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The US Food and Drug Administration pressed forward with its investigation of e-cigarette companies Friday, sending letters to 21 companies in an effort to uncover whether they are marketing products illegally and outside the agency's compliance policy.This latest phase of the investigation addresses more than 40 e-cigarette products and is part of the agency's ongoing efforts to combat e-cigarette use among youth. It also comes less than two weeks after the agency conducted a surprise inspection of e-cigarette maker Juul's corporate headquarters in San Francisco, seizing thousand of documents, many of which relate to its sales and marketing practices."Companies are on notice," FDA Commissioner Dr. Scott Gottlieb said in a statement Friday. "The FDA will not allow the proliferation of e-cigarettes or other tobacco products potentially being marketed illegally and outside of the agency's compliance policy, and we will take swift action when companies are skirting the law."In September, Gottlieb called the increasing teen use of e-cigarettes "an epidemic," adding that teen nicotine use is dangerous to young people's health and brains.Federal law prohibits the sale of e-cigarettes to people under the age of 18, but more than 2 million middle and high school students were current users of e-cigarettes in 2017, according to the FDA. The US Centers for Disease Control and Prevention says it's the most common nicotine product used by middle and high schoolers.Also last month, the FDA requested that five major e-cigarette manufacturers, including Juul, explain how they plan to combat the use of their products by minors. The agency said it was looking into steps to eliminate the sale of flavored products and unveiled a public education campaignabout e-cigarettes.The FDA said it's considering civil and criminal avenues to enforce these regulations, including fines, seizures and injunctions, according to Friday's announcement.CNN reached out to some of the companies that received letters for comment but did not immediately receive a response."We're going to address issues related to the access kids have to e-cigarettes, as well as the youth appeal of these products," Gottlieb said Friday. "We know flavors are one of the principal drivers of the youth appeal of e-cigarettes and we're looking carefully at this."No reasonable person wants to see these products reaching epidemic use among kids," he said. 2500

The US Food and Drug Administration has raised alarm about one way people might access opioids to misuse and abuse: their pets.As America's opioid epidemic rages, some pet owners could be stealing pain medications intended for their furry friends, according to a statement from FDA Commissioner Dr. Scott Gottlieb."We recognize that opioids and other pain medications have a legitimate and important role in treating pain in animals -- just as they do for people," Gottlieb said in Wednesday's statement."But just like the opioid medications used in humans, these drugs have potentially serious risks, not just for the animal patients, but also because of their potential to lead to addiction, abuse and overdose in humans who may divert them for their own use," he said.Gottlieb also said there hasn't been much information about responsible opioid prescribing for veterinary medicine professionals, and so the FDA developed a resource guide on what veterinarians need to know.The resource includes information on state and federal regulations, alternatives to opioids and how to properly safeguard and store opioids, as well as how to identify if a client or employee may be abusing opioids and take action with a safety plan."While each state creates its own regulations for the practice of veterinary medicine within its borders, including regulations about secure storage of controlled substances like opioids, veterinarians should also follow professional standards set by the American Veterinary Medical Association in prescribing these products to ensure those who are working with these powerful medications understand the risks and their role in combatting this epidemic," Gottlieb said."Veterinarians are also required to be licensed by the Drug Enforcement [Administration] to prescribe opioids to animal patients, as are all health care providers when prescribing for use in humans," he said."These measures are in place to help ensure the critical balance between making sure animals can be humanely treated for their pain, while also addressing the realities of the epidemic of misuse, abuse and overdose when these drugs are diverted and used illegally by humans."The FDA statement came one week after a perspective paper in the American Journal of Public Health called for the veterinary, public health, pharmaceutical and regulatory communities to dedicate time and resources to addressing the issue of prescription opioid diversion in veterinary medicine."I was thrilled to see the FDA commissioner make a statement that not only validated our findings but also demonstrates why research is so important for good policy," said Liliana Tenney, a senior instructor with the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and deputy director of the Center for Health, Work & Environment, who was a co-author of the paper.Tenney was unaware of the FDA statement until CNN contacted her for an interview, she said.The paper included data from a 24-item online survey that 189 veterinarians in Colorado completed in collaboration with a local veterinary society. The survey, which was about the possible abuse and misuse of opioids by pet owners and the role veterinarians play in prevention, was administered in summer 2016, Tenney said.The survey results showed that 13% of the veterinarians were aware that an animal owner had intentionally made an animal ill or injured -- or seem to be ill or injured -- to obtain opioid medications."This is significant for two reasons. These providers want to ensure the treatment of pets," Tenney said. "If this is truly the case and pet owners are intentionally harming animals, that's an animal rights issue. If opioids are being prescribed and aren't getting to the pets that need them because these drugs are being diverted, that's a public health issue."The survey results also showed that 44% of the veterinarians were aware of opioid abuse or misuse by either a client or a veterinary practice staff member, and 62% believed that they had a role in preventing opioid abuse and misuse."We recognize that this ... sample, representing 10% of the society's members, has limited generalizability and cannot be used to extrapolate to all practices. Nonetheless, these data are sufficient to warrant immediate action," the authors wrote.American Veterinary Medical Association spokesman Michael San Filippo emphasized in a statement Wednesday that the association has provided resources for veterinary staff to help combat this issue and the association will continue to monitor the situation."Though our animal patients are not the ones struggling with opioid addiction, concerns about misuse and diversion are top-of-mind for the veterinary profession, and the AVMA is actively involved in providing resources to practitioners describing alternative ways to treat pain and minimize opioid use," the statement said."While the limited data available suggests diversion from veterinary practices isn't a widespread problem, that doesn't mean we should pretend it doesn't exist," it said. "In fact, AVMA policy calls for further research to determine the prevalence of veterinary drug shoppers and to further clarify the degree to which veterinary prescriptions are impacting, or not, the human opioid epidemic."? & ? 2018 Cable News Network, Inc., a Time Warner Company. All rights reserved. 5456

