One way to stop someone wanting something is to make it less appealing.
And that’s been the inspiration behind many of the current strategies and research to help people to quit smoking. But reducing the appeal of something as addictive as a cigarette has been an uphill battle.
So instead of making cigarettes less appealing, what about making them less addictive?
The idea was first proposed in 1994 by two American researchers, Benowitz and Henningfield, who were trying to convince the US Food and Drug Administration (FDA) that limiting the amount of nicotine in cigarettes to approximately 0.5 mg per cigarette (about 30 times weaker than usual) you could effectively render them non-addictive.
Unfortunately the Supreme Court shot down the idea because the FDA didn’t have “jurisdiction to regulate tobacco products” and, since then, the majority of research has – quite sensibly – focused on finding ways to reduce the demand for tobacco products.
However, a few studies have continued to look into the effects of changing the product itself.
Today, a new study published in the New England Journal of Medicine by Dr Michael Fiore and his colleagues adds to the growing body of work that looks at the effect of lowering the nicotine levels in cigarettes.
The results suggest this does reduce smokers’ dependence and the number of cigarettes they smoked. But is this really the way towards a smokefree society?
The relatively large, and therefore fairly robust, study included 840 smokers who were randomly assigned to either smoke normal cigarettes or one of six types of modified cigarettes.
The modified cigarettes contained varying levels of nicotine ranging from 15.8 mg (a typical amount in a normal cigarette) to 0.4 mg (arguably a ‘non-addictive’ amount).
After six weeks, the findings showed that those who smoked cigarettes that contained less than 2.4 mg of nicotine had lower exposure to nicotine, measured using urine samples, as well as lower scores for nicotine dependence, cravings and they smoked fewer cigarettes.
The authors conclude that reducing the amount of nicotine in cigarettes could help people to cut down (although the evidence around cutting down, vs quitting, isn’t clear cut).
While Professor Linda Bauld, Cancer Research UK’s cancer prevention champion, thinks the study is “interesting” she points out some of the limitations.
“This trial is at odds with some studies with longer term follow up,” she says, referencing a study published earlier this year by Benowitz.
That study looked at 135 smokers over two years (compared with six weeks in today’s study) and it didn’t find that smokers using reduced nicotine cigarettes smoked less, nor were they more likely to quit.
Bauld further highlights differences between the USA, where the study took place, and policy in other countries.
“The FDA can regulate aspects of the product that authorities in other regions cannot, or are not currently considering, despite it being recommended by the World Health Organisation’s Framework Convention on Tobacco Control,” she explains.
“From a UK perspective we don’t currently have a regulatory authority who can require these types of changes to products.”
In other words, there’s no one in the UK who can force the tobacco companies to make cigarettes with less nicotine in them.
“Also,” she points out, “cigarettes are a global product and you could speculate that, if all cigarettes in one country had reduced nicotine, smokers would just buy cigarettes from another country. This would be particularly the case in places like the EU. For this to make a real difference, the trans-national tobacco companies would need to agree to do this globally.”
Something she thinks is “highly unlikely.”
The final limitation, and possibly the biggest, is that reduced nicotine cigarettes may not help people quit, just cut down how much they smoke.
Bauld thinks more studies that look at changing the product would be a good thing but recommends prioritising what we know works: “existing evidence-based tobacco control interventions to reduce smoking, alongside new ones like standardised packaging.”
Donny, E. C., et al (2015) Randomized Trial of Reduced-Nicotine Standards for Cigarettes. NEJM. DOI: 10.1056/NEJMsa1502403