Slash nicotine in cigarettes? FDA offers an intriguing idea
Five decades of warnings about the deadly consequences of smoking have helped cut smoking rates in half, but more than
36 million Americans are still puffing away. And if history is any guide, about half of them will die premature deaths, plagued by everything from heart disease to lung cancer.
Now Scott Gottlieb, a physician and commissioner of the Food and Drug Administration, has proposed an intriguing plan to help the remaining smokers kick the habit and prevent more teenagers from getting hooked: Reduce the nicotine in cigarettes to minimally addictive levels.
The proposal, unexpected from an administration that is often pro-industry and anti-science, is far from a cure-all. But it has some support in the research, and the potential upside appears greater than the downside.
Understand this: Nicotine is not the deadly ingredient in cigarettes. The cancer-causing agents are chemical compounds inhaled through the smoke. But nicotine hooks customers and keeps them coming back for more.
In fact, nicotine in traditional cigarettes is so addictive that it rivals heroin and cocaine, says Neal Benowitz of the University of California-San Francisco.
Reducing the level by at least
90% could wean some hardcore smokers from cigarettes. Because the vast majority of smokers start by age 18, it could also prevent teens from getting hooked. They could experiment with smoking but more easily give it up.
A large study released in 2015 — with nearly 800 participants divided randomly into groups that smoked cigarettes with different levels of nicotine for six weeks — found that those using cigarettes with the lowest levels smoked fewer per day, were more likely to attempt to quit than others in the study, and did not compensate by smoking more.
In the real world, the plan would work only if all cigarettes contained low levels of nicotine.
Reducing nicotine has potential risks. Critics of Gottlieb’s proposal argue that if only low-nicotine cigarettes were available, smokers would compensate by smoking more or turning to the black market. Yes, some might. But cigarettes are expensive, as much as $10.44 a pack in New York, including taxes. Many smokers have low incomes and could not afford to smoke more. Nor is everyone willing to break the law.
Today, smokers can turn to less harmful nicotine-delivery devices, such as electronic cigarettes and so-called heat sticks. “What we’re trying to do is ensure these (cigarette) products are minimally addictive,” Gottlieb told the USA TODAY Editorial Board. “And if there are addictive products on the market, then they’re far less risky. That’s the policy in a nutshell.”
Some anti-smoking advocates, while thrilled by Gottlieb’s nicotine reduction proposal, were appalled by his decision to push back regulation of e-cigarettes to 2022, arguing that more needs to be known about their safety.
More study is surely needed. While a major British health organization last year urged smokers to switch to e-cigarettes, American health advocates remain skeptical.
Tobacco companies will surely resist efforts to slash nicotine levels. Yet any proposal with the potential to save millions of lives deserves better than to be summarily snuffed out by critics.