On December 18, 2018, the US Surgeon General declared e-cigarette vaping among adolescents an “epidemic.”1 This declaration coincided with a report in The New England Journal of Medicine2 highlighting a 10% increase in youth vaping between 2017 and 2018, the equivalent of an additional estimated 1.3 million teenagers. In a public hearing in January 2019, the former US Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, stated that e-cigarettes pose an “existential threat” to youth, and called for exploration of drug therapies to help adolescents overcome addiction.3 In February 2019, the Morbidity and Mortality Weekly Report4 from the Centers for Disease Control and Prevention (CDC) declared that the e-cigarette surge has erased recent progress in preventing tobacco use among youth. These statements summarize the current story of how loosely regulated products intended to help individuals quit traditional combustible cigarettes became the fastest growing abused substance and the Achilles’ heel of our youngest generation.

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