Low-Nicotine Cigarettes Could Make Quitting Easier for Smokers

"New Proposal Aims to Reduce Nicotine   Levels in Some Tobacco Products"

"In January, the FDA announced a plan to   drastically cut nicotine levels in   cigarettes and other tobacco products to   make it easier for people to quit smoking."

If cigarettes contained only a fraction of the nicotine they currently do, it could help people break their addiction and move away from smoking.  

That’s the focus of a new rule proposed by the FDA on January 15. The rule aims to cut nicotine levels in cigarettes to less than 5% of what’s found in regular cigarettes, making them far less addictive. It would also limit nicotine in other tobacco products that involve burning, offering smokers more support in their journey to quit."

" The FDA’s proposed rule is just one step toward making reduced-nicotine cigarettes and other tobacco products the norm. However, this process could take years, depending on the priorities of future administrations and potential legal challenges from the tobacco industry. In the past, the industry has fought similar regulations, such as the FDA’s attempt to introduce graphic warning labels on cigarette packages. The FDA’s authority to lower nicotine levels and require warning labels comes from the 2009 Family Smoking Prevention and Tobacco Control Act.

The idea of setting a nicotine limit has been around for many years, and over  time, the evidence for reducing nicotine in smoked tobacco products has continued to grow. Research, including controlled trials, shows that people who use reduced-nicotine cigarettes tend to smoke fewer cigarettes each day. This has also been true for groups who are at higher risk of smoking, such as those facing economic challenges or dealing with mental health issues.

By offering smokers a way to gradually reduce the number of cigarettes they smoke each day, there’s a real opportunity for them to eventually move toward less harmful alternatives, like noncombusted nicotine delivery options or nicotine replacement therapies. This could be the first step toward fully breaking their addiction to nicotine.

The science behind reduced-nicotine cigarettes suggests they can help smokers lower their nicotine intake, making it easier for them to quit over time. For the nearly 30 million adult smokers in the United States around two-thirds of whom want to quit this approach could offer a realistic path to finally overcoming their addiction.

How Reduced-Nicotine Cigarettes Could Help Break Addiction?

Nicotine, the highly addictive substance in cigarettes, is what keeps people smoking, but it's the other chemicals in cigarette smoke that cause cancer. Cigarettes are carefully designed to deliver just enough nicotine to keep smokers hooked without making them feel sick from the chemical, says Megan Piper, a research director at the University of Wisconsin Center for Tobacco Research and Intervention in Madison.The reason behind this design? It’s to keep people dependent.

Regular cigarettes typically contain about 16 milligrams of nicotine per gram of tobacco. The FDA is considering a proposal to lower this amount to 0.7 milligrams in cigarettes and other tobacco products that are burned.

Several clinical trials have investigated how smokers react to using reduced-nicotine cigarettes compared to regular ones, focusing on factors like smoking behavior. For instance, a study followed nearly 800 participants over six weeks, randomly assigning smokers who weren't intending to quit to use either regular cigarettes or one of several reduced-nicotine alternatives.

By the end of the six-week study, participants who were assigned to smoke cigarettes containing 2.4 milligrams of nicotine or less had significantly reduced their daily cigarette consumption compared to those who smoked regular cigarettes. On average, they smoked about five or six fewer cigarettes per day, as reported by Jennifer Tidey, a behavioral scientist at Brown University’s School of Public Health in Providence, R.I., who helped lead the study.

In addition to smoking fewer cigarettes, those using lower-nicotine cigarettes also showed notable reductions in nicotine dependence after six weeks. This was reflected in their lower scores on tests that measured their addiction to nicotine. Furthermore, when participants were asked to take a day off from using any nicotine products, those who had been using the reduced-nicotine cigarettes experienced considerably fewer cravings for nicotine compared to those who had been smoking regular cigarettes. This suggests that the reduced nicotine content may help lower both the frequency of smoking and the intensity of cravings

A month after the six-week study period, around 80 percent of the participants took part in a follow-up phone interview. The individuals who had been given cigarettes with 1.3 milligrams or 0.4 milligrams of nicotine were smoking notably fewer cigarettes daily than those who had smoked regular cigarettes.

Why is it so hard to quit smoking, and how could lower-nicotine cigarettes help?Quitting smoking is difficult for a lot of reasons, and it's not just because of the nicotine high. According to Piper, the withdrawal symptoms when reducing nicotine can make the process really uncomfortable and even painful. These symptoms can include feelings of sadness, anxiety, irritability, and trouble sleeping. On top of that, many smokers have gotten used to relying on nicotine as a way to cope with stress, which makes quitting even more challenging.

Tidey points out that people who don’t smoke may not fully understand just how tough it can be to quit.

Reduced-nicotine cigarettes might be a way to help people quit smoking. While these cigarettes contain much less nicotine than regular ones, research shows that smokers don't try to smoke more to make up for it. They also don’t experience more cravings or withdrawal symptoms. One reason for this is that the behaviors associated with smoking like taking the cigarette out of the pack, lighting it, holding it, and inhaling have been linked to the nicotine high for so long that just performing those actions can trigger a mood boost.

These familiar habits help make up for the smaller nicotine rush that comes from reduced-nicotine cigarettes. At the same time, consuming less nicotine over time helps reduce dependence on the substance. The fact that cravings and withdrawal symptoms don’t worsen, even though smokers are using less nicotine, is an important finding for people trying to quit. As Piper explains, realizing that you can still have some control over your smoking is key to eventually stopping. Being able to cut back with reduced-nicotine cigarettes helps people believe that quitting for good might actually be possible.

Smokers who participated in a study on low-nicotine cigarettes shared similar thoughts on their experience, as reported in Drug and Alcohol Dependence in 2021. The participants stayed at a hotel for two separate five-day sessions. During the first stay, they smoked regular cigarettes, and for the second stay nine days later they were only given cigarettes containing 0.4 milligrams of nicotine. While using the reduced-nicotine cigarettes, researchers interviewed the participants about how they felt.

Many of them expressed feeling less dependent on cigarettes and more hopeful about their ability to quit. One participant shared, “I finally feel like the cigarettes aren’t in control anymore.” Another said,"Honestly, I think I could quit after smoking these for a couple of weeks."

What Should People Know About Reduced-Nicotine Cigarettes and Quitting?

The main goal of using reduced-nicotine cigarettes is to help people quit smoking, not to keep using these products long-term, as they still contain harmful chemicals that can cause cancer. Some smokers might turn to other nicotine alternatives, such as e-cigarettes or non-combusted tobacco products. There are also FDA-approved nicotine replacement options, like patches or gum, designed to support people through the quitting process.

Introducing reduced nicotine cigarettes could offer smokers a new way to gradually reduce their nicotine dependence. Given how challenging quitting can be, it's important to have multiple options available. “Most people who successfully quit smoking have tried several times before,” Tidey says. “It’s tough, but don’t give up. Keep trying.”