Finding a way to wean America’s 42.1 million adult smokers from their deadly habit is one of the great challenges in public health. But a new study offers hope that a trick proposed two decades ago — dialing back the nicotine that smokers get from their cigarettes — might help many quit, and steer others toward less dangerous means of feeding their addiction.
The new research, published Wednesday in the New England Journal of Medicine, also offers reassurance that smokers restricted to very low nicotine cigarettes will not smoke more, nor inhale more deeply, to get the same addictive hit.
In an unusual clinical trial, longtime smokers who were assigned to smoke cigarettes with less than 15 percent of the nicotine in standard cigarettes saw their tobacco dependence drop by as much as 20 percent after six weeks.
Smokers getting their usual dose of nicotine did not reduce the number of cigarettes they smoked daily. But those who got low-nicotine cigarettes smoked 23 percent and 33 percent fewer cigarettes daily, with “minimal evidence of withdrawal-related discomfort,” the researchers reported.
The fear that slashing cigarettes’ nicotine content would drive smokers into more dangerous habits has long discouraged U.S. health officials from rallying behind proposals to limit the amount of the chemical in combustible tobacco products.
That reluctance may be coming to an end.
A sweeping reduction of nicotine in smoked tobacco is “the most promising regulatory policy option” available for preventing the premature deaths of at least 20 million smokers, University of Wisconsin tobacco researchers Timothy Baker and Dr. Michael Fiore wrote in a commentary published with the study.
Such an initiative would need to cover all smoked tobacco products to ensure that people could not merely switch brands to get their fix, they wrote. And the research shows that nicotine limits need not be gradual to work, they added.
Smokers in the study were not told how much nicotine was in the cigarettes they received. However, many longtime smokers who got very-low-nicotine cigarettes suspected as much, said University of Pittsburgh psychologist Eric C. Donny, who led the study.
That wasn’t surprising, he said: In addition to its addictive properties, nicotine “contributes to that ‘hit’ in the back of the throat” when a smoker inhales.
What did surprise the researchers was that longtime smokers who got much smaller daily doses of nicotine than they were used to did not experience some of the extreme withdrawal symptoms — constipation, distraction, increased appetite — that cause many would-be quitters to turn back.
Donny invoked tobacco researcher Michael Russell’s 1976 observation that “people smoke for the nicotine, but they die from the tar.”
