with those at 3% described as ‘super high’ intended for two packs/day smokers. The goal of this study is to evaluate the degree to which JUUL, with its 5% nicotine and 75% US market share, has spurred other e-liquid vendors to raise the nicotine levels of their products.

Methods Online search to identify brands offering e-liquid in exceptionally high nicotine concentration (≥5%) and to catalogue the appearance of devices which emulate JUUL.

Results JUUL compatible pods (14) and JUUL knock off devices (39) were identified which offer equal or higher nicotine than JUUL. More than 70 e-liquid brands sell high-nicotine products (≥5%) in bulk (≥30 mL) equivalent to >40 cigarette packs. All of these products come in multiple youth appealing sweet and fruity flavours. It was noted that nicotine percentage is inconsistently reported (eg, JUUL is 5% by weight vs 5.9% by volume).

Conclusions JUUL has triggered a widespread rush among aerosol purveyors to market e-liquid in unprecedentedly high nicotine concentrations. The rapidly rising popularity of high-nicotine e-liquids threatens to addict a generation of youth. When sold in large quantity bottles (eg, 30 mL) they represent a childhood poisoning risk. Labelling of nicotine concentration in e-liquids needs to be standardised to avoid consumer confusion. The addictiveness and toxicity of these products makes it imperative that regulators act swiftly to enact protective measures.

  • electronic nicotine delivery devices
  • nicotine
  • non-cigarette tobacco products
  • public policy

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  • Contributors RKJ conceived the project. RKJ and DR collected and analysed the data and prepared the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.