Reduced-nicotine cigarettes could help smokers quit

A new study suggests that reducing the addictive nicotine in cigarettes helps people to smoke less and feel more motivated to quit -- a finding that hints at a new way for the federal government to reduce tobacco use.

The study answers a long-standing question about nicotine addiction and cigarette consumption, said Stanton Glantz,  director of the Center for Tobacco Control Research and Education at the University of California-San Francisco, who wasn't involved in the new study.

For decades, public health experts have questioned the value of reducing nicotine levels, Glantz said. That's because no one knew if smokers would compensate for the low levels of nicotine per cigarette by smoking more of them.

In the study, researchers randomly assigned 780 adult smokers to use either their usual brand of cigarettes, other conventional cigarettes or experimental cigarettes with lower doses of nicotine. Conventional cigarettes have 15.8 milligrams of nicotine per gram. The experimental cigarettes had nicotine doses that ranged from 5.2 milligrams to 0.4 milligrams.

After six weeks, smokers given cigarettes with 5.2 milligrams of nicotine smoked just as much as those consuming their usual brands or conventional cigarettes. But people given cigarettes with 2.4 milligrams of nicotine or less smoked 23% to 30% fewer cigarettes a day, according to the study, published Wednesday in The New England Journal of Medicine. 

Smokers given cigarettes with the lowest nicotine levels were twice as likely to try to quit compared to people given conventional cigarettes. None of the people in the study planned to quit smoking at the start of the study.

"The evidence is getting stronger that reducing nicotine reduces smoking and makes people less addicted to cigarettes and, in doing so, might make them more likely to quit," said the study's lead author, Eric Donny, a professor of psychology at the University of Pittsburgh.

Smokers given reduced-nicotine cigarettes weren't more likely to experience bothersome withdrawal symptoms, Donny said.

Donny notes that his study had another important finding: Smokers were able to transition to cigarettes with extremely low nicotine levels overnight. Many advocates of reduced-nicotine cigarettes had assumed that sharp reductions in nicotine would cause severe withdrawal symptoms. But the new study suggests there's no need to reduce nicotine levels gradually over time.

Some smokers eased their withdrawal symptoms by "cheating" with their usual cigarettes, Donny said. Even after cheating, however, smokers still reduced the amount of nicotine in their blood.

The Food and Drug Administration should act on these new findings by requiring tobacco companies to sharply reduce the nicotine content of their cigarettes, Glantz said. The FDA should also reduce nicotine in electronic cigarettes and other types of tobacco, to prevent smokers from simply transferring their addiction from one product to another, Glantz said.

Congress gave the FDA the power to regulate cigarettes in 2009 with the Tobacco Control Act.

In an accompanying editorial, Michael Fiore and Timothy Baker of the University of Wisconsin School of Medicine and Public Health in Madison wrote that reducing nicotine levels would prevent many young people from becoming addicted and motivate many people to stop smoking.

Yet it’s difficult to predict how smokers would react to this sort of change, Baker and Fiore wrote.

Smokers might seek out black market cigarettes with high nicotine levels. It’s also possible that tobacco companies could try to “game the system” by spiking “low nicotine” cigarettes with more nicotine, Baker and Fiore wrote.

Others say the FDA should hold off on new regulations until there are longer-time studies showing that reduced-nicotine cigarettes really help people quit. Donny said he's currently conducting a study that follows 1,250 people for five months.

A spokesman for Altria, parent company of leading tobacco company Philip Morris USA, said the FDA should be cautious about changing regulations.

"As the authors point out, a longer-term study is currently underway," spokesman Brian May said. "Before establishing any regulations in this area, FDA will assess relevant science and evidence and solicit input on these topics from members of the public.”

Donny noted that tobacco companies marketed “light” cigarettes as a safer alternative for many years, arguing that they contained less tar. But smokers often inhaled as much tar from light cigarettes as from regular ones, if they took long, deep or frequent puffs, according to the National Cancer Institute. The Tobacco Control Act forbid the use of terms such as “light” or “mild.”

The FDA should "move carefully,” said Norman Edelman, senior scientific advisor at the American Lung Association. “We don’t want to say we've made cigarettes safer if we haven’t really made cigarettes safer, because that could encourage people to smoke.”

Tobacco kills 480,000 Americans a year, according to the Centers for Disease Control and Prevention.