Reduced Nicotine Content Cigarettes and Nicotine Patch

Abstract

Background Reduced nicotine content (RNC) cigarettes have led to smoking fewer cigarettes, withdrawal relief, and facilitation of cessation. The aim of this study is to examine the effects RNC cigarettes with and without nicotine patch and patch alone on smoking behavior, toxicant exposure, withdrawal discomfort and as an exploratory analysis, on long-term abstinence. Methods This study involved a randomized, parallel arm design and six weeks of: 1) 0.05-0.09 mg nicotine yield cigarettes (N=79); 2) 21 mg nicotine patch (N=80) or 3) 0.05-0.09 nicotine yield cigarettes with 21 mg nicotine patch (N=76); all groups received six weeks of additional behavioral treatment with follow-ups up to six months. Results Combination approach led to lower rates of smoking assigned cigarettes and hence lower CO levels than RNC cigarettes alone. Additionally, the combination approach was associated with less withdrawal severity when switching from usual brand to assigned product, and less smoking of usual brand cigarettes during treatment, but not after treatment compared to the other approaches. Conclusion Combining very low nicotine content cigarettes with nicotine patch may improve the acute effects resulting from switching to either of these products alone. Impact These findings may have implications for smoking cessation treatment or a policy measure to reduce nicotine content in cigarettes.

Reduced Nicotine Cigarettes: Smoking Behavior and Biomarkers of Exposure among Smokers Not Intending to Quit

“…Similarly, Hatsukami and colleagues (42) also found lower cotinine levels following a switch to Quest 3 cigarettes after 6 weeks compared with baseline. The Hatsukami and colleagues studies (41,42) and Benowitz and colleagues studies (39,40) are particularly important given that participants used reduced nicotine cigarettes for significantly longer periods than this study. When comparing results across studies, it is important to consider differences in the samples.…”

“…This study excluded participants interested in quitting in the next 30 days, similar to the Benowitz and colleagues studies (39,40) that excluded participants interested in quitting within the next 6 months. In contrast, the Hatsukami and colleagues studies (41,42) included participants interested in quitting. Smokers intended to quit may have greater motivation to achieve complete smoking abstinence and may exhibit lower levels of continued use of reduced nicotine content cigarettes compared with individuals less interested in quitting.…”

“…A 2007 study that examined the use of reduced nicotine content cigarettes over several weeks, found that cigarette consumption, cardiovascular biomarkers, and biomarkers of exposure to CO, polycyclic aromatic hydrocarbons remained stable, whereas urinary NNAL excretion decreased (39). More recent switching studies also indicate either no change or decreases in biomarkers of exposure following a switch to reduced nicotine cigarettes (40)(41)(42)(43).…”

Reducing the nicotine content of combusted tobacco products sold in New Zealand

“…Standardised effect sizes comparing 0.4–15.8 mg/g nicotine are moderate (Fagerström Test for Nicotine Dependence: 0.65) to large (cigarettes per day: 0.79; urinary total nicotine equivalents: 0.82) after 6 weeks of use5 (EC Donny, 2016, unpublished observations). Likewise, in smokers currently interested in quitting, the use of VLNC cigarettes prior to a quit attempt leads to decreased nicotine exposure,9 10 decreased cigarette dependence9 and fewer cigarettes per day 9 10. Furthermore, use of VLNC cigarettes prior to making a quit attempt has been shown to decrease the likelihood of relapse relative to use of control cigarettes9 with mixed evidence as to whether VLNC cigarettes facilitate abstinence over and above nicotine replacement therapy 10 11.…”

Reduced-Nicotine Cigarettes in Young Smokers: Impact of Nicotine Metabolism on Nicotine Dose Effects

“…While transdermal nicotine helps some smokers quit (eg, Stead et al, 2008), most who use nicotine replacement therapies eventually relapse, partly because they miss the behavioral and sensory aspects of smoking (Rose et al, 2000). Smoking cigarettes that deliver less than conventional doses of nicotine (ie,~1 mg/cigarette) reduce nicotine dependence (Benowitz et al, 2007;Benowitz et al, 2012;Benowitz et al, 2015) and promote smoking cessation when used with transdermal nicotine (Hatsukami et al, 2013). Further, a trial of reduced-nicotine cigarettes delivering~0.05-1.2 mg nicotine in 780 smokers showed decreases in nicotine dependence and cigarette consumption at 6 weeks compared to baseline (Donny et al, 2015).…”