Just over a week ago, the United States Food and Drug Administration announced what new FDA chief Dr. Scott Gottileb called “a cornerstone of our new and more comprehensive approach to effective tobacco regulation”: an initiative to reduce the nicotine content in cigarettes to “minimally or nonaddictive” levels. The 2009 Tobacco Control Act gave FDA authority to reduce any “additives, constituents…, or other component of a tobacco product.”
President Barack Obama signing the Tobacco Control Act
Public health historian Robert Proctor was thrilled. “This is exceptionally good news for tobacco control, and for human health,” he wrote last week in the New York Times. Not so for companies like Altria and British American Tobacco, whose stock value fell within an hour of the statement (and recovered somewhat before the closing bell).
Big Tobacco was reeling for good reason: nicotine is the primary addictive component of cigarette smoking, not incidentally the leading cause of preventable deaths in the U.S. The addictive capacity of nicotine is now practically indisputable. For over sixty years, government regulators, independent researchers, and tobacco company scientists have investigated the extent of that capacity and the danger it poses when delivered via tar-laden cigarettes.
FDA has made no effort to target other nicotine delivery methods such as patches, gums, or even e-cigarettes and vape pens. Clearly, the goal is a net reduction in cigarette consumption and its associated health problems.
Will reducing nicotine reduce smoking rates?
Gottileb believes so. “The science of nicotine regulation, and understanding what the addictive level is, is well established,” he said. “There is a threshold level below which cigarettes probably wouldn’t be addictive.” Proctor noted that cigarettes today are nicotinized to a “Goldilocks optimum,” around one to two percent nicotine by weight, but reducing that level by a factor of ten would make addiction “very difficult”; and by more, “virtually impossible.”
Why? The $64,000,000,000 question
When it comes to cigarette smoking, some evidence suggests more than pharmacology is at play. Drug addiction involves a constellation of reinforcing factors including social stimuli. A sizable body of literature indicates environments, people, and other cues smokers associate with lighting up can trigger intense cravings. Pharmacologically speaking, constituents in cigarette smoke other than nicotine are monoamine oxidase inhibitors (MAOIs), hampering the brain’s ability to efficiently recycle dopamine. In other words, every puff amounts to hitting a mild antidepressant with outrageously harmful side effects.
However, all studies involving habitual cigarette smokers in the last century took place in the long shadow of initial nicotine exposure. Particularly for young people, if those who resisted their early distaste for smoking had less pharmacological and, consequently, peer pressure to continue, fewer would habituate themselves to a product most harmful when used as intended. “Kids might start smoking,” Proctor predicted, “but they wouldn’t have trouble quitting.”
Today, the market is flooded with more cigarette alternatives than ever, and one Philip Morris executive recently went on record claiming, “We are absolutely serious – one day we want to stop selling cigarettes,” adding to chatter within the industry about multiyear phase-outs. But don’t hold your breath. Regardless of the public health implications, it is a pipe dream to believe cigarette manufacturers will co-sign Gottileb and Proctor’s vision anytime soon. “We intend to be fully engaged throughout this process,” Altria assured its shareholders.
The imminent prospect of Big Nicotine may present a host of problems, but it is undoubtedly preferable to the current public health crisis promoted by Big Tobacco.
Stay tuned for Part II, which more thoroughly analyzes the role of nicotine and other substances in the addictive process.