There’s no question that the leading cause of preventable death and disease is smoking tobacco products, such as cigarettes and cigars. And while the federal government and its agencies haven’t taken steps to outlaw combustible tobacco products up to this point, they are working to lessen the damaging effects with limitations.
The latest effort seeks to reduce the amount of nicotine in cigarettes to “non-addictive” levels.
In concert with the Food and Drug Administration (FDA), the Biden administration announced a new proposed rule last week that would establish a maximum amount of nicotine in cigarettes and other tobacco products in 2023.
The rule will take some time to implement and will undoubtedly trigger several rounds of legal action from tobacco companies. Still, it’s one of the most impactful actions against tobacco addiction seen in decades, according to scientists.
Ted Wagener, PhD, director of the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center, told Verywell that lowering nicotine is one the most effective ways to curb future addiction.
“A typical cigarette has about 10–13 milligrams of nicotine in it, but not all of that is absorbed by the smoker,” Wagener said. “They might absorb 1–2 milligrams of that original amount. This would take that level from 10–13 milligrams to a level near zero.”
The Family Smoking Prevention and Tobacco Control Act of 2009 stipulated that the FDA cannot require manufacturers to reduce nicotine levels to zero, but the incoming rule would propose a near-zero percentage. According to a 2018 report published in the New England Journal of Medicine, the impact of such a reduction could be huge.
The report projected that lowered nicotine levels in cigarettes could result in a projected decrease in smoking among adults from 12.8% to 10.8% within a year after the implementation of such a policy. Since the nicotine level in cigarettes would be significantly reduced, they anticipate that attempts to quit smoking would increase. By 2100, the policy could also prevent an estimated 33 million people from becoming new smokers.
Established smokers won’t take kindly to having their nicotine slashed. Experts such as Patricia Folan, RN, DNP, CTTS, director of the Northwell Health Center for Tobacco Control, wonder if reduced nicotine levels would result in smoking more cigarettes for established smokers.
“I do have some concern about older smokers who are accustomed to a certain level of nicotine in their cigarettes and may increase use,” Folan told Verywell via email.
But Wagener said that if the policy goes into effect, it would be impossible to smoke enough to get the same amount of nicotine.
“Once you get down to these very low levels of nicotine, there’s no amount of compensatory puffing that people can do to get nicotine levels similar to fully nicotinized cigarettes,” Wagener said.
Regular smokers are likelier to try to get their fix via other tobacco products, such as cigars, cigarillos, pipe tobacco, or hand-rolled cigarettes. The current rule only applies to traditional combustible cigarettes.
Once you get down to these very low levels of nicotine, there’s no amount of compensatory puffing that people can do to get nicotine levels similar to fully nicotinized cigarettes.
Wagener said he would expect to see more smoking cessation attempts as well, or perhaps a move toward e-cigarettes, which he sees as exponentially better than combustible cigarettes.
“If smokers did turn to e-cigarettes or nicotine replacement therapy products, that would be great,” Wagener said. “Long-term use of nicotine gum, patch, lozenge, or inhaler does not appear to have any negative health effects. That’s why they are approved for use by the FDA.”
The most critical impact of the ban seems to be the potential to discourage new users, especially young people. The potential ban on menthol cigarettes could be the one-two punch the FDA needs to dissuade young people from becoming addicted, Folan said.
“I certainly support measures to reduce tobacco use. I think this measure will have its most significant impact on young people trying cigarettes for the first time. With less nicotine, teens may not become addicted so quickly and continue initiation of tobacco use,” Folan said. “Eliminating menthol, which makes smoking easier to start and hard to quit, may also have a huge impact on the initiation of smoking among our youth; and encourage others to quit.”
In late April 2022, the FDA announced it would propose standards that eliminate menthol cigarettes and all flavorings in cigars. Menthol provides a cooling flavor and sensation that dulls the harshness of traditional tobacco products, making them more palatable for new smokers. It also interacts with nicotine, heightening nicotine’s addictive quality.
Not only does this restriction seek to make them less appealing to young people, but it also targets health equity. According to the CDC, 85% of non-Hispanic Black or African American smokers smoked mentholated cigarettes in 2019. Women, Hispanic people, and people in lower socio-economic classes are also more likely to smoke mentholated cigarettes.
This disproportionate use by marginalized groups has a real impact. The CDC says that approximately 40% of deaths from 1980–2018 related to smoking menthol cigarettes were those of Black Americans, despite being only 12% of the U.S. population.
While the new rule is exciting to health care advocates, it still has a long way to go before implementation. The rule won’t go into effect until 2023, and even then, it will face lengthy legal battles as tobacco companies fight to keep their clientele addicted and smoking.
The Biden administration’s proposed rule to slash nicotine levels in cigarettes will face backlash from tobacco companies. It doesn’t apply to e-cigarettes or other tobacco products like cigars, pipe tobacco, or cigarillos. For the present, it seems that nicotine is here to stay.