ATTUD Journal Club Postings

Potential Harm From Very Low Nicotine Cigarettes

Very low nicotine cigarettes (VLNC) have been proposed (and encouraged by the FDA) as a tool to reduce addiction in kids, increase smoking cessation and reduce risks from smoking. Studies suggest these benefits may be occurring and, contrary to concerns, compensatory smoking does not appear to occur.

But there may be an important problem with VLNCs. Three studies (NTR 6: S333, 2004) (Tobacco Control 27:712, 2018) and (Preventive Medicine 96:94, 2017) found that many smokers (46%, 47% and 30% respectively) believed that VLNCs reduce the harm from smoking. Experimental studies of VLNCs (Addiction 105: 343, 2010) suggest that is not the case, a finding consistent with many studies in humans suggesting nicotine itself is not a major cause of cancer or cardiovascular disease.

The worry here is that smokers unable to quit will switch to VLNCs, but not move on to quitting because they believe they are using a safer cigarette.

Why do smokers think nicotine harms health? When I was an expert witness in tobacco litigation, I was surprised that, to juries, manipulating nicotine appeared to be a greater evil than exposure to carcinogens. Apparently, addicting someone and robbing them of their freedom was a potent argument. As a result, many trials and, more importantly, the media repeatedly discussed nicotine, not tar or carbon monoxide – and that may have facilitated the belief that nicotine is the bad thing in smoking. In addition, the lay public assumes that the drug in a substance that addicts you is also the drug that harms you. While this is the case with some drugs (e.g. alcohol), it is not the case for nicotine.

So clearly if we do promote VLNCs, we will need a media campaign to educate smokers that although switching to VLNCs may make it easier to quit, simply switching to VLNCs is unlikely to product health benefits.