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By Catherine Egbe, PhD
What is nicotine?
Nicotine is the addictive drug which keeps people smoking tobacco (like cigarettes) and nicotine (like electronic cigarettes) products. It is a naturally occurring chemical in the tobacco plant but can now be produced in the laboratory (synthetic nicotine). Nicotine from tobacco plants and synthetic nicotine are also sometimes tweaked to become easier to consume. For example, the nicotine used for e-liquids and consumed via electronic delivery systems i.e. vapes are usually free base nicotine with the addition of acids (usually benzoic acid). This process makes the resulting nicotine salt smoother to consume and more easily absorbed into the bloodstream. Nicotine is classified as a poison in several countries due to its toxic properties, particularly in high doses. Nicotine is also used in making nicotine replacement therapy (like Nicotine patch, lozenges and inhalers) to manage nicotine withdrawal symptoms and wean people off nicotine addiction. NRT products are designed to release nicotine at a slower rate and in lower doses compared to smoking or vaping.
Summary of the newly proposed FDA rule
On January 15, 2025, the U.S. Food and Drug Administration (FDA) proposed a rule to limit nicotine levels in cigarettes and certain other combusted tobacco products to 0.7 milligrams per gram of tobacco, aiming to make them minimally or nonaddictive. This initiative which was first announced in 2018 seeks to prevent youth initiation and assist current smokers in quitting. The FDA estimates that by 2100, this could prevent approximately 48 million young people from starting smoking and lead over 12.9 million smokers to quit within a year of implementation. The proposal is open for public comment until September 15, 2025, and, if finalized, would take effect two years later.
Implications of the FDA proposed rule
An average cigarette contains about 10–14 mg of nicotine but can be higher in some cases. Typically, during smoking, only about 10–20% of the nicotine in a cigarette is absorbed by the person who smokes but this is enough to keep people addicted. Therefore, a person who smokes one stick of cigarette takes in about 1–2 mg of nicotine and this is due to incomplete absorption and combustion. Roll-Your-Own cigarettes may deliver up to 2 mg of nicotine. Factors Influencing nicotine levels include cigarette size, design, filter efficiency, type and blend of tobacco used, and additives like menthol.
For a cigarette containing 0.7 mg of nicotine, the delivery to the smoker would be about 0.07–0.14 mg of nicotine. At 0.7 mg nicotine content, the nicotine delivered would therefore be 85–95% less than in traditional cigarettes. At such low levels, the nicotine delivered may be insufficient to sustain addiction, which aligns with the FDA’s goal of making cigarettes minimally or non-addictive.
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Some public health benefits of reduced nicotine levels in tobacco products
Here are 10 benefits of the FDA proposed ruling if passed as it is, in no particular order.
1. Reduced Tobacco Addiction
By making cigarettes minimally addictive, fewer people will become dependent on nicotine and fewer people will become addicted to tobacco products. This also implies that fewer people will lower the rates of smoking uptake and consequently result in a reduction in tobacco-related diseases.
2. Fewer Youth Smokers
More than 80% of those who currently smoke as adults started smoking when they were teenagers. Young people are less likely to get addicted due to lower nicotine levels. This will also create a new generation that is less burdened by smoking-related diseases.
3. Higher Quit Rates
Generally, about two-thirds of those who currently smoke want to quit but find it challenging due to their addiction to nicotine. When the nicotine level in cigarettes is reduced to a non-addictive level, such people may find it easier to quit as nicotine cravings decrease. Naysayers argue that low nicotine containing cigarettes may lead to compensatory behaviors with those who smoke seeking to get their fix of nicotine by smoking more cigarettes and or smoking more intensely. However, two studies by Smith et al., (among other studies) have found this may not be true.
4. Reduced Smoking-Related Deaths
Tobacco is the number one cause of preventable deaths and diseases. It kills about 8 million people annually around the world and about 1.3 million of those who die of tobacco- related diseases do not smoke but who are exposed to secondhand tobacco smoke. When there are fewer people who smoke and fewer people who are exposed to secondhand smoke (SHS), the risk of tobacco-related diseases like cancer, heart disease, and chronic obstructive pulmonary disease (COPD) will be reduced. This will increase life expectancy and reduce preventable deaths.
5. Healthcare Savings
Many governments spend more in healthcare costs than what the tobacco industry pays as taxes. Decreased smoking prevalence will reduce the costs associated with treating tobacco-related illnesses and translate to healthcare savings.
6. Improved Public Health Equity
The majority of those who currently smoke are those of low socio-economic status (SES) and marginalized groups resulting in further pushing them into poverty and increasing health disparity. People of low SES and marginalized groups are also disproportionately affected by smoking. Therefore, lower nicotine levels in cigarettes will reduce health disparities and increase health equity.
7. Economic Productivity Gains
Another impact of tobacco use is the cost in manpower due to smoke breaks and sick leaves or absenteeism. Fewer smoking-related illnesses mean a healthier workforce and less absenteeism therefore translating into increased productivity and economic growth.
8. Positive Ripple Effects on Other Tobacco Policies
A ‘low nicotine tobacco’ policy is one of the tobacco endgame strategies proposed by the global tobacco control community to bring an end to the tobacco epidemic. Malone, McDaniel and Smith, (2014) described Tobacco endgame strategies as “initiatives designed to change/eliminate permanently the structural, political and social dynamics that sustain the tobacco epidemic, in order to end it within a specific time”
With the proposal of this ruling, the FDA will be triggering stricter regulations for tobacco products globally resulting in a shift by many governments to prioritize public health and set up stricter mechanisms to end the tobacco epidemic.
9. Support for Tobacco Farmers’ Transition
Article 17 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) calls on countries to promote alternative livelihoods to tobacco growing, helping farmers transition to more sustainable and health-friendly agricultural practices. If the policy on reduced nicotine in cigarettes is implemented alongside support programs for tobacco farmers, workers and sellers, this could enable them to transition to alternative, sustainable crops and economically viable livelihoods.
10. Reduced Secondhand Smoke Exposure
Reduced smoking prevalence in the population means fewer smokers and reduced cigarette consumption. This also means there would be less exposure to secondhand tobacco smoke. The implication of less exposure to SHS is improved health in families and communities and less children falling ill. It is well documented that less exposure to SHS has been found to lead to decreases in hospital admissions and mortality rates for cardiovascular and respiratory conditions. Less exposure to SHS has also been noted to reduce preterm births, childhood asthma and cancer among other medical conditions and illnesses.
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Broader benefits extending beyond individual health to societal, environmental, and global gains in public health
- Long-Term Cultural Shift
The reduced addictiveness of cigarettes could contribute to a societal norm to de-normalize tobacco smoking. It is expected to cause a decline in tobacco use over generations, creating a healthier, smoke-free culture therefore bringing the tobacco endgame vision closer to fruition.
ii. Reduced Environmental Damage
When fewer people smoke, fewer cigarettes will be consumed, and this will cause a decline in cigarette butts’ litter and other tobacco-related waste. Cigarette butts are the most abundant form of plastic waste in the world. About 4.5 trillion individual butts currently pollute our global environment. Fewer butts will be most impactful in ensuring clean urban and coastal areas globally.
iii. Boosted Research on Addiction
A low nicotine policy may stimulate global scientific research into addiction mechanisms and how to mitigate dependence on other substances. This could advance effective treatment and public health strategies to wean those addicted to other drugs from their addiction.
I will bring you updates about this ruling as the policy-making process continues.
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