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August 24, 2018

Reduced nicotine cigarettes lower smoking rates, Penn study finds

Last summer, the U.S. Food and Drug Administration announced its intentions to lower nicotine levels in cigarettes, a move aimed at helping millions of people quit smoking.

Anti-smoking advocates applauded the news. But critics wondered whether reducing the addictive stimulant would produce the desired result. Wouldn't smokers simply consume more cigarettes or puff harder?

The answer appears to be no, according to a study published Friday in the journal of the American Medical Association.

Researchers from the University of Pennsylvania found that smoking rates did not increase when a group of smokers switched to cigarettes with reduced nicotine content. And those rates did not differ between participants with different genetic metabolism rates.

"These were non-treatment-seeking smokers," senior researcher Andrew Strasser said. "They were not interested in seeking to quit. We see them using the product less intensely. There's a lot of promise that this might be a good option for decreasing the smoking burden."

For the study, researchers had 84 adult smokers maintain their typical cigarette use for five days. Then, the researchers asked the smokers only to use reduced nicotine content cigarettes for two 15-day periods.

During the first period, the participants received cigarettes with nicotine levels reduced to 5.2 milligrams per gram of tobacco. The second period reduced nicotine levels even more, to 1.3 mg/g. But the smokers were not informed of the change.

Total puff volumes and urinary biomarkers decreased during both portions of the trial. Daily cigarette consumption rose slightly during the first period, but returned to baseline levels during the latter period – when the participants were smoking the cigarettes with the lowest amount of nicotine.

"That part was really important to add to the literature and add to the field – that the cigarettes per day and that the puffing volume were not increasing," Strasser said.

Additionally, smoking rates did not increase among smokers with different genetic metabolism rates, a finding that suggests reduced nicotine content cigarettes do not pose an adverse threat to fast metabolizers.

"That suggests the nicotine metabolism rate is not a significant area of worry in terms of a subgroup at risk," Strasser said. "That's important. We have a good understanding of how the entire population may end up using these products."

The FDA has not released a timeline for establishing its first maximum nicotine level. In March, the agency issued a public notice seeking public input on its intention.

Nicotine levels currently range from 1.1 to 1.7 milligrams, according to the notice. One analysis referenced in the notice suggests that capping nicotine levels at 0.4 milligrams could prompt 5 million adults to quit smoking.

"By the year 2100, the analysis estimates that more than 33 million people – mostly youth and young adults – would have avoided becoming regular smokers," FDA Commissioner Scott Gottlieb said in March. "And smoking rates could drop from the current 15 percent to as low as 1.4 percent."

That could prevent more than 8 million tobacco-caused deaths by the end of the century, Gottlieb said. Currently, tobacco use kills more than 480,000 Americans every year.

Tobacco use remains the leading cause of preventable disease and death within the United States.

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