Smoker Study Reignites Fire to Reduce Nicotine in Cigarettes

A study published today in the New England Journal of Medicine reports that smoking low-nicotine cigarettes could reduce dependence and cravings for nicotine in smokers.

The idea that less nicotine means decreased addiction seems intuitive at first, but the studies backing it up have been scant. The FDA was first introduced to the concept 20 years ago and received strong support from the medical community, but its initial push to regulate nicotine content in American cigarettes was shut down by the Supreme Court in 2000 with its FDA v. Brown & Williamson Tobacco Corp. ruling.

Baffling, right?

Over the past eight years, however, multiple health organizations have revisited the idea of lessening the amount of nicotine in cigarettes. While so-called “light” cigarettes were originally marketed as “safer” cigarettes for possibly having less tar and nicotine, they were still unhealthy.

The NEJM study is the biggest of its kind, to date. Over six weeks, 780 participants were randomly assigned to smoke either their usual brand of cigarettes or a low-nicotine variety. None of the smokers had any previous interest in quitting smoking. By the final week of the study, the low-nicotine smokers were smoking fewer cigarettes than those smoking their usual brand.

There was a correlation between the amount of nicotine and the number of cigarettes smoked. A “normal” cigarette has about 15.8 mg of nicotine, while the ‘investigational’ ones had between 0.4-2.4 mg. By week 6, participants who had normal cigarettes smoked about 21.3 per day, whereas those smoking the ultra-low-nicotine, 0.4-mg cigarettes were down to 14.9 a day.

Overall, the low-nicotine smokers had decreased dependence and fewer cravings. And because the test cigarettes were free, the researchers point out, participants were probably smoking even more than they normally would have.

But if there’s less nicotine in cigarettes, won’t smokers just puff more to compensate? Not quite, write doctors Michael Fiore and Timothy Baker in an article expanding on the study also in this week’s NEJM:

“Reducing the nicotine content of combustible tobacco is not without risks. For instance, people who are already addicted to conventional cigarettes might compensate for reduced nicotine yield by smoking more cigarettes or smoking them more intensively. Such compensation might increase smokers’ exposure to the harmful toxicants of combusted tobacco, including tar, carbon monoxide, and other carcinogens. However, studies, including the one by Donny et al. in this issue of the Journal (pages 1340–1349), tend to show only modest compensation in response to a reduction in nicotine yield.”

The authors also advocate for a law that would reduce the amount of nicotine in cigarettes:

“The current study by Donny and colleagues adds to a growing literature supporting the feasibility and potential benefits of a national nicotine-reduction policy — one that, in our view, could help to end the devastating health consequences of combustible-tobacco use.”

While the Tobacco Control Act in 2009 gave the FDA the power to reduce the amount of nicotine in cigarettes, it doesn’t allow the FDA to reduce nicotine to zero.

While the FDA will no doubt take the new findings into consideration, to what degree they’ll have any impact on the tobacco industry remains for now shrouded in smoke.