FDA looks to remove nicotine from cigarettes

By Dr. Ananya Mandal, MDMar 18 2018

Smoking kills thousands each year and in a bid to reduce the impact of smoking the Food and Drug Administration (FDA) announced a tobacco regulation plan. This new plan is essentially simple – it aims to reduce the nicotine content of the cigarettes to such a level that they cease to be addictive any more.

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Smoking is the cause of lung cancer in more than 90% of cases and is the single biggest risk factor for lung cancer. There are more than 60 different toxins in tobacco smoke that can cause cancer. Although tobacco smoking is the main risk factor for lung cancer, other tobacco products such as pipe tobacco, cigars, chewing tobacco and snuff can also raise the risk of lung cancer and other forms of cancer such as mouth cancer and esophageal cancer.

According to FDA Commissioner Scott Gottlieb, very soon cigarettes may contain up to 0.4 milligrams of nicotine per gram of tobacco. This would be a 97 percent reduction from the conventional cigarettes sold today. Gottlieb says that this reduction would result in 5 million individuals quitting smoking in a year. Smoking rates at present are 15 percent and with this regulation implementation, it is expected to come down to 1.4 percent.  By end of this century, this measure alone would have saved 8 million lives he explained calling this “an undeniable public health benefit.” These numbers are obtained from a research by the FDA and researchers from Sandia National Laboratories in Albuquerque, published in the latest issue of the New England Journal of Medicine (15th March 2018).

The announcement yesterday is an advance notice of the regulation plan at present. Gottlieb has called for a public consensus and debate on the ideal nicotine levels in the tobacco that is used in cigarettes. He raised concerns regarding black markets that could arise with high-nicotine cigarettes. He explained that there were also concerns regarding smokers increasing their number of cigarettes to get the “kick” rather than quitting with the low-nicotine cigarettes. “It's critical that our policies reflect the latest science and is informed by the input we receive,” he said. He called upon experts and public to debate over these issues. Comments are invited over the next 90 days. The rules may come into the picture somewhere around mid-June.

James Figlar, executive vice president of research and development for R.J. Reynolds Tobacco Co., from the other end said that they would work alongside FDA to appreciate the continuum of risk as well as “tobacco harm reduction”. According to experts low-nicotine cigarettes like Marlboro UItra Lights containing 0.5 milligrams of nicotine per cigarette have been on the markets for years and they are less popular. Further Michael Russell in 1976 in his pioneering research work had found that people die of the diseases caused by the “tar” in the cigarettes rather than the nicotine. Further electronic cigarettes have been found to deliver much less nicotine and toxic chemicals than traditional cigarettes. It is not clear now how low-nicotine cigarettes would fare compared to the e-cigarettes and the impact they would have.

However there are several studies that show that reducing the nicotine amounts in the cigarettes can reduce the number of cigarettes smoked daily. Many of the participants in these exercises were found to be quitting at the end of the trial.

Mitch Zeller, director of the FDA's Center for Tobacco Products, along with Gottlieb said that they would be launching two other regulatory initiatives related to tobacco soon. These would be regarding the menthol and flavoring agent content of the cigarettes and contents of premium cigars respectively.