Massachusetts on Tuesday went further than any other state in trying to keep e-cigarettes out of consumers’ hands, with its governor declaring a public health emergency and ordering a four-month prohibition on the sale of all vaping products.
Hours later, Juul Labs, the e-cigarette company that has become synonymous with vaping, said that it had begun a restructuring plan that could result in layoffs. Division heads have been ordered to submit specific plans by Wednesday to deal with financial headwinds, according to a person familiar with the company’s strategy and finances.
The two developments are the latest in an escalating nationwide backlash against vaping, as the number of people who have developed severe lung illnesses after using vaping devices continues to climb. The latest tally, from the Centers for Disease Control and Prevention, is 530 cases, but a top C.D.C. official told a Congressional committee on Tuesday that the agency will announce more cases this week. Nine deaths from the vaping-related ailments have been reported so far.
Also on Tuesday, the California Department of Health urged state residents to refrain from all vaping “no matter the substance or source, until current investigations are complete.”
The exact cause — or causes — of the sicknesses has not been identified and health investigators have not pointed to any specific company, brand or device. But the illnesses have led to hundreds of hospitalizations, with many of those affected in intensive care units. Health officials have said many patients have reported using vaping products containing THC, the high-inducing ingredient in marijuana. Others have reported using products containing THC or nicotine, and some had used both. Some have reported using only nicotine products.
Gov. Charlie Baker said the Massachusetts ban would cover all vaping products, whether they were flavored or unflavored, used with nicotine or with THC, or purchased online or in stores. The ban was approved by a state public health council on Tuesday afternoon.
“I’m declaring this public health emergency because medical and disease control experts have been tracking a rapidly increasing number of vaping-related illnesses that in some cases have led to death,” Mr. Baker said at a news conference.
Juul is the overwhelmingly dominant e-cigarette manufacturer, commanding more than 70 percent of the market. It now has more than 3,800 employees.
But many critics believe its astronomical growth since its launch in 2015 came in large part because of the enormous popularity of its sleek devices and flavored nicotine pods with teenagers.
Juul has denied targeting underage consumers but the Food and Drug Administration and some state attorneys general are investigating the company’s marketing practices. Earlier this month, the F.D.A. sent the company a warning letter, finding that Juul was illegally marketing its products as safer than cigarettes.
Last week Walmart said it would stop selling e-cigarettes. Several key international markets that were part of Juul’s international expansion plans, including India, have said they will ban the technology.
Juul has already seen a drop in sales nationally. It lost half its domestic sales when it voluntarily pulled most flavors from the shelves last year, a company official said. And sales have declined in recent weeks alongside the steady spate of illnesses this summer, concerns raised about teenage vaping and additional states curbing sales of e-cigarettes, especially flavored products.
During the most recent four weeks of data, ending on Sept. 14, product sales fell four straight weeks by 2.6 percent, 2.1 percent, 8 percent, 7.5 percent respectively, according to figures published Monday by Nielsen, a market-research firm.
During the week ending Sept. 14, the company sold 12 million pods, which was two million fewer than during the week ending Aug. 31, according to Nielsen. Weekly sales fell to $52.7 million by mid-September from $63 million in August, but still remained higher than sales for the same period last year.
“Juul gone from saying: ‘The sky’s the limit,’ to saying: ‘How do we survive this?” said Stefanie Miller, co-founder of Sand Hill Strategy, a consulting firm based in Washington, D.C.
Juul officials said a proposed federal ban by the Trump administration on most flavored e-cigarettes, including mint and menthol, would result in a loss of 80 percent of its sales. The company made $1.2 billion in the first six months of the year.
Supporters of vaping products said they were opposed to the move by Massachusetts, highlighting the benefit of alternatives to traditional cigarettes. The C.D.C. says cigarettes are responsible for nearly half a million deaths each year in the United States.
Austin Finan, a spokesman for Juul, said banning the products would push people back to cigarettes and would “create a thriving black market” of fake and unregulated products.
Gregory Conley, the president of the American Vaping Association, said he expected that the Massachusetts ban would quickly be challenged in court.
“If a governor is permitted to just ban e-cigarettes for four months, what else could they ban?” he asked.
Peggy Mack, a manager at Big Cloud Vape Shop in Springfield, Mass., said she was flabbergasted by Mr. Baker’s decision.
“We have employees, we have rent to pay.” she said. “It’s like nothing I’ve ever heard of before.”
Ms. Mack said people had flooded into her store in the hours since Mr. Baker declared the ban, and that she wasn’t even sure she was allowed to continue selling vape products.
A state website issued guidance for retailers late on Tuesday afternoon: “Because this is a temporary ban, at this time retailers are not being asked to destroy products, however, products need to be taken off of the shelves immediately.”
The C.D.C. has issued a broad warning recommending that anyone concerned about contracting a lung illness refrain from using vaping products. Users should also avoid products bought on the street or that have been modified, the center said, adding that teenagers and women who are pregnant should not use vaping products at all.
At a hearing before members of the House Committee on Oversight and Reform on Tuesday, a top C.D.C. official, Dr. Anne Schuchat, said she expected the number of vaping-related cases to increase when the agency releases new data on Thursday.
“We are seeing more and more cases each day,” she said, adding later that “hundreds” of new cases were expected to be announced this week.
“We don’t know the cause,” said Dr. Schuchat, the principal deputy director of the C.D.C. “No single product, brand, substance or additive has been linked to all cases. It’s very dynamic.”
Nearly three-quarters of those sickened were male, and two-thirds were ages 18 to 34, the C.D.C. has said. Sixteen percent are 18 or younger. Some of the people who died, however, were older and had underlying illnesses. Illnesses have been reported in 38 states and one United States territory.
Sheila Kaplan contributed reporting.