Society for Research on Nicotine and Tobacco Europe debate: the case for countries adopting a policy of reducing nicotine content of cigarettes and other smoked products to minimal levels

While various tobacco control measures have achieved significant progress, tobacco use—and particularly cigarette smoking—remains one of the world's most pressing public health crises, claiming approximately 7 million lives annually, including 1.2 million deaths in Europe alone.1,2 A potentially powerful new evidence-based intervention is mandating the reduction of nicotine content in cigarettes to non-addictive levels.3 Such policy represents a logical next step in tobacco control that could save millions of lives. The scientific rationale for nicotine reduction in cigarettes and other smoked tobacco products rests on 3 pillars of evidence. First, it is well-established that nicotine is a powerful addictive drug and the primary driver of tobacco use, facilitating the transition from experimentation to sustained use and making cessation difficult.4 Attesting to the addictive power of nicotine is the fact that over half of people who smoke express intention to quit, while less than 10% succeed in quitting.5 Second, each dose of nicotine in tobacco smoke is accompanied by over 7000 chemicals, many of which are potent toxicants and carcinogens, which makes tobacco smoking the deadliest delivery mechanism for nicotine administration.6,7 Tobacco smoking affects nearly every organ in human body, causing at least 16 types of cancer as well as a range of respiratory, cardiovascular, and other non-malignant diseases.7 Third, there is a substantial and growing body of evidence demonstrating that a reduction of nicotine content in cigarettes by 90% or more leads to lower cigarette dependence, significantly fewer cigarettes smoked per day, lower exposure to cigarette-related toxicants and carcinogens, and higher rates of quit attempts and smoking cessation.8 These effects hold true across smoking intensities (eg, those smoking daily or intermittently) and sociodemographic characteristics, including among youth and young adults, people of various income and educational attainment, and people with co-morbid disorders.8–11 Thus, if nicotine is the reason why people experience dependence on a deadly product, removing nicotine’s reinforcing effects by reducing its content to non-addictive levels is a logical regulatory step in efforts to decrease the prevalence of smoking and the associated morbidity and mortality.