The Biden administration is considering whether to lower the nicotine content of cigarettes to nonaddictive levels, according to a report in The Wall Street Journal. This raises a number of pressing questions.
Wait, what? The nicotine can be taken out of cigarettes? Yep. It can be done in a few ways, including genetically modifying tobacco plants or removing nicotine from the leaf during manufacturing.
I’m confused. Nicotine in cigarettes is the equivalent of caffeine in soft drinks. It doesn’t need to be there; it’s the addictive substance that keeps consumers reaching for another.
Why didn’t the FDA try to do this earlier? It did. In 2017, then-President Trump’s FDA commissioner tried to reduce the nicotine in cigarettes, but his policy efforts were abandoned when he abruptly resigned in 2019.
So let me get this straight: Low-nicotine cigarettes have bipartisan support, have been known about for years, and have not yet been implemented. Correct. Regulating nicotine content has reportedly been under discussion at the FDA since the 1990s. In the United States, half a million people die per year from smoking—that’s about 1 in 5 deaths.
What’s the hold-up? The 2009 Tobacco Control Act allows the FDA to regulate ingredient levels in cigarettes, but it also required that regulations be backed up by scientific research. This clause was a coup for the tobacco industry, because scientific research takes years.
If this happens, will everyone stop smoking? Well, low-nicotine cigarettes are not necessarily the slam dunk you’d expect. One randomized, double-blind study of 775 heavy smokers (25 cigarettes per day!) found that participants given low-nicotine cigarettes smoked 5-7 fewer cigarettes per day, at 17-19 cigarettes per day. But they did not stop smoking, even when offered $100 to stop for a day. Other studies have found similar results: Users smoke less but still smoke. Experts have pointed out that concurrent harm reduction policies will be essential. FDA models are optimistic.
How will committed smokers react to low-nicotine cigarettes? It’s likely that some will just start buying normal cigarettes online illicitly.
Would consumers even understand this change? Nope. Not a chance. There’s a problem: A box that says “95% less nicotine!” seems safe. In reality, low-nicotine cigarettes are every bit as toxic as standard cigarettes, albeit less addictive. Most people wrongly believe that low-nicotine cigarettes are not carcinogenic (or less so). A public health campaign explaining this little detail will be pivotal.