Very Low Nicotine Content Cigarettes: Smoking Cessation Friend or Foe?
With 95% less nicotine than traditional cigarettes, evidence is mounting that smokers
who transition to these products smoke less and have reduced exposure to harmful
Very low nicotine content (VLNC) cigarettes are an emerging tobacco product that has received a lot of attention recently as a potential means for decreasing tobacco dependence. The assumption is that since nicotine is the addictive component in cigarettes, introducing a product that has 25 times less nicotine than a traditional cigarette would lead to less nicotine dependence. For context, VLNC cigarettes have around 0.5 mg of nicotine per rod, a level at which people would not experience the psychoactive and reward-generating effects of nicotine. In contrast, a conventional cigarette contains between 10-15 mg of nicotine per cigarette.
In June, the Food and Drug Administration (FDA) announced a proposed rule that would establish a maximum nicotine level in cigarettes and other combustible tobacco products with the goal of decreasing their addictiveness. This comes after the FDA approved the marketing of “VLN King” and “VLN Menthol King” VLNC cigarettes as a modified-risk tobacco product (MRTP) in December 2021. They are the first combustible cigarettes to receive this designation. Dr. James Davis, Medical Director of the Duke Center for Smoking Cessation and Co-Founder of the Duke-UNC TTS Training Program, offers some insight into this ruling and what clinicians need to know about VLNC cigarettes.
“There is now compelling evidence that when cigarette smokers transition to very low nicotine content cigarettes, they significantly reduce their smoking,” Dr. Davis explained.
One example he cites is a 2019 randomized controlled trial by Smith et al. showing that patients assigned to use VLNC cigarettes reduced the number of cigarettes smoked per day during a 6-week period (p=0.001) compared to those who smoked regular cigarettes.
While findings from several studies like this one are promising, the use of VLNC cigarettes is currently not an FDA-approved treatment for smoking cessation. Instead, VLNC cigarettes are classified as a Modified Risk Tobacco Product (MRTP), which means that the FDA sees them as having lower risk than traditional lit end cigarettes.
Dr. Davis emphasized that the smoke from VLNC cigarettes is just as harmful as conventional cigarettes; however, VLNC cigarettes are less addictive because of the reduced nicotine content, so smokers may smoke less after switching to VLNC cigarettes.
“From a treatment perspective, the Duke Smoking Cessation Program will continue to use FDA-approved tobacco treatments for tobacco use and in most cases will not prescribe or recommend the use of MRTPs [such as VLNC cigarettes] to our patients,” Dr. Davis said. “As providers, our goal is to help our patients stop the use of all forms of tobacco and nicotine. That said we recognize that some products are more dangerous than others. VLNC cigarettes are a perfect example of products that have been shown to lead to harm reduction.”
Dr. Davis anticipates that future evidence may emerge showing that VLNC cigarettes can be used alone or in conjunction with existing FDA-approved smoking cessation treatments and facilitate smoking cessation. “As this evidence grows, we may begin to see the use of VLNC cigarettes in clinical practice.”
Check back soon for part 2 of our series on VLNC cigarettes, in which I speak with Justin Byron, PhD, with UNC Gillings School of Global Public Health, who explains the potential public health impact of VLNC cigarettes and the FDA's proposed rule to establish a maximum nicotine level for certain combustible tobacco products.
For more great content from Drs. Davis and 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.