Loud voices coming from a boys bathroom at Pine Bush High School alerted district superintendent Tim Mains as he passed by.

“When I walked in, one boy moved behind several others and hid something behind his back. Another said, ‘Hi, Mr. Mains,’ loudly, probably so the guys in stalls could hear. At least four of them shook my hand and pretended to be happy to see me,” Mains said.

He suspected they had e-cigarettes. Probably the Juul variety, he said, those that look like flash drives, fit in pockets and convey assorted unregulated, sometimes illegal, vaporized substances to the lungs. Often used in bathrooms, they have become a “routine” disciplinary issue over the past two years, like cigarettes, Mains said.

Mains and other school administrators around the mid-Hudson and the country facing the same issue are strategizing to discourage vaping. It has been blamed for a handful of recent deaths and hundreds of serious illnesses nationally.

Schools are “overburdened” with Juuling devices, said Orange County District Attorney David Hoovler. “It’s an epidemic among youth. I don’t know what they’re putting in it, but there’s been a drastic increase in the last two years. It jumps off the page. We see it when we have search warrants.”

The Food and Drug Administration, backed by President Donald Trump, said last week it will develop guidelines to remove from the market all e-cigarette flavors except tobacco, according to Health and Human Services Secretary Alex Azar.

The FDA also wants to know what vaping products have in them, saying that what companies claim is too often inaccurate, omitting carcinogenic compounds, heavy metals and other risky ingredients. But in August, the Vapor Technology Association, representing 800 vaping companies, sued to delay the May 2020 FDA deadline for product approval submission, claiming small companies would be put out of business.

Meanwhile, vaping revenue was $2.3 billion in 2018, according to Forbes. In a documentary on the trend, Juul CEO Kevin Burns apologized for youth vaping addiction.

Smokeless signals

After a decline in vaping between 2015 and 2017, it surged in high schools and middle schools between 2017 and 2018, according to the National Youth Tobacco Survey. The authors traced the trend to Juul and other flash-drive-like e-cigarettes, with their high nicotine content, flavors and concealability.

According to state Department of Health data, nearly 40 percent of 12th-grade students and 27 percent of high school students in New York state are using e-cigarettes. High school use in 2018 (27.4%) is 160 percent higher than it was in 2014 (10.5%).

“Most vaping has a plume, but Juuling has no smoke. The air just smells,” said Matt Curreri, a Port Jervis Police Department juvenile detective who has seen vapers start as early as sixth grade. “It can be disguised in markers. Kids take hits and hide it. I hear reports of kids Juuling in class. It gets them hooked; it tastes and smells good, with flavors like watermelon, raspberry and blueberry, and it’s addictive. It has so much nicotine, and they keep puffing until the liquid runs out.”

A single pod contains the amount of nicotine in a whole pack of cigarettes, and a $20 package contains four pods, Curreri said.

Travis Conklin, 17, the Port Jervis school board's student representative, said he occasionally smells the “flavored smoke” in school bathrooms. But while the smell is subtle, Juul marketing is not. After school, he said he often sees students at a nearby convenience store with a large Juul display at the register.

As with other nicotine products, selling vaping materials to anyone under 21 is prohibited in New York, but minors often rely on older friends and family to buy it for them, Curreri said.

Addiction isn't age-restricted

In addition to nicotine, any drug that can be liquefied, such as THC, can also be vaped.

However, nicotine alone brings trouble. Exposure during adolescence can alter brain function, predisposing users to addiction, impulsivity and mood disorders, said the National Youth Tobacco Survey authors.

“I often make house calls where there are problem behaviors and find Juuling to be frequent,” said Esther Suarez, school and community outreach coordinator for state police Troop F, based in Middletown. “Parents clean kids’ rooms, do their laundry and say, ‘What’s this?’ They don’t realize what’s plugged in when Juuls are charging. They take it away, and it’s like taking cigarettes from smokers. Parents say their kids become unbearable; they’re more irritable and aggressive.”

Suarez has been called by parents of kids ages 7 to 17 who were Juuling, she said. Curreri said he assisted a parent with getting a nicotine-addicted child into a 28-day rehab program.

Ingested vs. inhaled

State Health Commissioner Howard Zucker has expressed concern about rampant vaping in schools, with about 40 cases of vaping-associated pulmonary illnesses having been reported in the state as of Sept. 9.

“The vast majority of cases under investigation in New York state involve people who report using cannabis. However, we are also investigating cases in which people report using both cannabis and nicotine products,” he said.

Recently, state investigators identified vitamin E acetate as a commonality in vaped cannabis associated with the illness. The nutritional supplement, typically harmless when ingested, can become deadly when inhaled as a vapor.

“Ingesting is different from inhaling,” said Irina Gelman, Orange County health commissioner.

She sees this episode of death and illness as ominous, as kids refill pods with their own homemade concoctions. Because of the lungs’ sensitivity, many ingredients could cause similar crises. And as commercial varieties are yet to be evaluated for safety, she notes reports of asthma, bronchitis and gastrointestinal problems associated with vaping.