Lower nicotine content in cigarettes is an idea whose time has come.
On July 28, 2017, the U.S. Food and Drug Administration struck panic among tobacco companies by announcing a comprehensive proposal to reduce the amount of nicotine in cigarettes to non-addictive levels. The level of nicotine that would be required to render cigarettes “non-addictive” has however not been mentioned.
This is aimed at striking at the root of the problem of smokers getting addicted to cigarettes, and being unable to quit the habit. While the proposal is at an early stage and it may take a while become before it gets implemented, if at all, it outlines a powerful strategy.
Nicotine in cigarettes does not directly cause cancers and other diseases that kill people, but it is extremely addictive. By keeping smokers addicted for the long term, nicotine exposes them to nearly 7,000 chemicals, many of them deadly, every time they smoke.
Reducing nicotine in cigarettes to non-addictive levels would therefore have multiple benefits — reduce the likelihood of new users (those in the 15-24 age group) getting hooked to cigarettes, increase the chances of habitual smokers being able to quit, and overall cut smoking-related disease and death burden. In the U.S. alone, nearly half a million smoking-related deaths are reported every year.
While cutting down the nicotine levels by more than 90% will make it non-addictive to a large number of smokers, there will still be a percentage of smokers for whom even the tiny amount would continue to be addictive. After all, different people inhale different amounts of nicotine even from the same cigarette, and process it differently in their bodies.
There are concerns that reduced nicotine levels will result in increased number of cigarettes smoked. While more studies are required to establish a clear causality, a paper published in the New England Journal of Medicine in 2015 showed smokers using reduced-nicotine cigarettes smoked a fewer number of cigarettes per day compared with those smoking standard cigarettes.
The idea of reducing the amount of nicotine in cigarettes as a tobacco control strategy was proposed as early as 1994 by the FDA even when it did not have any authority to regulate nicotine levels. But with the adoption of the Tobacco Control Act in 2009, the FDA could do precisely that — limit the amount of nicotine in cigarettes, though it cannot eliminate it completely.
The FDA, however, has no plans to regulate the nicotine content in electronic cigarettes and other nicotine-replacement products, which are seen to be alternatives to help smokers quit the habit. A study published a few days ago in the journal BMJ found that a “substantial increase” in electronic cigarette use among adult smokers led to a “significant increase” in the quitting rate among smokers.
By making it illegal to sell e-cigarettes to children a year ago, the FDA has also effectively addressed the growing concern about children taking to vaping. While India should also take similar steps to reduce the nicotine levels in cigarettes, the U.S. has much to learn from India on several tobacco control measures.
While India is yet to prohibit the sale of e-cigarettes to minors, it has followed most of the measures mentioned in the WHO Framework Convention on Tobacco Control guidelines. Unlike the U.S., India banned tobacco advertisements long ago, introduced pictorial warnings (covering 85% of the front and back of packages of tobacco products), prohibited the use of the risk claims and descriptors such as light, mild and low and forbid the sale of flavoured cigarettes.
But threatened by the dwindling number of young smokers, tobacco companies are sure to target developing countries such as India with renewed vigour. While companies may pull out all the stops to subvert or dilute tobacco control measures, the government should remain resolute in not losing the gains achieved in the last few years — the number of tobacco users came down by more than eight million between 2010 and 2016. Most gain was seen among teenagers (15-17 years) as the percentage of users fell sharply from 9.6% to 4.4% during this period, the Global Adult Tobacco Survey 2 2016-2017 says.