By Anne Blythe

In North Carolina, where tobacco reigned as a king crop for ages, the state budget plan sailing through the General Assembly includes funds for the first time since 2012 to help prevent young people from getting addicted to nicotine through vaping, smoking and chewing tobacco.

That’s in large part because of a $40 million settlement that Josh Stein, the state attorney general, reached this summer with Juul, the e-cigarette giant criticized for its flavored products that attract many teens to vaping.

When Stein announced the settlement in July, the consent order signed by Durham Superior Court Judge Orlando Hudson included directions for how the funds should be used as they flow to North Carolina over the next six years.

That included education campaigns to prevent nicotine use among teens and treatment for those who become addicted to or are having trouble giving up vaping.

Stein’s office, though, does not hold the power of the purse strings. The General Assembly does.

Republicans in leadership have tried more than once to clip the wings of Stein, a Democrat who has shown twice that he can win statewide office.

In the $25.9 billion budget approved by General Assembly on Thursday and signed into law by the governor, Stein would have to seek approval from the 10-member Council of State, which has a Republican majority, before filing or signing on to any lawsuits outside North Carolina.

That provision, Gov. Roy Cooper said Tuesday, as well as the attempt to limit his emergency powers beginning in 2023, is likely to lead to lawsuits that will test the separation of powers guaranteed in the state constitution.

Going after Juul founders

Despite that attempt to redefine Stein’s job, the lawmakers who worked behind closed doors to develop a two-year spending plan did not try to reroute the Juul settlement funds. They allocated $11 million from the first $13 million to come to the state for nicotine abatement programs, gathering data on nicotine use, a media campaign and education programs designed to prevent vaping among teens, a habit that has exploded in popularity in that age group over the past decade. 

Stein announced Tuesday that he was suing Juul founders James Monsees and Adam Bowen accusing them of personally participating in the company’s marketing strategies to attract youth. He also praised the lawmakers for working with DHHS to develop a multi-pronged plan to attack vaping and nicotine use.

“Half is going to go to prevention efforts and half is going to treatment efforts,” Stein said during a briefing with reporters broadcast on Facebook on Tuesday.

Elizabeth Cuervo Tilson, the state health director and DHHS chief medical officer, was with Stein on Tuesday and provided statistics about children who use e-cigarettes and other nicotine products.

OMG flavored pods

Nationally, more than two million children in middle school and high school used e-cigarettes in 2021, Tilson said. Almost half of those high school students used e-cigarettes frequently, for as many as 20 out of 30 days, Tilson said.

In North Carolina, Tilson added, a third of people in that age group used tobacco products, most of which are e-cigarettes. Another 25 percent of North Carolina’s children in those age groups say they are open to experimenting with nicotine products in the next year.

“Tobacco use in North Carolina, especially the epidemic of e-cigarettes amongst our youth, are a very serious, public health threat,” Tilson said.

In North Carolina, according to Tilson, Juul was the most popular brand among young people surveyed in 2021. Puff Bar came in second, Tilson said, highlighting one of the flavored products offered called OMG, or orange, mango, guava.

Stein also announced Tuesday that he was launching a statewide investigation into Puff Bar, retailers that sell flavored e-cigarettes and distributors that help manufacturers get their products to the shops that sell them, 20 companies in all.

“We made major progress in protecting young people from e-cigarette addiction when we secured a court order dramatically changing the way Juul does business and recovering $40 million to help kids conquer their nicotine addiction,” Stein said Tuesday. “But many of the billions Juul made from addicting kids to nicotine are now in the personal accounts of its founders and early investors. The people behind this company must be held accountable and pay to clean up the mess they made.

“At the same time, the market Juul created still exists, and other companies are filling the vacuum. We are actively investigating Puff Bar and other companies at all stages of the distribution chain, from manufacturers to retailers and everything in between to ensure they are not profiting off kids,” Stein added. “Where I find illegal behavior, I will not hesitate to take legal action.”

Industry-wide flavor regulations

Additionally, Stein said, he planned to urge Robert Califf, the Duke physician recently nominated by President Joe Biden to lead the Food and Drug Administration, to create regulations on flavors across the industry and country. If the state reins in Juul’s ability to sell flavored products in North Carolina, other companies such as Puff Bar have been able to fill the void.

“Until the FDA acts to protect kids, we will all be playing whack-a-mole with these companies,” Stein said, mentioning the letter that he sent Tuesday.

Stein led the way in taking legal action against Juul.

His action this week against company founders Bowen and Monsees, and Nicholas Pritzker, Hoyoung Huh and Riaz Valani, key investors and company board members over the past decade, mentions the $206 billion Master Settlement Agreement that North Carolina and 45 other states reached in 1998 with the country’s four largest tobacco companies.

Some of that money was to go to smoking cessation programs.

In 2013, when Republicans held control of both General Assembly chambers and the governor’s office, that money stopped flowing to programs targeted at young smokers and nicotine users.

That will change this year.

The budget that Cooper signed into law on Thursday transfers $2 million from the first $13 million allotment from the Juul settlement to the attorney general’s office to cover litigation costs.

Another $4.4 million will go to tobacco cessation media campaigns, resources and programs to help children in middle school, high school and young adults quit vaping and using tobacco products after becoming addicted.

The budget allocates $3.3 million for “evidence-based media and education campaigns” geared toward prevention of e-cigarette and tobacco use and $1.1 million for data monitoring to better understand how young people are exposed to such products and evaluate programs designed to help users quit.

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Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.