Reducing the addictiveness of cigarettes

Abstract

Objective-To assess the feasibility of reducing tobacco-caused disease by gradually removing nicotine from cigarettes until they would not be eVective causes of nicotine addiction. Data sources-Issues posed by such an approach, and potential solutions, were identified from analysis of literature published by the US Food and Drug Administration (FDA) in its 1996 Tobacco Rule, comments of the tobacco industry and other institutions and individuals on the rule, review of the reference lists of relevant journal articles, other government publications, and presentations made at scientific conferences. Data synthesis-The role of nicotine in causing and sustaining tobacco use was evaluated to project the impact of a nicotine reduction strategy on initiation and maintenance of, and relapse to, tobacco use. A range of potential concerns and barriers was addressed, including the technical feasibility of reducing cigarette nicotine content to non-addictive levels, the possibility that compensatory smoking would reduce potential health benefits, and whether such an approach would foster illicit ("black market") tobacco sales. Education, treatment, and research needs to enable a nicotine reduction strategy were also addressed. The Council on Scientific AVairs came to the following conclusions: (a) gradually eliminating nicotine from cigarettes is technically feasible; (b) a nicotine reduction strategy holds great promise in preventing adolescent tobacco addiction and assisting the millions of current cigarette smokers in their eVorts to quit using tobacco products; (c) potential problems such as compensatory over-smoking of denicotinised cigarettes and black market sales could be minimised by providing alternate forms of nicotine delivery with less or little risk to health, as part of expanded access to treatment; and (d) such a strategy would need to be accompanied by relevant research and increased eVorts to educate consumers and health professionals about tobacco and health. Conclusions-The council recommends the following: (a) that cessation of tobacco use should be the goal for all tobacco users; (b) that the American Medical Association continue to support FDA authority over tobacco products, and FDA classification of nicotine as a drug and tobacco products as drug-delivery devices; (c) that research be encouraged on cigarette modifications that may result in less addicting cigarettes; (d) that the FDA require that the addictiveness of cigarettes be reduced within 5-10 years; (e) expanded surveillance to monitor trends in the use of tobacco products and other nicotine-containing products; (f) expanded access to smoking cessation treatment, and strengthening of the treatment infrastructure; and (g) more accurate labelling of tobacco products, including a more meaningful and understandable indication of nicotine content.

Nicotine and Carcinogen Exposure with Smoking of Progressively Reduced Nicotine Content Cigarette

“…However, federal regulation of the availability of nicotine in tobacco products might make it possible to avoid the transition from experimental or occasional smoking to addiction. A strategy for tobacco regulation that has been widely discussed is the Benowitz-Henningfield 1994 proposal to reduce the nicotine content of cigarettes to make cigarettes nonaddictive (4)(5)(6). This proposal argued that if the nicotine content of cigarettes were lowered gradually, smokers would decrease their intake of nicotine (essentially weaning them from the nicotine addiction).…”

Research Required for the Effective Implementation of the Framework Convention on Tobacco Control, Articles 9 and 10

“…Eliminating the nicotine would in effect be prohibition. Unless this is the chosen policy option, the policy can only be about limiting the nicotine in ways likely to reduce addictiveness, most simply by reducing levels of nicotine but also by regulating the forms of delivery systems (Benowitz & Henningfield, 1994;Hatsukami et al, 2010;Henningfield, Benowitz, Slade, Houston, Davis, & Deitchman, 1998). There are a number of intervention points in the manufacturing process that allow this.…”

Commentary on Nardone et al. (2016): Satisfaction, dissatisfaction and complicating the nicotine‐reduction strategy with more nicotine

“…Acknowledging undiminished toxins in VLNC, they hoped that the '…risk may be offset by the long-term benefit of a greater likelihood that they will stop smoking (as cigarettes become less satisfying)' and by the prevention of addiction in non-smokers. Four years later [14], unsatisfying, nicotine-replacement medicines were welcomed into the strategy as short-term smoking-cessation aids. In an enormous further step, proponents have now embraced nicotine for long-term harm reduction [4]: 'The key to successful cigarette nicotine reduction is likely to lie with providing readily available, consumer-acceptable non-combusted forms of nicotine to support shifting the source of nicotine from cigarettes to a non-combusted product' [15].…”