Very Low Nicotine Content Cigarettes: A Revolution or Just Another Tobacco Product?

Are very low nicotine content cigarettes an effective way to decrease tobacco use and save lives? Researcher and public health tobacco control expert, Dr. M. Justin Byron, weighs in on FDA’s actions and plans to lower nicotine content in cigarettes.


This is part 2 of our series on very low nicotine content (VLNC) cigarettes. Please click here to read part 1.


M. Justin Byron, PhD

Very low nicotine content cigarettes (VLNC) have received a lot of attention recently as a potential means for decreasing tobacco dependence. In June, the Biden-Harris Administration released an upcoming policy agenda plan that included nicotine reduction. It highlighted a Food and Drug Administration (FDA) proposal to establish a maximum nicotine level in cigarettes and some other combustible tobacco products to decrease their addictiveness. This comes after the FDA allowed the marketing of 22nd Century’s VLN brand VLNC cigarettes as modified risk tobacco products (MRTP), permitting the company to make specific claims about reduced risk.


These VLNC cigarettes have 95% less nicotine than conventional cigarettes, a level at which people would not experience the psychoactive and reward-generating effects of nicotine. Thus, as studies have shown, people who transition to VLNC cigarettes in clinical trials smoke less.


However, it is crucial to emphasize that reducing the nicotine in cigarettes does not reduce their toxicity, because the harm comes from chemicals other than nicotine, especially chemicals formed during combustion. Unfortunately, many people incorrectly believe that VLNC cigarettes are less harmful for health. Although VLNC cigarettes are less addictive, they are not safer to smoke.


M. Justin Byron, PhD, a tobacco control researcher with UNC Family Medicine and the UNC Gillings School of Global Public Health, has been examining public perceptions of a potential VLNC cigarette policy. His research has found that nearly half of all smokers surveyed in a nationally representative sample in the US “believed that smoking VLNC cigarettes for 30 years would be less likely to cause cancer than smoking current cigarettes” (Byron et al., 2018).


“This is absolutely not the case,” Dr. Byron says. “They are just as toxic to smoke.”


Dr. Byron’s take-home message for the Duke-UNC TTS community on VLNC cigarettes: “If smoked, reduced nicotine cigarettes are just as deadly. They are not cessation products. Continue to use FDA-approved cessation products to help people quit.”

What should we expect from the addition of a VLNC product to the current tobacco marketplace? “Probably, not much,” said Dr. Byron, noting that a similar product, called Quest Cigarettes, was on the market in the US from 2002-2010 but was discontinued due to poor sales.


However, there is a much more powerful possible scenario. The announcement from the Biden-Harris Administration was not simply that MRTP would be approved, but that the FDA was planning to require all cigarettes sold in the US to have much less (about 95% less) nicotine. Thus, people who can’t or won’t quit would only be able to buy these less addictive tobacco products and would, in theory, smoke less, reducing their harm.


“A national nicotine reduction scenario would be monumental,” said Dr. Byron, citing a FDA modeling study that indicates such a policy could make it easier for millions of people to quit smoking combustible tobacco altogether. Not surprisingly, the policy faces strong opposition from the tobacco industry. If it happens, it may be years away.


For now, Dr. Byron and other researchers in the field of tobacco control are keeping a close eye on New Zealand, which has laid out some aggressive regulatory public policies for tobacco. The government’s Smokefree Aotearoa 2025 plan, which aims to decrease the country’s smoking prevalence below 5%, includes a measure to have only low nicotine content smoked tobacco products for sale. Another bold plan is to create a “tobacco-free generation” policy, banning the sale of tobacco to anyone born after a certain year. If this takes effect, anyone born after 2008 will be ineligible to buy tobacco products for the rest of their lives. Both policies are expected to pass in the next year.


For more great content on new and emerging tobacco products from Dr. Byron and other experts in tobacco control and treatment, sign up for our upcoming comprehensive tobacco treatment specialist (TTS) training.


 

About The Author

Rachael Joyner is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.