A U.S. government call for deep cuts in nicotine in cigarettes could save millions of lives, an expert on tobacco addiction explained.

Cigarettes are the only legal consumer product and, when used as intended, cause half of the premature deaths of long-term users.

In response to this long-standing health threat, the Biden-Harris administration announced in late June 2022 a plan to set new standards for cigarettes and other combusted tobacco products to be minimally addictive or non-addictive .

The New Zealand government recently announced a similar nicotine reduction strategy, which has been described as a key component of the country's new smoke-free plan.

The Biden-Harris proposal predated a 2017 plan to reduce the amount of nicotine allowed in cigarettes during Trump's presidency. Mitch Zeller, director of the FDA's Center for Tobacco Products from 2013 to April 2022, said in 2019 that the rule could have the biggest public health impact in history.

So what does the proposal mean in practice? After implementation — likely at least another three years — this would mean that all cigarettes and cigars sold in the U.S. would have to have about 95 percent less nicotine than they currently do. Since nicotine is the addictive substance in tobacco, this means that these tobacco products are hardly addictive. Young people are no longer addicted to cigarettes, and current smokers will find it much easier to quit.

As a professor of public health sciences who has studied smoking cessation for more than 30 years, I am impressed by any intervention that increases cessation rates among smokers who do not have a cessation program. In one of our recent randomized clinical trials of very low nicotine cigarettes, my Penn State research group and colleagues at Harvard found that those who were assigned to use them were more than four times as likely to quit smoking as normal smokers Nicotine cigarettes.

Research suggests that the full public health benefits of successful implementation of reduced cigarette nicotine standards could be substantial.

A 2018 FDA study predicted that by 2060, lowering the nicotine standard for cigarettes could significantly reduce smoking rates—from around 13% today to less than 2%, prevent 16 million people from becoming regular smokers, and prevent more than 16 million people from becoming regular smokers. 2.8 million people smoke - causing death.

In addition to heart disease, stroke and cancer, smoking can cause infertility, erectile dysfunction, cataracts, premature aging, hair loss and tooth loss.

The proposed standard would not simply produce something resembling a "light" cigarette. Light cigarettes, which have been on the market for decades, contain the same amount of nicotine as regular cigarettes—about 10 to 15 milligrams per cigarette. To meet the new standards, a cigarette may need to contain less than 0.5 mg of nicotine.

So-called light or low-tar cigarettes have small holes in the filter that allow air to flow into the filter to dilute the smoke. Light cigarettes have lower tar and nicotine content per puff when smoked by machine. However, when held by a person, these holes are often blocked by fingers, and a smoker can easily puff a little to inhale equal amounts of nicotine and tar.

Some skeptics of the nicotine reduction proposals have raised concerns that smokers may simply smoke reduced-nicotine cigarettes more intensely, just as they smoke light cigarettes. However, dozens of studies have shown that smokers don't increase their smoking for cigarettes with very low nicotine content.

Conversely, over a short period of time, smokers will find extremely low-nicotine cigarettes unsatisfactory, and they will gradually reduce their smoking. Those who used extremely low-nicotine cigarettes were also more likely to quit smoking in randomized trials.

The role of electronic cigarettes

When the Trump administration initially proposed reducing nicotine levels in cigarettes, Zeller and former FDA Commissioner Scott Gottlieb recognized that one of the main challenges to the program's success was that the regulation could lead to illegally high nicotine levels. Market cigarettes.

Zeller and Gottlieb understand that a key way to prevent this from happening is to allow non-smoking nicotine products, such as e-cigarettes, to remain on the market. Compared to regular cigarettes, e-cigarettes provide smokers with a satisfactory level of nicotine while exposing users to significantly lower levels of toxic substances. Therefore, e-cigarettes are likely to be much less harmful.

A recent new study by our team and colleagues at Virginia Commonwealth University found that when smokers without a smoking cessation program used e-cigarettes with cigarette-like nicotine delivery, they were significantly more likely than those who used zero-nicotine or no e-cigarettes. A greater percentage of smokers quit smoking completely.

Exercise and support from family and friends -- along with nicotine patches -- are some of the strategies this smoker uses to quit.

The E-Cigarette Controversy

The potential of e-cigarettes to help replace smoking explains why, two days after Biden-Harris announced in June that he would drastically reduce the amount of nicotine allowed in cigarettes, the FDA announced an effective ban on Juul, the top-selling e-cigarette brand of the past five years. When Juul appealed the decision, the FDA put the denial order on hold until an additional review was completed, which is expected to take several months.

And Juul isn't the only e-cigarette under threat of a ban. Of the millions of e-cigarette applications submitted to the FDA by the September 2020 deadline, more than 99 percent were rejected.

The reason the FDA's e-cigarette ban is so puzzling and counterintuitive in the context of FDA's efforts to reduce nicotine in cigarettes is that the availability of e-cigarettes is critical to the program's viability. Many researchers, myself included, believe that having a variety of legal, regulated high-nicotine e-cigarettes on the market is a key factor in reducing consumer demand for illicit high-nicotine vaping products.

Health authorities in other parts of the world, including the UK and New Zealand, have recognised the important role e-cigarettes can play in reducing smoking. New Zealand's nicotine reduction plan explicitly includes the provision of alternative nicotine products such as e-cigarettes.

Studies have shown that e-cigarettes are far less harmful than cigarettes and have been shown to help smokers transition from highly toxic cigarettes. Therefore, to protect public health, it may well be appropriate to keep various e-cigarette brands on the market until successful implementation of cigarette nicotine reduction programs.

As we spend World Lung Cancer Day as quiet as ever, I believe we now have a plan that can do more than anything else to reduce the number of people dying each year from this terrible disease. It's a plan proposed by Republican and Democratic administrations and backed by the best science available. In my opinion, imposing nicotine reduction standards on combustible tobacco represents the possibility of finally ending cigarette addiction in our lifetime.