The US called on Turkey to not follow through on threats to attack US-backed forces in Syria Wednesday, an incursion the Pentagon warned could threaten US personnel and derail the fight against ISIS."Unilateral military action into northeast Syria by any party, particularly as US personnel may be present or in the vicinity, is of grave concern. We would find any such actions unacceptable," Commander Sean Robertson, a spokesman for the Department of Defense, told CNN."We believe this dialogue is the only way to secure the border area in a sustainable manner, and believe that uncoordinated military operations will undermine that shared interest," he added.Earlier on Wednesday, Turkey's President Recep Tayyip Erdogan said in a televised speech that Turkish troops would launch a military operation east of the Euphrates in Syria, an operation aimed at targeting Kurdish militants.The US troops in Syria regularly work with Kurdish elements of the Syrian Democratic Forces as part of their campaign against ISIS.Turkey sees all Kurdish forces in in Northern Syria as an extension of the Kurdistan Workers' Party (PKK), listed as terror group by the US and the EU. The US does not share Turkey's view."Our target is definitely not American troops. It is the members of terror organization operating in the region. I want to emphasize this," Erdogan added, saying that he expected the operation to begin "in a couple of days."Secretary of Defense James Mattis recently directed US troops to establish a series of observation posts in the northeast Syria border region as part of an effort to reduce tensions between Turkey and the US-backed Syrian Democratic Forces.Two US officials told CNN that while the US has observed additional Turkish forces arriving in the area, at this point in time it is assessed that Turkey does not have enough troops in the area to conduct the type of operation in the timeline outlined by Erdogan.However the threat of cross-border shelling remains, potentially putting US troops there at risk.Previous cross-border clashes caused the Syrian Democratic Forces to suspend their hard-fought offensive against the ISIS-held town of Hajin, the terror group's last remaining redoubt east of the Euphrates River."The campaign against ISIS is not over. Coalition forces are working closely with the Syrian Democratic Forces who are in the midst of offensive operations against ISIS in the Middle Euphrates River Valley," Robertson, the Pentagon spokesman said."We should not and cannot allow ISIS to breathe at this critical point or we will jeopardize the significant gains we have made alongside our Coalition partners and risk allowing ISIS to resurge," he added. 2703

The White House announced Tuesday that official public tours of the complex will resume September 12, nearly six months after tours were suspended during the onset of the coronavirus pandemic.While the White House resumes tours, a number of social distancing guidelines will be implemented, including mandatory face coverings for all visitors over the age of 2. Tours will only operate two days a week, Friday and Saturday, from 8 to 11 a.m. Capacity for the tours will be at 18%.On a given year, the White House welcomes over 1 million visitors to the complex each year. And even with the large number of tours, the demand for tours far exceeds the supply.The White House tours are generally held away from working areas of the White House.While the White House is resuming tours, a number of other capital-area facilities have remained closed to the public since March, including the US Capitol. As of Tuesday, the National Zoo and the National Air and Space Museum in Virginia are the only Smithsonian institutions to be currently open. 1047

The Scripps National Spelling Bee is welcoming applicants for its second year of RSVBee, the invitational program that creates more opportunities for champion spellers to compete in the national finals in National Harbor, Maryland.Last year, more than 230 students competed in the national finals through RSVBee, including the 2018 Champion, Karthik Nemmani, from McKinney, Texas.To be eligible, students must attend a school that is enrolled in the Scripps National Spelling Bee program and be a school or community spelling champion during the 2018-19 school year. Students who previously competed in the national finals also are eligible to apply. Parents can complete the online application form on behalf of their children between now and March 22, 2019.There are new application and invitation acceptance guidelines for RSVBee: 841