Researchers warn that reward-based smart vapes may deepen addiction risks

Some newer vaping devices link use to cryptocurrency, points and other rewards. Researchers at MUSC Hollings Cancer Center warn that rewarding continued vaping could increase addiction risks and work against efforts to quit.

In a perspective published in the New England Journal of Medicine, the researchers examine how vaping products that combine addictive substances with financial incentives, game-like features and artificial intelligence may keep users engaged. They say the potential public-health effects deserve attention while these products are still relatively new.

The perspective focuses on two products: Puffpaw, a nicotine vaping device marketed as an aid for quitting e-cigarettes, and Gudtrip, a cannabis vaping device that links artificial intelligence and cryptocurrency to use and engagement. Both connect to smartphone apps and track user behaviour.

Rewards are tied to continued use

Nicotine and cannabis affect the brain's reward system. The researchers note that vaping can allow people to take individual puffs throughout the day, creating repeated opportunities for use to become part of daily routines.

Unlike approaches that use incentives to support abstinence or healthy behaviour, the devices discussed in the perspective reward vaping. Points earned through use can be exchanged for cryptocurrency or used to buy refill cartridges.

“What really stood out is that these products are rewarding people for engaging in an already rewarding behavior. In substance use treatment, we do the opposite. We try to help people find rewarding activities that aren't associated with using a substance,” said Amanda Palmer, Ph.D., a Hollings researcher and the perspective's lead author.

Palmer said that rewards which can be exchanged for more refills could create a system that keeps users involved with the product. Tracy Smith, Ph.D., an addiction scientist and co-leader of Hollings' Cancer Prevention and Control Research Program, also raised concern about financially incentivising nicotine use.

The researchers compare smart vapes with earlier tobacco promotions, such as Camel Cash and Marlboro Miles, which let smokers redeem coupons for merchandise. They say newer devices add smartphone technology, cryptocurrency and game-like features that track and reward vaping.

The perspective distinguishes these products from cessation strategies that use financial incentives to reward abstinence or healthy behaviours. The devices described instead reward continued use.

Concerns about who may be drawn to the products

The researchers say the products' technology- and gaming-style marketing may appeal to adolescents and young adults. Benjamin Toll, Ph.D., co-director of the Lung Cancer Screening Program and director of the Tobacco Treatment Program at Hollings, said the combination of artificial intelligence, cryptocurrency and cannabis was a particular concern because of its potential appeal to young people.

They also raise concerns about people facing financial hardship, who may be attracted by the prospect of earning money or digital assets through vaping, and people with substance use disorders. The researchers note that some evidence-based addiction treatments use rewards to support recovery, while these devices reward continued use of an addictive substance.

Researchers point to oversight and data questions

The perspective says regulation has not kept pace with changing vaping technology. It states that the smart nicotine vaping devices it discusses had not received U.S. Food and Drug Administration (FDA) authorization and were not legally authorized for sale in the United States, although unauthorized vaping products were widely available there.

Smith said the FDA can take enforcement action against specific companies but faces difficulty addressing the wider availability of unauthorized products. The researchers argue that nicotine products rewarding vaping through cryptocurrency, game-like features and other incentives warrant scrutiny similar to that applied to products designed to appeal to young people.

The paper describes cannabis oversight as more complicated. It says there is no equivalent federal agency overseeing cannabis products nationwide, and that rules vary by state. Palmer also raised questions about how detailed user information collected through connected apps might be used or shared.

Researchers call for early review

The researchers say their concerns are not an argument against harm reduction or technology that supports quitting. Their focus is on the possibility that financial rewards for vaping could make nicotine or cannabis use harder to stop.

They say they published the perspective now to encourage consideration of the products before they become commonplace. They hope to raise awareness among clinicians and parents and argue that vape-to-earn products should receive careful review by federal and state regulators.

For people seeking to quit nicotine, the article notes that evidence-based tobacco cessation treatments remain available. It also identifies MUSC Health's Tobacco Treatment Program as a source of support for patients seeking to quit smoking or vaping.