18.4 Low nicotine – nicotine reduction

Last updated: August 2016 

Suggested citation: Greenhalgh, EM, & Scollo, MM 18.4 Low nicotine–nicotine reduction. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/18-4-low-nicotine

It is well established that addiction to nicotine maintains most smokers’ use of tobacco products.1 Once addicted, quitting can be extremely difficult, with many smokers repeatedly relapsing following their cessation attempts.2  Young people have a very poor understanding of addiction, often believing that they will be able to stop smoking at will.3 However, once they take up smoking, the nicotine addiction sustains the behaviour into adulthood, dramatically increasing their risk of tobacco-related harm.4 

The regulation of the level of nicotine in tobacco products has been suggested as a potential strategy for avoiding the transition from experimental smoking to addiction. Reducing the nicotine content in cigarettes so that they are non-addictive could prevent adolescents and occasional smokers from becoming addicted. A gradual reduction could also allow smokers to slowly decrease their intake of nicotine, thereby weaning themselves off the product and making quitting substantially easier.5,6 Unlike ‘low tar and light’ cigarettes promoted by tobacco companies, which did not actually reduce delivery of tar and instead involved design features that allowed smokers to easily compensate for the reduced nicotine content by drawing harder (see section 12.4), reduced nicotine cigarettes could be manufactured the same as regular cigarettes except with tobacco that has a lower nicotine content. If the nicotine content was low enough, it would be virtually impossible to absorb significant levels of nicotine by using these products.6 Research comparing gradual with immediate nicotine reduction in cigarettes found that neither led to compensatory smoking, while both strategies reduced levels of cotinine.7 However, another trial of gradually reducing the nicotine content of cigarettes found no long-term benefit for level of dependence or cessation among a sample of smokers who were not interested in quitting.8 A larger randomised trial found that, among another sample of adult smokers with no interest in quitting, abrupt switching to reduced-nicotine cigarettes versus standard-nicotine cigarettes for six weeks reduced nicotine exposure and dependence and the number of cigarettes smoked.9   

Developing low-nicotine cigarettes has been a prominent approach in considerations of tobacco endgame strategies; it is endorsed by the American Medical Association, the British Medical Association, the US Food and Drug Administration (FDA) and the US Surgeon-General, and is also supported within the WHO Framework Convention on Tobacco Control.10 The approach more broadly calls for research, government regulation, gradual reduction, consumer education, and increased availability of lower-risk options, in order to combat addiction and eliminate gateway risks.6

Health Canada issued a tender in 2016 calling for research into the possibility of forcing tobacco companies to make their cigarettes less addictive.11 The FDA included in its 2009 tobacco law the authority to reduce nicotine,12 potentially advancing the possibility of low-nicotine cigarettes. However, critics of the approach have argued that it may not be practicable within the confines of FDA law. Or, if it is, it may take many years to implement, and would require mandatory low nicotine content to succeed. They contend that resources would be better allocated to more pleasurable and likely less harmful forms of nicotine use, such as vaping and snus.10  Alternatively, others have suggested a combination of these strategies; that is, reducing the nicotine content of smoked tobacco products while allowing non-combustible recreational nicotine products to be sold.13

Recent news and research

For recent news items and research on this topic, click here (Last updated June 2018) 

 

References

1. Benowitz N. Pharmacologic aspects of cigarette smoking and nicotine addition. New England Journal of Medicine, 1988; 319(20):1318–30. Available from: http://www.nejm.org/doi/full/10.1056/NEJM198811173192005

2. Zhou X, Nonnemaker J, Sherrill B, Gilsenan AW, Coste F, et al. Attempts to quit smoking and relapse: factors associated with success or failure from the ATTEMPT cohort study. Addictive Behaviors, 2009; 34(4):365–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19097706

3. Gray RJ, Hoek J, and Edwards R. A qualitative analysis of 'informed choice' among young adult smokers. Tobacco Control, 2014. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25192770

4. Benowitz NL, Hall SM, Stewart S, Wilson M, Dempsey D, et al. Nicotine and carcinogen exposure with smoking of progressively reduced nicotine content cigarette. Cancer Epidemiology Biomarkers & Prevention, 2007; 16(11):2479–85. Available from: http://cebp.aacrjournals.org/content/16/11/2479.short

5. Benowitz NL and Henningfield JE. Establishing a nicotine threshold for addiction: the implications for tobacco regulation. New England Journal of Medicine, 1994; 331(123–5). Available from: http://www.ncbi.nlm.nih.gov/pubmed/7818638

6. Benowitz NL and Henningfield JE. Reducing the nicotine content to make cigarettes less addictive. Tobacco Control, 2013; 22(suppl 1):i14–i7. Available from: http://tobaccocontrol.bmj.com/content/22/suppl_1/i14.abstract

7. Hatsukami DK, Donny EC, Koopmeiners JS, and Benowitz NL. Compensatory smoking from gradual and immediate reduction in cigarette nicotine content. Cancer Epidemiology, Biomarkers & Prevention, 2014; 24(2):472–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25515551

8. Benowitz NL, Nardone N, Dains KM, Hall SM, Stewart S, et al. Effect of reducing the nicotine content of cigarettes on cigarette smoking behavior and tobacco smoke toxicant exposure: 2-year follow up. Addiction, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26198394

9. Donny EC, Denlinger RL, Tidey JW, Koopmeiners JS, Benowitz NL, et al. Randomized trial of reduced-nicotine standards for cigarettes. New England Journal of Medicine, 2015; 373(14):1340–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26422724

10. Kozlowski LT. Prospects for a nicotine-reduction strategy in the cigarette endgame: alternative tobacco harm reduction scenarios. International Journal of Drug Policy, 2015; 26(6):543–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25795345

11. Government of Canada. Health benefits modeling, expert elicitation and analysis relating to a product standard (1000174109). 2016. Available from: https://buyandsell.gc.ca/procurement-data/tender-notice/PW-16-00718749  

12. United States Code. Family smoking prevention and tobacco control act. In Stat 1776 United States. 2009. Available from: http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/ucm237092.htm

13. Hall W and Gartner C. Supping with the Devil? The role of law in promoting tobacco harm reduction using low nitrosamine smokeless tobacco products. Public Health, 2009; 123(3):287–91. Available from: http://www.sciencedirect.com/science/article/pii/S0033350608003533

 

      Previous Chapter Next Chapter