A review of the evidence on cigarettes with reduced addictiveness potential

Abstract

Background In May 2018, the Secretariat for the World Health Organization Framework Convention on Tobacco Control convened a meeting to discuss the potential for reducing the addictiveness of tobacco products. A central focus was to review research findings on the behavioral effects of reducing the addictiveness of cigarettes. Methods This manuscript reports the results of a review of the behavioral science literature, updated through April 2021, with special attention to both the potential benefits and unintended consequences of reducing nicotine in cigarettes. Results Available evidence suggests that reducing nicotine content in cigarettes to very low levels could benefit public health in three primary ways, by 1) decreasing uptake of regular smoking, 2) decreasing the amount people smoke, and 3) increasing the likelihood of smoking cessation. Current evidence also suggests that reducing nicotine in cigarettes may produce similar benefits across many important subpopulations of people who smoke, including those with psychiatric comorbidities, those who use other substances, those with low socioeconomic status, young people, people who smoke infrequently and people who prefer menthol cigarettes. Cigarette nicotine reduction could also lead to some undesirable outcomes, such as experiencing withdrawal, product manipulation, an illicit market, and harm misperceptions; strategies that may mitigate each are discussed. Conclusion Overall, behavioral research suggests product standards that limit the nicotine content of combusted tobacco products could render cigarettes and similar products less addictive. The availability of legal, non-combusted products that effectively substitute for cigarettes and the dissemination of public health campaigns that clarify misperceptions about the relationship between nicotine, tobacco and disease may facilitate the extent to which a nicotine reduction policy reduces smoking.

The effects of reduced nicotine content cigarettes in smokers with mood or anxiety disorders: a double-blind randomized trial

“…The present study is consistent with others (9, 12, 13) in being broadly reassuring about the effects of switching to very low nicotine cigarettes on mental health outcomes in those with unipolar mood and anxiety disorders, and adds the findings of reduced toxicant exposure and increased probability of successful smoking cessation when treatment is offered. A recent trial (11) that excluded smokers with serious psychiatric illness demonstrated that abrupt nicotine reduction in cigarettes is feasible.…”

“…The U.S. Food and Drug Administration (FDA) regulates tobacco products, and in 2017, announced plans to reduce the nicotine content of cigarettes to minimally addictive levels (2).While these plans remain under consideration in USA, the government of New Zealand recently announced a plan to only allow reduced nicotine cigarettes to be sold (3). Previous studies have generally found that reduction of nicotine content in cigarettes is feasible and safe in smokers with and without comorbid psychiatric illness, and it has been estimated that this would save millions of lives (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Over 25% of smokers have an affective (unipolar mood or anxiety) disorder, representing over 8 million people in the US.…”

New Insights in the Involvement of the Endocannabinoid System and Natural Cannabinoids in Nicotine Dependence

“…Health effects derived from tobacco are mainly caused by nicotine [ 20 ]. However, many other hazardous compounds are found, regardless of the tobacco administration route (it can be smoked, chewed, or sniffed) [ 21 , 22 , 23 , 24 ].…”

Knockout of a key gene of the nicotine biosynthetic pathway severely affects tobacco growth under field, but not greenhouse conditions

“…In recent years there has been increased interest in developing tobacco varieties that possess very low levels of nicotine while retaining acceptable agronomic qualities. Two of the motivating factors behind this interest include: (1) evidence from numerous clinical studies that have shown that smokers who switch to cigarettes containing nicotine levels below that capable of sustaining an addiction response will smoke less and/or find it easier to quit (reviewed in [ 1 ]); and (2) the possibility that the US Food and Drug Administration (FDA) may mandate such reductions in future cigarette products [ 2 ]. From a plant genetic perspective, lowering the nicotine content of the leaf can be accomplished through the utilization of naturally occurring mutations, genetic engineering, and genome editing [ 3 – 7 ].…”