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Failure to dramatically cut the legal limit for nicotine could have unintended consequences.
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The FDA wants to reduce the nicotine in cigarettes to “non-addictive levels”

By Zoë Schlanger

The US Food and Drug Administration issued an “advance notice of proposed rulemaking” on Thursday (Mar. 15) that it is embarking on a quest to “explore” the possibility of lowering nicotine in cigarettes to “minimally or non-addictive levels.”

Basically, it means the FDA is giving cigarette companies a heads-up that it plans to issue a rule in the near future slashing the legal levels of nicotine in a cigarette.

But whether there is such thing as a “non-addictive” level of nicotine is not so clear-cut.

The FDA has been teasing this announcement for almost a year. When the news first surfaced in July 2017, experts were skeptical. Wouldn’t less nicotine per cigarette…just make people smoke more cigarettes?

“The idea of gradually reducing the addictive ingredient of cigarettes, nicotine, looks attractive on the surface,” Robert West, a professor of health psychology at University College London, told the Guardian at the time. “But unless nicotine is pretty much eliminated quickly and comprehensively in all available tobacco products—which seems unlikely—it runs a serious risk of making things worse as smokers smoke cigarettes harder in order to get the nicotine they need, leading to more exposure to the harmful tar.”

But some research has found lower-nicotine cigarettes could reduce dependence—but only if the amount of nicotine was dramatically reduced. One study, published in Feb 2018, enrolled more than 800 smokers who had no interest in quitting in a six-week trial. The smokers were broken up into groups, and given cigarettes with different amounts of nicotine; the control group smoked normal cigarettes (with 15.8 mg of nicotine each), and each group had progressively less potent cigarettes, with the lowest group smoking cigarettes with just 0.4 mg of nicotine each.

It seemed to work to reduce addiction—but only with the groups smoking 2.4 mg of nicotine per cigarette or less. And it was particularly effective in the 0.4 mg per cigarette group. The researchers found smokers in that lowest group not only showed fewer signs of addiction, but smoked fewer cigarettes per day at the end of six weeks. When polled, more people from that group said they would consider quitting all together, if the price of cigarettes stayed the same and no “normal” were available on the market—likely in part because it would be far more expensive for the smokers to get their usual nicotine fix.

“Dependence is not magically gone in six weeks,” Eric Donny, director of the Center for the Evaluation of Nicotine in Cigarettes at the University of Pittsburgh and a co-author on that study, told STAT News. “But it’s certainly reduced, and we would predict [less dependence] would enable more quitting.”

He said regulators should consider cutting nicotine by 95% to 97% per cigarette to really see an effect. But getting those results would be a dramatic regulatory step, one that the FDA is unlikely to take.

“If you just reduce it a little, people might smoke more to make up the difference. They need to reduce it a lot,” Donny told the Los Angeles Times.

(h/t Hannah Weinberger and Madeleine Stirling for the tips)