Will Targeting Nicotine Reduce Smoking Deaths?

The Food and Drug Administration last week announced a proposed rule that would force tobacco companies to dramatically reduce the amount of nicotine in their cigarettes, a step the agency said could save millions of lives by the end of the century.

smokingNicotine itself is not known to cause cancer, but it is a powerfully addictive substance that is viewed as the main driver of smoking habits that cause roughly 480,000 deaths in the United States each year, the agency said in a statement announcing the potential policy.

Two days later, the FDA also ordered Juul, one of the biggest companies in the vaping industry, to pull all of its products from the U.S. market. E-cigarettes and other vaping products are often pitched as safer alternatives to smoking because they allow adults to meet their nicotine needs without inhaling toxic chemicals found in traditional cigarettes. But the industry has come under intense scrutiny, both from the public and from federal regulators, because of a recent spike in vaping among teens. Though the FDA has allowed vaping products from other companies to remain on the market, the agency said Juul had failed to provide evidence that its products served “the protection of the public health.”

Neither the nicotine curbs nor the Juul product ban are in effect right now. The FDA intends to enact its limit on nicotine in cigarettes in May 2023, though the possibility of legal challenges could severely delay its enforcement. Juul won a temporary court order allowing its products to remain on shelves while the company prepares an appeal.

Cigarettes have been the target of regulators for decades, but these new actions from the FDA — along with a rule proposed in April that would ban menthol cigarettes — represent a new approach that has put the causes of addiction at the center of antismoking efforts.

Why there’s debate

The FDA has received praise from a number of prominent health advocacy groups for its goal of lowering nicotine levels in cigarettes, which they argue will make it easier for regular smokers to quit and less likely that nonsmokers — especially teens — will pick up the habit. The American Heart Association called it “one of the most consequential actions” the FDA could take to reduce smoking-related deaths. Matthew Myers, the president of the Campaign for Tobacco-Free Kids, called it “transformative.”

But critics of the decision say it could backfire. There’s a risk, they argue, that having less nicotine in individual cigarettes will mean smokers will simply smoke more and for longer to get the same amount of nicotine they need, ultimately increasing the amount of cancer-causing chemicals they inhale. There are also concerns that a dangerous black market might emerge if smokers aren’t able to access the high-nicotine cigarettes they crave.

Responses were also mixed to the FDA banning Juul products. Some argue that the company played a major role in the current epidemic of teen vaping, and removing its products from the market will reduce the number of kids who become addicted to nicotine and take up cigarettes as they get older. But critics say it makes little sense to ban a single company when so many other vaping products remain available.

Others say going after vaping directly undermines the FDA’s primary goal of reducing smoking-related deaths. They argue that, though not harmless, vaping products are undeniably less dangerous than cigarettes and any rules making them harder to find will mean fewer smokers switching to a much safer alternative.


Lower nicotine levels will help people quit and save lives

“Count us fans of the Food and Drug Administration’s historic push to reduce nicotine levels in cigarettes, which, in concert with a proposed ban on menthol-flavored cancer sticks, promises to liberate millions of Americans from deadly addiction.” — Editorial, Daily News

Less nicotine will make cigarettes even more deadly

“In a world with lower-nicotine cigarettes, people already addicted to nicotine will still be addicted—they'll just have to smoke more cigarettes to get their nicotine fix. That means that mandating all U.S. cigarettes be low-nicotine cigarettes could actually make smoking riskier by requiring smokers to smoke more and consume more of the other substances in cigarettes in order to get the same level of nicotine they're used to.” — Elizabeth Nolan Brown, Reason

The FDA has finally recognized that only aggressive action will solve the problem of smoking-related deaths

“These efforts could be the biggest factor in achieving Biden’s moonshot goal of reducing cancer deaths by half in 25 years. … The road ahead is not easy. … But the FDA should be commended for taking bold action that can improve health for generations to come.” — Dr. Leana Wen, Washington Post

Black markets for banned tobacco products will emerge

“The most optimistic outcome of all the new nicotine regulation is that smokers transition to legal e-cigarettes or even make the choice to quit nicotine entirely. But they will have another option: turning to black markets. The FDA is unwittingly setting up the conditions for illicit markets where menthol cigarettes, cigarettes with nicotine, and flavored e-cigarettes could thrive.” — Jacob Grier, Slate

A reduction in nicotine levels would be a game changer, but it’s far too early to celebrate

“While lowering nicotine levels in cigarettes would be a massive deal, the FDA this week only took a first, very small step, toward that goal. And it has even taken that small step before, though to far less fanfare.” — Nicholas Florko, Stat

Smokers may suddenly lose their desire to quit if cigarettes are seen as less dangerous

“Many smokers may understand the new products to be a government-approved green light to carry on smoking tobacco. This misguided understanding is liable to have deadly consequences.” — Martin Cullip, Filter

It’s a mistake to cut off any pathways for smokers to quit cigarettes

“[Vaping products] are off ramps that can provide smokers an alternative to combustibles, which are responsible for virtually every death related to tobacco. But now that off ramp is being narrowed and sort of paved over, which is putting millions of adult lives at stake.” — Clifford Douglas, tobacco policy expert, to New York Times

Vaping will never be the answer to smoking-related deaths

“Whatever you think of the public health benefits of electronic nicotine in whatever form as an alternative to traditional tobacco products, the crux of the situation is this: we’ve opted to solve a political/social problem (smoking) with a technological solution (e-cigarettes) designed, developed, and distributed largely by those responsible for the problem.” — Edward Ongweso Jr., Vice

The cigarette industry is already collapsing without government intervention

“Progressives have long wanted to put the tobacco industry out of business even as governments have become hooked on its tax revenue. But smoking rates have declined significantly over the past few decades, no thanks to government regulation.” — Editorial, Wall Street Journal

The promise of vaping as a smoking alternative hasn’t ever been realized

“If Juul, the company, had acted more responsibly—if it hadn’t been so popular with teenagers, if it hadn’t angered regulators, if it hadn’t lit the match that started a political firestorm—perhaps Juul, the product, could have made a real difference for public health.” — Jamie Ducharme, Time

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