Sales of e-cigarettes with the highest nicotine content (5% or higher nicotine strength) in the U.S. market have grown significantly over the past five years, from 5% of total e-cigarette sales in 2017 to 81% in 2022, a nearly 15-fold increase.

Disposable e-cigarettes, as the most popular type of e-cigarettes among young people, have a variety of flavors, and their growth rate is steeper. More than 90% of disposable e-cigarettes sold had the highest nicotine content, up from 0% in 2017. With the product exempted from the U.S. federal government’s restrictions on flavored e-cigarettes in 2020, the popularity of disposable e-cigarettes has skyrocketed, with usage increasing by about 1,000% among high school e-cigarette users between 2019 and 2020.

The study, published in Nicotine and Tobacco Research, a collaboration between the Centers for Disease Control and the Truth Initiative®, also found that prices for high-nicotine e-cigarettes have fallen or remained unchanged, while prices for lower-nicotine e-cigarettes have declined then declined.

The findings suggest that limiting the nicotine strength of e-cigarettes may be part of a comprehensive tobacco control strategy to reduce adolescent addiction to these products.

Rapidly rising nicotine levels in e-cigarettes may be addicting young people

According to the U.S. National Youth Tobacco Survey, by 2022, more than 2.5 million middle and high school students will report using e-cigarettes, and nearly half (46%) of high school students will vape almost every day, putting them on a potential trajectory to develop nicotine addiction life.

Nicotine strength has been climbing as e-cigarettes have expanded to include multiple flavors and device types. Between 2013 and 2018 alone, the average nicotine concentration in vaping products increased by 106.7%, from 2.10% to 4.34%. The popular JUUL device originally launched in 2015 with 5 percent nicotine salt pods, prompting JUUL competitors to start offering nicotine salt concentrations as high as 7 percent, in what has been dubbed the nicotine arms race.

High nicotine products dominate the e-cigarette market

To measure changes in nicotine levels, the researchers examined e-cigarette retail sales data from January 2017 to March 2022 at brick-and-mortar retailers in the continental United States. Sales of e-cigarettes containing more than 5 percent nicotine have grown significantly over the past five years, from 5 percent in 2017 to 81 percent in 2022. Between 2017 and 2022, unit share sales of high-nicotine products increased nearly 15-fold, and dollar share sales increased more than 13-fold.

Regardless of device type and flavor, products with the highest nicotine content accounted for the majority of e-cigarette sales. For example, most e-cigarettes sold in other (96%), mint (87%), menthol (79%) and tobacco (61%) flavors had nicotine concentrations of 5% or higher.

Between 2017 and 2022, sales of disposable e-cigarettes with a nicotine content of more than 5% rose from 0% to more than 90% of the market, while prefilled pods rose from 8% to 74%. On the other hand, products with a nicotine strength of less than 1%, including zero nicotine products, accounted for less than 0.1% of sales.

Prices of high-nicotine e-cigarettes plummet

The increase in market share and sales volume of high-nicotine e-cigarettes corresponded with the decline in prices. Products with higher nicotine content become cheaper or remain the same through 2022, while products with lower nicotine content become more expensive. Between 2017 and 2022, prices for products in the 1-2% nicotine strength rose from $10.40 to $29.20, while products in the 4-5% range dropped from $20 to just $12.80. Because young people value prices, reducing the price of high-nicotine e-cigarettes could lead to greater product uptake and use.

National standard for nicotine content

The United States has no limit on the concentration of nicotine in e-cigarettes.

In June 2022, the Biden administration has on its agenda a plan to reduce nicotine in cigarettes to non-addictive levels.

The Truth Initiative firmly believes that reducing nicotine to non-addictive levels must be extended to all tobacco products, including e-cigarettes.

"Nicotine standards may reduce the addictive properties of these products, especially among young people," the study authors wrote. "Strategies that address the factors that make e-cigarettes particularly appealing to young people, including flavor and product innovation, are critical."

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