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Low nicotine cigarettes: What evidence is available to indicate if these products could assist smokers with quitting?

Heart, Men's Health, Stroke, Asthma, General, Women's Health | December 1, 2015 | Author: The Super Pharmacist

women, heart, men, Stroke

Low nicotine cigarettes: What evidence is available to indicate if these products could assist smokers with quitting?

Does changing to a lower nicotine cigarette reduce or increase the number of cigarettes smoked daily?

Nicotine has long been known to be the addictive chemical in cigarettes and other tobacco products. While nicotine is naturally present in tobacco, cigarette companies have capitalised on the addictive properties of nicotine by enhancing nicotine in most cigarettes.1

Nicotine replacement therapy and its limitations

First-line smoking cessation treatment is nicotine replacement therapy, in the form of nicotine gum, lozenges, pills, patches, or sprays. The goal of nicotine replacement therapy is to give people addicted to smoking nicotine-laden cigarettes a means of getting the nicotinic crave without exposing themselves to the harmful effects of cigarettes. Nicotine replacement therapy is successful in the short term2, but it is a relative failure over the long term with approximately 18% success rates at one year.3

Low nicotine cigarettes: What evidence is available to indicate if these products could assist smokers with quitting?Reducing nicotine in cigarettes: A new treatment?

Another treatment approach to smoking cessation is almost the opposite of nicotine replacement therapy, namely reducing the amount of nicotine in cigarettes. The goal of low nicotine cigarettes is to make cigarettes less addictive.4 People who have never smoked and never been exposed to inhaled nicotine would, in theory, not develop the same chemical dependence as they would with full nicotine cigarettes. Smokers still receive the psychological gratification of smoking without the physiological dependence on nicotine.

A note about “low nicotine” cigarettes

The low nicotine cigarettes that experts are proposing are different than “low tar, low nicotine” and “light” cigarettes advertised by tobacco companies. These cigarettes have been modified to burn faster and allow for faster ventilation, but the nicotine content is the same.5 What actually occurs with these low yield cigarettes, is that smokers take bigger puffs, take these puffs more frequently, or simply smoke more cigarettes per day (i.e. compensatory smoking).5 In fact, the tobacco industry specifically exploits consumer misunderstanding through the use of these labels.6 True low nicotine cigarettes would have less nicotine in each cigarette, making it essentially impossible to absorb significant levels of nicotine during smoking.7 In fact, many researchers use the term very low nicotine content cigarettes to distinguish between what has been advertised as “low nicotine” and what actually is a cigarette with low nicotine.8

How well do low nicotine cigarettes work?

Clinical trials seem to indicate low nicotine cigarettes help smokers feel more satisfied and have fewer cravings than the nicotine patch.9 Even though the cigarettes contained no appreciable amounts of nicotine, smokers reported that low nicotine cigarettes cause less withdrawal than stopping smoking altogether.10 Some studies also suggest that using low nicotine cigarettes reduces cigarette intake without increasing compensatory smoking behavior and there is no increase in the amount of toxic substances that people inhale compared to their usual brand.11,12,13 Unfortunately, for veteran smokers who are not interested in quitting smoking, reducing nicotine levels in cigarettes does not reduce nicotine dependence nor does it prompt smokers to quit smoking.14 Researchers are still hopeful, however, that reducing nicotine levels in all cigarettes will help new smokers from becoming addicted in the first place.15

Making low nicotine cigarettes more helpful

Researchers have not abandoned the concept of a low nicotine cigarette for smoking cessation. While it may seem counterintuitive, researchers have combined low nicotine cigarettes with nicotine replacement therapy to help smokers quit smoking.11 The rationale behind this is somewhat strained, but the authors hypothesised that smoking behavior, toxin exposure, withdrawal, and craving would be less with a low nicotine cigarette and a nicotine patch than for either product alone.11 As the authors expected, combining treatments helped reduce all of these effects of smoking. Low nicotine cigarettes may be most helpful when they are combined with behavioral therapies and nicotine replacement. People who received combined therapy were slightly (18%) more likely to quit smoking.16 This is not a tremendous improvement over traditional treatment measures, but the results were statistically significant.

Low nicotine cigarettes: What evidence is available to indicate if these products could assist smokers with quitting?Nicotine might not be the only problem

Another barrier to this research is there are 4,000 other chemicals in cigarettes that may cause and sustain smoking behaviors. Ammonia, diammonium phosphate, and urea enhance the effects of nicotine, even when nicotine is present in very low levels.7 Nornicotine (a chemical related to nicotine) accumulates in the brain of a smoker and enhances cigarette-seeking behavior. Other chemicals in cigarette smoke such as anabasine, nornicotine, anatabine, cotinine, and myosmine can increase the reinforcement much more than nicotine alone. In other words, they enhance the addictive effects of nicotine. This means that unless nicotine is completely eliminated from cigarettes, nicotine may always pack a punch. And without regulations on these other chemicals, tobacco companies could enhance these unregulated substances to get the most out of the nicotine left in the new cigarettes.

Conclusions

There appears to be much research left to do before low nicotine cigarettes could be considered a smoking cessation therapy. Currently, the best that can be said is that low nicotine cigarettes (truly low nicotine, not advertised as low nicotine) could be used to supplement other smoking cessation therapies such as behavioral treatments and nicotine replacement therapy. Low nicotine cigarettes may hold promise for preventing new smokers from becoming addicted to the nicotine in cigarettes, but this assumes that worldwide regulations on nicotine content in cigarettes can be enacted and enforced.

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REFERENCES:

  1. Connolly GN, Alpert HR, Wayne GF, Koh H. Trends in nicotine yield in smoke and its relationship with design characteristics among popular US cigarette brands, 1997-2005. Tob Control. Oct 2007;16(5):e5. doi:10.1136/tc.2006.019695
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