The FDA Is Planning to Lower Nicotine Levels in Cigarettes
The Food and Drug Administration (FDA) has announced plans for a proposed rule to require companies to lower the nicotine levels in cigarettes.
The rule would establish a maximum nicotine level to reduce the addictiveness of cigarettes and some other combusted tobacco products. The goal of the rule, the FDA says in a press announcement, would be to reduce smoking in kids, addiction, and death.
The FDA points out that 480,000 people die prematurely each year from a smoking-related disease, which makes tobacco use the leading cause of preventable disease and death in the U.S. Tobacco use also costs nearly $300 billion a year in health care and lost productivity, the FDA says.
Of course, nicotine isn’t the only thing that makes cigarettes so bad for you—but it is what causes people to become addicted to them. Experts also say this move is interesting but may cause some unintended consequences. Here’s what you need to know.
What is nicotine, exactly?
Nicotine is a highly addictive chemical compound that’s found in a tobacco plant, the FDA says. All tobacco products, including cigarettes, cigars, smokeless tobacco, and e-cigarettes, contain nicotine.
Nicotine actually changes the way your brain works, leading to more cravings, the FDA says. “Nicotine acts on specific receptors in the brain called nicotinic receptors,” says Jamie Alan, Ph.D., associate professor of pharmacology and toxicology at Michigan State University. “These receptors are also throughout the body.”
Nicotine also has “physical and psychological addictive properties,” Alan says. Meaning, your body and brain can actually crave nicotine.
How would this reduction in nicotine work?
There aren’t a lot of specifics available at this time. However, a government notice was posted online that says a proposed rule would be issued in May 2023 that would seek public comment on a maximum nicotine level in cigarettes and other tobacco products. “Because tobacco-related harms primarily result from addiction to products that repeatedly expose users to toxins, F.D.A. would take this action to reduce addictiveness to certain tobacco products, thus giving addicted users a greater ability to quit,” the notice reads.
The FDA cited a 2018 paper published in the New England Journal of Medicine that projected that, by 2100, a potential nicotine product standard could cause more than 33 million people to not become regular smokers leading to a smoking rate of only 1.4%. (The current smoking rate is 12.5%.) It would also result in more than 8 million fewer people dying from tobacco-related illnesses.
What do experts think?
They’re mixed on this. “We know that 88% of adult daily smokers started by the age of 18 years,” says Lindy McGee, M.D., an assistant professor of pediatrics at Baylor College of Medicine who specializes in smoking and vaping prevention strategies. “We also know that nicotine is more addictive to the adolescent brain than to the adult brain. By reducing the level of nicotine in cigarettes, the goal is for fewer of those adolescents and young adults who try smoking to become addicted to it.”
Dr. McGee points out that “marketing and social pressure cause the teenager and young adult to first pick up a cigarette, but it is the addictiveness of the nicotine which keeps them hooked into adulthood.”
The main goal of this would be to make cigarettes less addictive, Dr. McGee says. “However, the chemical nicotine does have harmful side effects, so it would also make cigarettes less dangerous,” she says. “In adolescents, nicotine is tied to increased impulsivity and mood disorders and can have long-term effects on parts of the brain responsible for attention, learning, and memory.” Nicotine by itself can also lead to increased heart rate and blood pressure, and can have a bad impact on the lungs, GI system, and immune system, she adds.
Loren Wold, Ph.D., a researcher on tobacco’s effects on human health at The Ohio State University Wexner Medical Center, says that this is “a move in the right direction by the FDA.”
“Regulations are going to be important and will have ramifications for other nicotine delivery systems,” he says. But while the FDA focused on cigarettes in its press announcement, Wold says that younger people are mostly starting smoking with e-cigarettes. “They’re not starting with traditional combustible cigarettes,” he says.
If a maximum nicotine limit were to be set on cigarettes and other tobacco products, Wold says that “the hope” is that people would use less nicotine. “But they also may just vape or smoke more,” he says. “We don’t know the answer yet because we haven’t faced anything like this.”
Erin Calipari, Ph.D., a professor and addiction specialist at the Vanderbilt School of Medicine, also has concerns that a reduction in nicotine levels will lead to tobacco users smoking more. “From the research that I do that looks at the factors that influence reinforcement behavior—the probability of doing something over and over again—when you cut the dose in half with drugs, individuals will do whatever they’re doing to get twice as much,” she says.
With people who are already addicted to nicotine, “they’ll likely buy more cigarettes so they can take the same amount of nicotine,” Calipari says.
That has concerning health consequences, says Kathryn Boling, M.D., a primary care physician at Baltimore's Mercy Medical Center. “Theoretically, this is helpful because it means cigarettes might be a little less addictive,” she says. “In real practice, I think it’s a bad idea. If you cut those levels, people who are already addicted will smoke more and nicotine isn’t the only thing in cigarettes that causes damage in people’s lungs and bodies.”
Overall, Calipari says a maximum nicotine amount is a “good start” but says it’s difficult to know what the overall consequences will be. “I’m happy to see that the government is recognizing that this legal drug is a problem,” she says. “The question is how effective this will be in the long run. This is not necessarily going to cure addiction or protect people from nicotine addiction."
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