Nicotine product standard for combusted tobacco: support and barriers

With cigarettes killing more than 480,000 smokers each year in the U.S. alone, innovative and aggressive measures to facilitate quitting smoking among the almost 70% of smokers who want to quit is urgently needed.  These methods include eliminating or reducing the attractiveness of a product, such as banning characterizing menthol flavor.  However, the approach that will lead to the greatest reduction in the prevalence of smoking is likely to be reducing the addictiveness of cigarettes.  Recently, researchers have been systematically and comprehensively examining the potential effects of a nicotine product standard for cigarettes.  To date, results from randomized clinical trials indicate that, compared to smokers assigned to smoking normal nicotine content cigarettes, those who are assigned to very low nicotine content (VLNC) cigarettes experience reduced number of cigarettes per day, exposure to toxicants, and cigarette dependence and higher number of quit attempts and cessation rates.  These results are found among smokers who experience the greatest prevalence of smoking and experience the greatest health disparities.  The results also suggest that reducing the reinforcing value of cigarettes facilitates the uptake of alternative nicotine delivery systems, such as e-cigarettes.  This uptake augments the beneficial effects of VLNC cigarettes.  Modeling population impact showed that 8 million tobacco-related deaths would be averted by the turn of the century.  However, despite these promising findings, several barriers against a nicotine product standard exist such as:  1) a sentiment that reducing nicotine in cigarettes is a draconian measure and smacks of prohibition and that access to alternative products under the right circumstances should be sufficient; 2) similarly, the belief that such a standard would be an infringement on a person’s freedom to choose whether to smoke or not; 3) the potential for a flourishing illegal market; 4) misperceptions about nicotine (e.g., nicotine causes cancer so reducing nicotine will reduce cancer risk); and 5) inadequate resources for those who need or want to continue to use nicotine.  This presentation will describe what would be necessary to implement a nicotine product standard while minimizing unintended consequences.