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In long-term or heavy use, reported issues include addiction (risk is 9% overall, but 17% for those who start use in adolescence, and up to 50% in those who are daily users), altered brain development, poor educational completion/outcomes, cognitive impairment (IQ levels impaired with frequent use during adolescence), diminished long-term life satisfaction, increased risk of psychotic disorders such as schizophrenia

A study published in JAMA found that one ingredient in some brands provided even more cooling activity than the menthol equivalent

Smuggling counteracts the positive effects of limiting local demand as illicit products tend to be more harmful to consumers, are sold to minors, and cost governments billions of dollars in lost tax revenue

And adding insult to injury, a New Hampshire think tank in July went so far as to say businesses in the Granite State recently avoided a tax hike thanks in part to cigarette smokers and flavored tobacco scavengers from Massachusetts. Had general and education fund revenue in fiscal year 2020 fallen at least 6% below New Hampshires estimates, it would have triggered automatic business tax increases, the Josiah Bartlett Center for Public Policy said